Arthritis Drugs - What Are Your Options?

Drug Options for Treating Arthritis and Related Conditions

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Arthritis drugs have long been considered the "traditional" treatment option. Since individual response to drugs can vary and because potential side effects and adverse reactions are also a factor, finding the most effective combination of arthritis drugs can be a more difficult process than one would expect. You should become knowledgeable about the various arthritis drugs so you can make an informed decision with your doctor.

NSAIDs / COX-2 Inhibitors

NSAIDs (nonsteroidal anti-inflammatory drugs) are among the most commonly prescribed and widely used arthritis drugs. There are three types of NSAIDs: salicylates (both acetylated, such as aspirin, and nonacetylated such as (Disalcid) salsalate, (Trilisate) choline magnesium tri salicylate and (Doan's Pills, Novasal) magnesium salicylate), the traditional NSAIDs, and COX-2 selective inhibitors. NSAIDs work by blocking the activity of the enzyme, cyclooxygenase, also known as COX. Research has revealed that there are two forms, known as COX-1 and COX-2. NSAIDs affect both forms. COX-1 is involved in maintaining healthy tissue, while COX-2 is involved in the inflammation pathway. COX-2 selective inhibitors became a new subset of NSAIDs born of this research.

Traditional NSAIDs include:

  • Ansaid (flurbiprofen)
  • Arthrotec (diclofenac/misoprostol)
  • Cataflam (diclofenac potassium)
  • Clinoril (sulindac)
  • Daypro (oxaprozin)
  • Dolobid (diflunisal)
  • Feldene (piroxicam)
  • Ibuprofen (brand Motrin, Advil)
  • Indocin (indomethacin)
  • Ketoprofen (brand Orudis, Oruvail)
  • Lodine (etodolac)
  • Meclomen (meclofenamate)
  • Mobic (meloxicam)
  • Nalfon (fenoprofen)
  • Naproxen (brand Naprosyn, Aleve)
  • Ponstel (mefenamic acid)
  • Relafen (nabumetone)
  • Tolectin (tolmetin)
  • Vimovo (naproxen-esomeprazole)
  • Voltaren (diclofenac sodium)

COX-2 Inhibitors include:

  • Celebrex (celecoxib)

More About NSAIDs:

DMARDs

DMARDs (Disease-Modifying Anti-Rheumatic Drugs) have also been labeled "slow-acting antirheumatic drugs" (because they take weeks or months to work) and "second-line agents". However, research has shown the effectiveness of DMARDs in the treatment of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis and the importance of early, aggressive treatment with these drugs. For some, these drugs can stop disease progression and halt joint damage.

DMARDs include:

  • Arava (leflunomide)
  • Auranofin (brand Ridaura, Oral Gold)
  • Azulfidine (sulfasalazine)
  • Mycophenolate (brand CellCept)
  • Myochrysine (Injectable Gold)
  • Cyclosporine (brand Neoral, Sandimmune)
  • Cytoxan (cyclophosphamide)
  • Imuran (azathioprine)
  • Leukeran (chlorambucil)
  • Methotrexate (brand Rheumatrex, Trexall)
  • Minocin (minocycline)
  • Penicillamine (brand Cuprimine, Depen)
  • Plaquenil (hydroxychloroquine)

Xeljanz (tofacitinib citrate), an oral DMARD, was approved by the FDA on November 6, 2012, to treat adults with moderately- to severely-active rheumatoid arthritis who have had an inadequate response, or intolerance, to methotrexate. Xeljanz is the first in a class of drugs known as JAK (Janus kinase) inhibitors.

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Corticosteroids (Steroids)

Corticosteroids or glucocorticoids, often called "steroids", are potent drugs which can reduce swelling and inflammation quickly. These drugs are closely related to cortisol, a hormone produced by the cortex of the adrenal glands. They are prescribed in widely varying doses depending on the condition and goal of treatment. Used to control inflammation of the joints and organs in diseases such as rheumatoid arthritis, lupus, polymyalgia rheumatica, vasculitis, it has been determined that the potential for serious side effects increases at high doses or with long-term use. Doctors can prescribe short-term, high-dose intravenous steroids in some situations, or give shots or injections with drugs such as Triamcinolone (Kenalog) locally into a specific joint for relief.

