Types of Arthritis Medications

The term “arthritis” means joint inflammation. Arthritis is a disease that affects joints, muscles, bones, and structures around the joints such as cartilage, ligaments, and tendons.

Arthritis medications are drugs prescribed for the management of arthritis, a painful condition that primarily affects joints. Some arthritis medications relieve symptoms of the disease, while others slow down or stop its progression, and prevent permanent damage and deformity of the joint.

Medications such as painkillers, non-steroidal anti-inflammatory drugs (NSAIDs), and corticosteroids relieve pain and reduce joint stiffness and inflammation from arthritis.

Treatment for certain types of arthritis may include medications that treat the underlying cause, such as antibiotics for infectious arthritis or medications to reduce uric acid levels in the case of gout, a type of arthritis.

Disease-modifying antirheumatic drugs (DMARDs) are an important category of medications in treating certain types of arthritis-related autoimmune disorders.

DMARDs work at the cellular level to treat the underlying cause of arthritis. Several biologic and nonbiologic DMARDs have been developed, and each class of drugs works in a unique way to retard or stop the course of the disease.

The term “arthritis” means joint inflammation. Arthritis is a disease that affects joints, muscles, bones, and structures around the joints such as cartilage, ligaments, and tendons. Arthritis is a broad term that refers to more than 100 types of diseases that affect the musculoskeletal system.

Types of arthritis

Degenerative arthritis

Osteoarthritis is degenerative arthritis and the most common type. Joints have a rubbery tissue known as cartilage that acts as a cushion between the bones in the joint. When the cartilage degenerates, the bones start rubbing against each other and the joint gets inflamed. 

Age, excess weight, and previous injury are all risk factors for developing degenerative arthritis. Bone loss (osteoporosis), especially in menopausal women, can worsen the condition. Osteoarthritis can be prevented by maintaining a healthy weight, staying active, and taking care to avoid injury and activities with a repetitive motion that can overstress a joint.

Inflammatory arthritis

Inflammatory arthritis is caused by autoimmune disorders, in which the body’s own immune system goes haywire and attacks the joints, causing persistent inflammation. Inflammatory types of arthritis can eventually affect other organs such as the eyes, skin, heart, lungs, and kidneys. Examples of inflammatory arthritis include:

Rheumatoid arthritis (RA): A progressive disease in which the immune system attacks connective tissue, known as synovium, which lines joints.

Psoriatic arthritis: Joint inflammation caused by an autoimmune skin condition known as psoriasis.

Ankylosing spondylitis: A form of arthritis that affects the spine.

Systemic lupus erythematosus (SLE): A disease that causes inflammation in many organs of the body including joints.

Fibromyalgia: Fibromyalgia causes widespread pain all over the body, fatigue, and sleep problems. Fibromyalgia often occurs with rheumatoid arthritis or lupus.

Juvenile idiopathic arthritis: A type of arthritis that develops in childhood or teens, but the cause is unknown.

Infectious arthritis

Infectious arthritis is caused by a bacterial, viral, or fungal infection that enters the joint, or by a heightened immune reaction to an infection in another part of the body. Timely treatment with antibiotics is usually effective for infectious arthritis, but sometimes it may turn chronic. Some of the types of infectious arthritis are:

• Septic arthritis: Septic arthritis is caused by infection from a wound or nearby bone entering the joint space, most often from Staphylococcus aureus bacteria.
• Reactive arthritis: Reactive arthritis is both infectious and inflammatory, caused by autoimmune hyperactivity triggered by an infection in another part of the body. Common infections that cause reactive arthritis include:
  • Food poisoning from contamination by bacteria such as Salmonella or Shigella
  • Sexually transmitted infections such as chlamydia and gonorrhea
  • Hepatitis C virus infection

Metabolic arthritis

Metabolic arthritis is the result of a metabolic disorder, and gout is a typical example. Gout is caused when excess uric acid builds up in the body and forms needle-like crystals in the joint causing episodes of extreme pain.

Uric acid is a metabolic byproduct from the breakdown of a substance known as purine, present in many foods. Uric acid is normally excreted by the kidneys and bowels.

Avoiding purine-rich foods and alcohol can help lower uric acid levels. Gout can become chronic if uric acid levels are not controlled.

Symptoms of arthritis

• Arthritis can cause the following symptoms in the joints:
• Redness and warmth
• Tenderness and swelling
• Pain and stiffness
• Locking and loss of range of motion
• Weakness and wasting of muscle around the joints

There is no permanent cure for chronic arthritis. Timely treatment of the underlying condition with appropriate medications can completely resolve some types of arthritis such as gout and septic arthritis. To a great extent, osteoarthritis can be prevented or effectively controlled by adopting healthy lifestyle habits.

