Arthritis Medications

  • Medical Reviewer: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

onse_modifiers_brms or dmards">Biological Response Modifiers (BRMs or DMARDs)

Substances that modify the body's response to infection and disease. The body naturally produces small amounts of these substances. Scientists can produce some of them in the laboratory in large amounts for use in treating cancer, rheumatoid arthritis, and other diseases.
BRMs used in biological therapy include monoclonal antibodies, interferon, interleukin-2 (IL-2), and several types of colony- stimulating factors (CSF, GM-CSF, G-CSF). Interleukin-2 and interferon are BRMs being tested for the treatment of advanced malignant melanoma. Interferon is a BRM now in use to treat hepatitis C.

The side effects of BRM therapy often include flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Some patients develop a rash, and some bleed or bruise easily. Interleukin therapy can cause swelling. Depending on the severity of these problems, patients may need to stay in the hospital during treatment. These side effects are usually short-term and go gradually away after treatment stops.

Brand Name Generic Name
Enbrel etanercept
Humira adalimumab
Kineret anakinra
Orencia abatacept
Remicade infliximab

Disease-Modifying Antirheumatic Drugs or DMARDs

While "first-line" medicati

ons (NSAIDs and corticosteroids) can relieve joint inflammation and pain, they do not necessarily prevent joint destruction or deformity. For patients with an aggressively destructive form of rheumatoid arthritis, medications other than NSAIDs and corticosteroids are needed. These "second-line" or "slow-acting" medicines (listed below) may take weeks to months to become effective. They are used for long periods of time, even years, at varying doses. If effective, they can promote remission, thereby retarding the progression of joint destruction and deformity. Sometimes a number of second-line medications are used together as combination therapy.

Hydroxychloroquine (PLAQUENIL) is related to quinine, and is used in the treatment of malaria. It is used over long periods for the treatment of rheumatoid arthritis. Side effects include upset stomach, skin rashes, muscle weakness, and vision changes. Even though vision changes are rare, patients taking PLAQUENIL should be monitored by an eye doctor (opthalmologist).

Sulfasalazine (AZULFADINE) is an oral medication traditionally used in the treatment of mild to moderately severe inflammatory bowel diseases, such as ulcerative colitis and Crohn's colitis. AZULFADINE is used to treat rheumatoid arthritis in combination with antiinflammatory medications. AZULFADINE is generally well tolerated. Common side effects include rash and upset stomach. Because AZULFADINE is made up of sulfa and salicylate compounds, it should be avoided by patients with known sulfa allergies.

Gold salts have been used t

o treat rheumatoid arthritis throughout most of this century. Gold thioglucose (SOLGANAL) and gold thiomalate (MYOCHRYSINE) are given by injection, initially on a weekly basis for months to years. Oral gold, auranofin (RIDAURA) was introduced in the 1980's. Side effects of gold (oral and injectable) include skin rash, mouth sores, kidney damage with leakage of protein in the urine, and bone marrow damage with anemia and low white cell count. Patients receiving gold treatment are regularly monitored with blood and urine tests. Oral gold can cause diarrhea.

Brand Name Generic Name
Arava leflunomide
Azulfidine sulfasalazine
Cuprimine, Depen penicillamine
Enbrel etanercept
Humira adalimumab
Imuran azathioprine
Plaquenil hydroxychloroquine
Remicade infliximab
Rheumatrex methotrexate
Ridaura auranofin
Solganal aurothiglucose

edications">Fibromyalgia Medications

Because the symptoms of fibromyalgia are diverse and vary among patients, treatment programs have to be individualized. Treatment programs are most effective when they combine patient education, stress reduction, regular exercise, and medications. Recent studies have verified that the best outcome for each patient results from a combination of approaches that involves the patient in customization of the treatment plan.

Brand Name Generic Name
Celexa citalopram
Effexor venlafaxine
Elavil, Endep amitriptyline
Luvox fluvoxamine
Norpramin desipramine
Pamelor, Aventyl nortriptyline
Paxil paroxetine
Prozac fluoxetine
Tofranil imipramine
Zoloft sertraline

ortisone-related_drugs">Glucocorticoids (Corisone-Related Drugs)

Glucocorticoids are medications that include cortisone and related drugs. A glucocorticoid is hormone that predominantly affects the metabolism of carbohydrates and, to a lesser extent, fats and proteins (and has other effects). Glucocorticoids are made in the outside portion (the cortex) of the adrenal gland and chemically classed as steroids. Cortisol is the major natural glucocorticoid. The term glucocorticoid also applies to equivalent hormones synthesized in the laboratory. Glucocorticoid drugs are also called corticosteroids.

Corticosteroids have potent anti-inflammatory properties, and are used in a wide variety of inflammatory conditions such as arthritis, colitis, asthma, bronchitis, certain skin rashes, and allergic or inflammatory conditions of the nose and eyes. There are numerous preparations of corticosteroids including oral tablets, capsules, liquids, topical creams and gels, inhalers and eye drops, and injectable and intravenous solutions.

