What is the best prescription medicine for arthritis pain?
Most people who have rheumatoid arthritis take some type of medication. Medications for RA typically fall into five categories: Non-steroidal anti-inflammatory drugs (NSAIDs); steroids; disease-modifying anti-rheumatic drugs (DMARDs); biologics; and Janus kinase (JAK) inhibitors.
When prescribing a medication, a physician will consider the patient’s age, disease activity, and medical background, but each patient is different. Therefore, figuring out which medication or combination of drugs works best for someone can be challenging and often requires a process of trial and error.
It is recommended for most people with RA to take a non-steroidal anti-inflammatory drug to decrease pain and inflammation. NSAIDs require no prescription and are sold over-the-counter, under such names as Advil and Aleve. Those that do require a prescription are known as Mobic and Celebrex.
Fast-acting steroids, such as prednisone, are beneficial during initial treatment before other RA medications have had a chance to take effect (often 12 weeks or more).
One advantage of steroids is that they can be injected into joints. Injected steroids can provide targeted pain relief to one or two painful joints with limited side effects.
Experts recommend taking the lowest possible dose of steroids and advise against relying on them longer than necessary. This is because steroids’ effectiveness often diminishes over time—meaning the longer a person takes a steroid, the less likely it is to relieve symptoms. In addition, taking steroids continuously for several months or years can lead to health problems such as weight gain, increases in blood pressure, diabetes, and heart disease.
Methotrexate and Other Traditional DMARDs
Disease-modifying antirheumatic drugs (DMARDs) are used to slow or stop rheumatoid arthritis by suppressing the immune system. The generic names for commonly used drugs of this type include:
Methotrexate is often the first drug for people newly diagnosed with rheumatoid arthritis. RA patients take this medication once a week, alone or in combination with other medicines.
High-dose methotrexate is also used to treat some cancers. However, RA patients take significantly lower doses than cancer patients.
Biologics for Rheumatoid Arthritis
This class of medications, called biologic response modifiers, is technically a subcategory of DMARDs. They may be used with traditional DMARDs or as an alternative to them. Biologics:
If you disrupt the part of the chain of events that leads to RA inflammation, you have the chance to stop the disease from progressing.
Increase a person’s risk of infection and tend to be expensive. Because of these potential downsides, biologics are used when methotrexate or other DMARDs prove insufficient or cause unacceptable side effects.
It may become less effective and/or exacerbate the side effects over time. The doctor and patient can work together to monitor changes and decide if and when it is a good idea to switch medication.
Biologics fall into four categories: Tumor necrosis factor (TNF) inhibitors, Interleukin (IL) inhibitors; B-cells inhibitors; and T-cells inhibitors. These medications are administered via injection or infusion. Examples include Remicade, Enbrel, and Humira.