When looking at the drug treatment options that are currently available for rheumatoid arthritis, there are three major groups of drugs to take into consideration. First, there are the drugs that control inflammation. These are drugs that are considered Nonsteroidal Anti-Inflammatory Agents (NSAIDs). The drugs that fall under this category are drugs such as Ibuprofen, or Naproxen. These drugs have pain relieving properties, and relief of pain is a very important aspect of the treatment for rheumatoid arthritis. By themselves, these drugs do not control the disease, and they do not prevent joint damage. For joint damage, there are another group of drugs which are called Disease-Modifying Antirheumatic Drugs, also known as “DMARDs.”
DMARD’s can be placed into two basic categories. The first category is the older drugs that you can take by mouth. These include medications such as Methotrexate, Hydroxychloroquine, and Sulfasalazine. These drugs have the purpose of slowing down the immune system’s overactivity to prevent the damage that rheumatoid arthritis causes to the joints.
Another group of drugs that are used is known as “Biologics.” These drugs are generally used when the first group of drugs are not adequately effective. Some of these drugs work against proteins which are called “Cytokines.” Cytokines are inflammatory proteins that are generated by cells in the immune system which cause or contribute to the damage in joints that we know as rheumatoid arthritis. Certain forms of Cytokines therapy include Tumor Necrosis Factor Antagonists or TNF antagonists. Some drugs in this category include Etanercept, Adalimumab, and Infliximab among several others.
There is another group of biologics that affect the function of cells of the immune system. These include Rituximab and Abatacept. In addition, there are some newer drugs that are being developed which are called “small molecules”, that also work on proteins that are very important in the inflammatory process such as Tofacitinib. Very often, patients with rheumatoid arthritis have such severe symptoms that Corticosteroids are necessary. Corticosteroids or cortisone, known to us as Prednisone, in most cases can be taken by mouth or it can be injected into affected joints that are especially painful and swollen. In general, doctors try to limit the use of cortisone because of the many known side effects of cortisone, and because it has been found that cortisone has a very limited effect on reducing the joint damage in rheumatoid arthritis. Still, many patients need cortisone simply because of the pain, the swelling, and the stiffness that is affecting them.