Medications cannot cure inflammatory arthritis, but early treatment is vital to retard or halt further progression of the disease and prevent permanent joint damage, deformity, and disability. Some of the advanced generations of medications can greatly improve the chances of remission.

Other therapies that can help in managing chronic arthritis include:

• Physical therapy
• Splints or other aids
• Surgical therapies such as
  • Joint repair
  • Joint fusion
  • Joint replacement

Arthritis medication regimens depend upon the diagnosis of the precise type of arthritis. Some types of medications that relieve pain and reduce inflammation are commonly used for all types of arthritis. These medications, however, do not alter the course of the disease.

Symptom-relief medications

Medications used for symptom relief from arthritis include the following:

• Analgesics (painkillers)
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids

Disease-specific medications

In addition to the pain relievers and anti-inflammatory medications, the disease-specific medications that are prescribed include:

• Antimicrobial medications for infectious arthritis
• Medications for bone loss (osteoporosis) and joint lubrication in osteoarthritis
• Medications to lower uric acid in gout
• Medications for fibromyalgia
• Disease-modifying antirheumatic drugs (DMARDs) for inflammatory and chronic reactive arthritis, which include:
  • Nonbiologic DMARDs
  • Biologic DMARDs

Symptom relief medications

Symptom relief medications relieve joint pain and reduce inflammation and swelling. These medications do not prevent disease progression or joint damage.

Analgesics

Non-opioid analgesics are useful for relieving moderate pain but opioids may be more effective for severe pain. Opioids are potent analgesics, but also carry a high risk for addiction. Some analgesics are available over the counter but stronger medications generally require a prescription.

Analgesics include:

• Non-opioid analgesics:
• Acetaminophen (Tylenol, Fever all)
• Tramadol hydrochloride (Ultram)

Opioids

• Fentanyl (Duragesic)
• Hydrocodone bitartrate (Hysingla ER, Zohydro ER)
• Hydromorphone hydrochloride (Dilaudid)
• Meperidine hydrochloride (Demerol)
• Methadone hydrochloride
• Morphine sulfate (MS Contin)
• Oxycodone hydrochloride (Oxycontin, Roxicodone)
• Oxymorphone hydrochloride
• Tapentadol hydrochloride (Nucynta)

Combination opioid drugs

• Acetaminophen/codeine (Tylenol 3, Tylenol 4)
• Acetaminophen/hydrocodone (Norco)
• Acetaminophen/dihydrocodeine/caffeine
• Ibuprofen/hydrocodone
• Acetaminophen/oxycodone (Percocet, Roxicet)
• Aspirin/oxycodone (Percodan)

Topical pain relief

The following over-the-counter analgesic creams and pain patches may provide pain relief:

• Methyl salicylate (Salonpas)
• Capsaicin (Zostrix cream, Qutenza pain patch)

NSAIDs

Non-steroidal anti-inflammatory drugs reduce swelling, inflammation, and pain by blocking the production of inflammatory chemicals. These drugs do not prevent the progression of the disease or joint damage. Anti-inflammatory drugs include:

• Aspirin
• Celecoxib (Celebrex)
• Diclofenac sodium (Voltaren)
• Etodolac
• Fenoprofen calcium (Nalfon)
• Flurbiprofen
• Ibuprofen (Advil, Motrin)
• Indomethacin (Indocin)
• Ketoprofen
• Meclofenamate sodium
• Meloxicam (Mobic)
• Nabumetone
• Naproxen sodium (Naprosyn, Aleve, Anaprox DS)
• Oxaprozin (Daypro)
• Piroxicam (Feldene)
• Salsalate
• Sulindac
• Tolmetin sodium

Corticosteroids

Corticosteroids are more potent anti-inflammatory drugs than NSAIDs, but long-term use can cause severe adverse effects that include bone thinning and immunosuppression. Corticosteroids include:

• Prednisone
• Prednisolone (Prelone)
• Methylprednisolone (Medrol, Depo-Medrol, Solu-Medrol)
• Cortisone acetate
• Dexamethasone
• Hydrocortisone (Cortef)
• Betamethasone (Celestone)
• Fludrocortisone acetate
• Triamcinolone (Kenalog, Aristospan)

Disease-specific medications

Disease-specific medications treat the underlying conditions that cause arthritis and are taken in addition to medications for symptom relief.