Dosage requirements of corticosteroids vary among individuals and the diseases being treated. In general, the lowest possible effective dose is used. Corticosteroids given in multiple doses throughout the day are more effective, but also more toxic, than if the same total dose is given once daily, or every other day.

Brand Name Generic Name
Cortisone Injection Corticosteroid Injection
of Soft Tissues & Joints
Decadron dexamethasone, oral
Deltasone, Liquid Pred prednisone, oral
Prednisolone, Pediapred Oral Liquid,
Medrol
prednisolone
Hydrocortone, Cortef hydrocortisone, oral
Medrol methylprednisolone

s">Gout Medications

There are three aspects to the medication treatment of gout. First, pain relievers such as TYLENOL or other more potent analgesics are used to manage pain. Secondly, anti-inflammatory agents such as nonsteroidal anti-inflammatory drugs (NSAIDS), colchicine, and corticosteroids are used to decrease joint inflammation. Finally, medications are considered for managing the underlying metabolic derangement that causes high blood levels of uric acid (hyperuricemia) and leads to gout attacks and kidney stones.

Brand Name Generic Name
see above NSAIDS
Anturane sulfinpyrazone
Benemid probenecid
Colchicine colchicine
Zyloprim allopurinol

NSAIDs (Nonsteroidal Anti-inflammatory Drugs)

Nonsteroidal anti-inflammatory drugs. These are medications that reduce inflammation and do not contain cortisone-related compounds.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed medications for the inflammation of arthritis and other body tissues, such as in tendinitis and bursitis. Examples of NSAIDs include ASPIRIN, indomethacin (INDOCIN), ibuprofen (MOTRIN), naproxen (NAPROSYN), piroxicam (FELDENE), and nabumetone (RELAFEN). The major side effects of NSAIDs are related to the gastrointestinal system. Some 10%-50% of patients are unable to tolerate NSAID treatment because of side effects, including abdominal pain, diarrhea, bloating, heartburn, and upset stomach. Approximately 15% of patients on long-term NSAID treatment develop ulceration of the stomach and duodenum. Even though many of these patients with ulcers do not have symptoms and are unaware of their ulcers, they are at risk of developing serious ulcer complications such as bleeding or perforation of the stomach.

NSAIDs are taken regularly by approximately 33 million Americans!

Brand Name Generic Name
Advil, Motrin, Medipren, Nuprin ibuprofen
Ansaid flurbiprofen
Aspirin, Bayer, Ecotrin aspirin
Celebrex celecoxib
Clinoril sulindac
Daypro oxaprozin
Disalcid, Salflex salsalate
Feldene piroxicam
Indocin, Indocin-sr indomethacin
Lodine etodolac
Meclomen meclofenamate
Mobic meloxicam
Nalfon fenoprofen
Naprosyn, Naprelan, Anaprox, Aleve naproxen
Orudis, Oruvail ketoprofen
Tolectin tolmetin
Trilisate choline magnesium salicyclate
Voltaren, Cataflam, Voltaren-xr diclofenac

Osteoporosis Medications

The best treatment for osteoporosis is prevention. Quitting smoking and curtailing alcohol intake are helpful. Exercise against gravity can reduce bone loss and can even stimulate new bone formation. Additionally, exercise increases agility, strength, and endurance; factors that can reduce accidents. Exercise programs are individualized and should be regular; at least several times weekly. For patients with underlying musculoskeletal disorders, combining exercising with joint protection techniques is important.

Calcium supplements are useful, especially in women. Average women in the United States receive less than 500 milligrams of calcium per day in their diet. The recommended daily allowance (RDA) of calcium intake is 800mg per day. The National Institute of Health Consensus Conference on Osteoporosis has recommended a calcium intake for postmenopausal women of 1000mg per day if they are also taking estrogen and 1500mg per day if they are not taking estrogen.

Estrogen replacement in postmenopausal women is important in the prevention of accelerated bone loss. Estrogen can even reverse the bone loss that occurs after menopause. Estrogen is available orally (PREMARIN, ESTRACE, ESTRATEST, and others) or as a skin patch (ESTRADERM, VIVELLE, and others). Women with certain conditions, such as a history of breast cancer, phlebitis, or stroke may not be candidates for estrogen because of the potential for worsening or inducing recurrences of these conditions.

Vitamin D supplementation has been shown to be of benefit in elderly patients, particularly those in nursing homes. This is probably due to the fact that many patients in nursing homes are vitamin D deficient.

Brand Name Generic Name
Actonel risedronate
Boniva ibandronate
Calcimar, Miacalcin calcitonin
Evista raloxifene
Fosamax alendronate

REFERENCE:

"Initial treatment of moderately to severely active rheumatoid arthritis in adults"
UptoDate.com


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Reviewed on 12/1/2014

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