Appendix Drugs Used To Treat Arthritis: Arthritis

Mild pain relievers (analgesics)

Generic name

Brand name

Use

Side effects

Comments

acetaminophen

Panadol, Tylenol, others

Relieves pain

Nausea, vomiting, diarrhea, jaundice, rash, tiredness, weakness; less likely to cause gastric bleeding than other pain relievers

Drinking large amounts of alcohol during long-term therapy with acetaminophen may cause liver damage. Kidney damage also possible with long-term use.

aspirin

Bayer, Bufferin, others

Reduces inflammation and relieves pain

Stomach pain, bleeding, ulcers

High doses may cause ringing in the ears. Before using, let your doctor know if you are on blood thinners or have liver or kidney problems.

Oral nonsteroidal anti-inflammatory drugs (NSAIDs)

Generic name

Brand name

Use

Side effects

Comments

diclofenac

Cataflam, Voltaren

Reduce inflammation and relieve pain

Stomach pain or bleeding, ulcers, weight loss, nausea, vomiting, drowsiness, dizziness, fluid retention, heartburn, diarrhea, constipation, blurred vision, tinnitus

Allergic reactions are rare but can occur. High doses can cause ringing in the ears. People who are allergic to aspirin should not take NSAIDs. People who take high doses for a long time should have periodic blood tests to check for bleeding and liver or kidney damage. May cause kidney damage in people who are dehydrated, or who already have a kidney problem or heart failure.

diflunisal

Dolobid

etodolac

Lodine

fenoprofen

Nalfon

flurbiprofen

Ansaid

ibuprofen

Advil, Motrin, others

indomethacin

Indocin

ketoprofen

Actron, Orudis, others

meclofenamate

Meclomen

mefenamic acid

Ponstel

meloxicam

Mobic

nabumetone

Relafen

naproxen

Aleve, Naprosyn, others

oxaprozin

Daypro

phenylbutazone

Cotylbutazone

piroxicam

Feldene

sulindac

Clinoril

tolmetin

Tolectin

COX-2 inhibitor

Generic name

Brand name

Use

Side effects

Comments

celecoxib

Celebrex

Reduces inflammation and relieves pain

Stomach upset, fluid retention; fewer gastrointestinal side effects than traditional NSAIDs; possible increased risk of heart attack or stroke

Same as for NSAIDs. Does not have the beneficial cardiovascular effects of aspirin. Should not be taken by those allergic to sulfonamides (common antibiotics). Talk with your doctor if you have heart disease.

Narcotic/analgesics

Generic name

Brand name

Use

Side effects

Comments

propoxyphene

Darvon (contains aspirin), Darvocet (contains acetaminophen), others

Relieves pain

Dizziness, sedation, nausea, vomiting, constipation, abdominal pain, rash, lightheadedness, headache

May be habit-forming when taken long-term or in large doses. Should be used cautiously by people with peptic ulcers, blood-clotting disorders, and liver disease.

tramadol

Ultram

Relieves pain

Convulsions

Those with a history of seizures, psychotropic drug use, or dependence on narcotics should not take tramadol. Drug interactions are common.

Corticosteroids*

Generic name

Brand name

Use

Side effects

Comments

methylpredni-solone

Medrol

Suppresses inflammation in severe organ disease or life-threatening disease

Fluid retention, weight gain, facial hair growth, easy bruising, ulcer, loss of calcium from bones (increases risk of fractures), cataracts, acne, bacterial infection, adrenal suppression (at doses above 5 mg per day), sleeplessness, muscle wasting and weakness, headache, glucose intolerance

Side effects are related to dosage and length of therapy. If a low dose is taken for a week or less, side effects are rare. Therapy for several months or years causes more noticeable and serious side effects, even at low doses.

prednisone

Deltasone, Orasone, others

Suppresses inflammation

injectable corticosteroids

varies

Relieve pain and suppress inflammation of synovitis, bursitis, tendonitis, or carpal tunnel syndrome

Same as above; also tenderness, burning, or tingling at injection site, thinning of skin at injection site, joint infections, cartilage damage

Injected into joints, tendon sheaths, or bursae. Undesirable systemic side effects seldom occur.

*Corticosteroids suppress the adrenal glands, which produce natural steroids. Abruptly stopping oral steroids can cause a life-threatening condition called Addisonian crisis. For this reason, corticosteroids must be taken exactly as prescribed. Before stopping corticosteroids, the dosage is lowered gradually, often over a period of several weeks or months.