Antimicrobial medications

Antimicrobial agents prescribed will depend on the type of organism causing the infection in infectious arthritis. Typically, broad-spectrum antibiotics are used to treat bacterial infections, which are the most common cause of infectious arthritis. Some of the commonly used antibiotics include:

• Tetracycline hydrochloride
• Erythromycin
• Ciprofloxacin
• Doxycycline
• Minocycline
• Azithromycin
• Cefdinir

Osteoporosis medications

Medications that help prevent bone loss include:

• Calcium supplements
• Vitamin D
• Estrogen to prevent the bone loss that occurs with menopause in women

One of the medications used for osteoarthritis is a substitute lubricant for a component of synovial fluid, which is the natural lubricant in joints. The FDA-approved medication specifically for injection into knee joints is:

• Hyaluronic acid (Euflexxa, Hyalgan, Orthovisc)

Gout medications

Gout medications reduce the uric acid level in the blood and prevent gout flares. Gout medications include:

• Probenecid (Probalan)
• Colchicine (Colcrys)
• Allopurinol (Zyloprim)

Fibromyalgia medications

Treatments for fibromyalgia are individualized because the symptoms are diverse among patients. The most effective treatment is a combination of exercise, stress reduction, and medications.

Typically pain relievers, antidepressants, muscle relaxants, and sleep medications are prescribed for fibromyalgia. Medications approved by FDA specifically for fibromyalgia are:

• Pregabalin (Lyrica)
• Duloxetine hydrochloride (Cymbalta)
• Milnacipran hydrochloride (Savella)

Antidepressants used to treat fibromyalgia include the following:

• Citalopram hydrobromide (Celexa)
• Venlafaxine hydrochloride (Effexor XR)
• Fluoxetine hydrochloride (Prozac)
• Fluvoxamine maleate (Luvox)
• Paroxetine hydrochloride (Paxil)
• Sertraline hydrochloride (Zoloft)
• Amitriptyline hydrochloride
• Imipramine hydrochloride (Tofranil)
• Nortriptyline hydrochloride (Pamelor)

DMARDs

Disease-modifying antirheumatic drugs stop or slow down the progression of arthritis. DMARDs are a mainstay treatment for rheumatoid arthritis and other types of arthritis caused by autoimmune disorders. DMARDs are also used for reactive arthritis that becomes chronic.

Each DMARD works uniquely at the cellular level to prevent the immune system from causing inflammation. DMARD therapy takes up to six months to be fully effective. DMARDS are immunosuppressive, and long-term use can result in immune deficiency and a higher risk for infections.

Nonbiologic DMARDs

Nonbiologic DMARDs are synthetic proteins produced in the laboratory. Common nonbiologic DMARDs include:

• Methotrexate (Trexall, Otrexup)
• Azathioprine (Imuran)
• Auranofin (Ridaura)
• Chloroquine phosphate
• Cyclophosphamide (Cytoxan)
• Cyclosporine (Neoral)
• Hydroxychloroquine (Plaquenil)
• Leflunomide (Arava)
• Minocycline hydrochloride (Minocin)
• Mycophenolate mofetil (CellCept)
• Penicillamine (Cuprimine)
• Sulfasalazine (Azulfidine)

JAK inhibitors

Janus kinase (JAK) inhibitors are the latest type of synthetic DMARDs developed to treat inflammatory arthritis. JAK inhibitors block the activity of JAK enzymes which stimulate the immune system’s pro-inflammatory activity. JAK inhibitors include:

• Tofacitinib citrate (Xeljanz)
• Baricitinib (Olumiant)
• Upadacitinib (Rinvoq)

Biologic DMARDs

Biologic DMARDs are proteins known as monoclonal antibodies that are genetically engineered in a laboratory. Biologics are more difficult to produce, more expensive, and used as second-line treatment if nonbiologic drugs like methotrexate are not sufficiently effective. Biologic DMARDs include:

• Etanercept (Enbrel)
• Infliximab (Remicade)
• Adalimumab (Humira)
• Certolizumab pegol (Cimzia)
• Golimumab (Simponi, Simponi Aria)
• Abatacept (Orencia)
• Anakinra (Kineret)
• Rituximab (Rituxan)
• Tocilizumab (Actemra)
• Sarilumab (Kevzara)

Experimental DMARD therapies

Experimental medications currently in clinical trials for the treatment of rheumatoid arthritis include the following:

• Belimumab
• Ofatumumab
• Ocrelizumab
• Fostamatinib

Warning: The American College of Rheumatology (ACR) recommends that before undergoing DMARD therapy, patients should get vaccinations for influenza, pneumonia, hepatitis, human papillomavirus, and herpes zoster virus because DMARD medications suppress immunity.

• Please visit our medication section of each drug within its class for more detailed information.
• If your prescription medication isn’t on this list, remember to look on MedicineNet.com drug information or discuss with your healthcare provider and pharmacist.
• It is important to discuss all the drugs you take with your doctor and understand their effects, possible side effects, and interaction with each other.
• Never stop taking your medication and never change your dose or frequency without consulting with your doctor.