Disease-modifying antirheumatic drugs (DMARDs)*

Generic name

Brand name

Use

Side effects

Comments

auranofin (oral gold)

Ridaura

Reduces inflammation in rheumatoid arthritis

Diarrhea, rash, kidney problems, blood abnormalities

Less toxic, but also less effective, than injectable gold. Rarely used for rheumatoid arthritis.

azathioprine

Imuran

Suppresses immune system in lupus, rheumatoid arthritis, and psoriatic arthritis

Nausea, vomiting, diarrhea, liver damage, blood abnormalities, risk of cancer with long-term therapy, infertility

Equal to other DMARDs in effectiveness, but slightly more likely to cause side effects. Generally reserved for people who do not respond to therapy with other DMARDs. Rarely used for rheumatoid arthritis.

cyclophospha-mide

Cytoxan

Suppresses immune system in severe lupus, rheumatoid arthritis, and other rheumatic diseases

Urinary tract bleeding, risk of infection including shingles, infertility in men and women, risk of cancers (including bladder cancer and leukemia)

Generally used to treat people who are unresponsive to other therapy, or who have dangerous inflammatory conditions. This drug was originally used to treat cancer. Rarely used for rheumatoid arthritis; more commonly used to treat lupus-related kidney disease or vasculitis.

cyclosporine

Neoral

Reduces inflammation in rheumatoid arthritis

Impaired kidney function, high blood pressure, hair growth, gum swelling, tremor, convulsions, headache

This drug was originally used to prevent organ rejection in transplant patients. Its effectiveness is equal to penicillamine and azathioprine. Generally used in combination with other DMARDs.

gold salts (injectable)

Myochrysine

Reduce inflammation in rheumatoid arthritis and psoriatic arthritis

Rash, mouth ulcers; in rare cases, blood abnormalities, kidney damage, inflammation of the upper respiratory tract

Effectiveness similar to many other DMARDs. Few people stay on this therapy for longer than five years because effect wears off or side effects occur. Rarely used for rheumatoid arthritis now.

hydroxychloro-quine

Plaquenil

Suppresses inflammation in rheumatoid arthritis; reduces disease activity in lupus

Nausea, vomiting, diarrhea, irritability, nervousness, rash, visual problems

This antimalarial drug is less likely to cause side effects than chloroquine; most commonly used to treat mild rheumatoid arthritis or lupus.

leflunomide

Arava

Reduces inflammation in rheumatoid arthritis

Birth defects, liver damage

Should not be used by people with liver disease or by women who are or plan to become pregnant. Women of childbearing age should use contraception while taking leflunomide.

methotrexate

Folex, Rheumatrex, Trexall

Suppresses inflammation in rheumatoid arthritis

Nausea, abdominal pain, ulcers, appetite loss, rash, liver damage, lung damage, headaches, blurred vision, drowsiness; long-term use results in immunosuppres­sion

Folic acid supplements reduce gastrointestinal symptoms. This drug is as effective as or slightly better than other DMARDs and works more rapidly (in one to two months) than most DMARDs.

penicillamine

Cuprimine, Depen

Suppresses inflammation in rheumatoid arthritis

Nausea, vomiting, diarrhea, rash, kidney damage, blood abnormalities, and several unusual autoimmune problems such as drug-induced lupus

Side effects are common: 25% of people stop taking the drug within the first year. Rarely used for rheumatoid arthritis or other rheumatic disease.

sulfasalazine

Azulfidine

Suppresses inflammation in rheumatoid arthritis, ankylosing spondylitis, and other spondyloarth-ropathies

Nausea, vomiting, loss of appetite, severe rash, abdominal pain, blood abnormalities, headache, low sperm count

Should not be taken by people allergic to sulfonamide antibiotics.

*While taking a DMARD, you will undergo frequent monitoring tests to avoid complications. Depending on the DMARD prescribed, such monitoring may include eye tests, blood pressure monitoring, regular urinalysis, and/or one or more blood tests (such as a complete blood count or those used to measure kidney or liver function).

Anti-TNF compounds

Generic name

Brand name

Use

Side effects

Comments

adalimumab

Humira

Suppress inflammation in rheumatoid arthritis

Redness and irritation at injection site, increased risk of infection; may reactivate tuberculosis; may be associated with multiple sclerosis–like reactions and, possibly, increased risk of lymphoma

Taken by self-injection. Taken biweekly with methotrexate, or weekly on its own.

etanercept

Enbrel

Same as above

Taken by self-injection.

infliximab

Remicade

Same as above; may worsen heart failure

Given intravenously, in conjunction with weekly oral methotrexate. Should not be used in people with heart failure.

Interleukin-1 inhibitor

Generic name

Brand name

Use

Side effects

Comments

anakinra

Kineret

Treats moderate to severe rheumatoid arthritis in people who do not respond to DMARD drugs

Mild redness and swelling at site of injection, headache, nausea, diarrhea

Taken by injection. Should not be used in combination with TNF-blocking agents.