Corticosteroids include:

  • Betamethasone (brand Celestone)
  • Cortisone (brand Cortone)
  • Dexamethasone (brand Decadron)
  • Hydrocortisone (brand Cortef)
  • Methylprednisolone (brand Medrol)
  • Prednisolone (brand Prelone)
  • Prednisone (brand Deltasone)

Learn more: Facts About Corticosteroids

Analgesics (Pain Medications)

Analgesics are pain relieving drugs. Controlling pain is a vital part of treating arthritis. However, unlike NSAIDs, analgesics do not relieve inflammation. Acetaminophen (Tylenol) is the most commonly used analgesic. Narcotic analgesic drugs can also be prescribed for more severe pain.

Narcotics include:

  • Codeine (Tylenol #3)
  • Duragesic (Fentanyl Skin Patch)
  • Hydromorphone (Palladone) - no longer on market
  • MS Contin (morphine sulfate)
  • OxyContin (oxycodone)
  • Percocet (oxycodone/acetaminophen)
  • Percodan (oxycodone/aspirin)
  • Talwin NX (pentazocine/naloxone)
  • Ultracet (tramadol/acetaminophen)
  • Ultram (tramadol)
  • Vicodin (hydrocodone/acetaminophen)

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Biologic Response Modifiers (Biologics)

Biologic Response Modifiers (BRMs), more commonly referred to as biologics, stimulate or restore the ability of the immune system to fight disease or infection. Biologics are drugs derived from living sources as opposed to being synthesized chemicals.

Enbrel (etanercept), Remicade (infliximab), Humira (adalimumab), Cimzia (certolizumab pegol), and Simponi (golimumab) target TNF-alpha, one of the most important cytokines involved in rheumatoid arthritis.

Biologics that bind to TNF-alpha, render it inactive, interfering with inflammatory activity and ultimately decreasing joint damage.

Kineret (anakinra), also a biologic drug, is considered an IL-1 antagonist. Kineret is the first selective blocker of interleukin-1 (IL-1), a protein which is found in excess in rheumatoid arthritis patients. By blocking IL-1, Kineret inhibits inflammation and pain associated with rheumatoid arthritis. Kineret can be used alone, or in combination with DMARDs other than anti-TNF drugs.

Orencia (abatacept) is the first T-cell co-stimulation modulator approved for the treatment of rheumatoid arthritis.

Rituxan, the world's best-selling cancer drug, was FDA approved 3/1/2006 to be used in combination with methotrexate to treat rheumatoid arthritis by reducing the signs and symptoms in adult patients who have moderately-to-severely active rheumatoid arthritis and have failed one or more anti-TNF drugs.

Rituxan is the first treatment for rheumatoid arthritis which selectively targets the CD20-positive B-cells.

Actemra (tocilizumab) is a monoclonal antibody that inhibits the interleukin-6 (IL-6) receptor, thereby blocking interleukin-6. Actemra was approved by the FDA on January 8, 2010 for the treatment of adult rheumatoid arthritis in patients who have failed one or more TNF blockers.

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Fibromyalgia Drugs

Until 2007, there were no drugs approved by the FDA for the treatment of fibromyalgia. Doctors treated fibromyalgia with a variety of drugs developed and approved for other purposes. In 2007, Lyrica was approved to treat fibromyalgia. In 2008, Cymbalta was approved for fibromyalgia. In 2009, Savella was approved for the condition.

Gout Drugs

Gout is one of the most acutely painful forms of arthritis. It can be managed through medication and diet. There are three aspects to the drug treatment of gout: pain relievers, anti-inflammatory agents and drugs to manage the underlying metabolic problem that causes high blood levels of uric acid and leads to gout attacks.

Drugs for gout include:

  • Acetaminophen (Tylenol) or other analgesic painkillers, for pain relief.
  • NSAIDs (nonsteroidal anti-inflammatory drugs), more specifically indomethacin (Indocin), for inflammation.
  • Colchicine, prevents or relieves gout attacks.
  • Corticosteroids, for anti-inflammatory response.
  • Probenecid (Benemid, Probalan) to decrease uric acid blood levels.
  • ColBenemid (Col-Probenecid and Proben-C), has anti-gout properties.
  • Allopurinol (Zyloprim), to lower blood uric acid by preventing uric acid production.
  • Losartan (Cozaar, Hyzaar), not specifically a gout drug, is an anti-hypertensive drug that may help control uric acid levels.
  • Fenofibrate (Tricor), not a specific gout drug, is a lipid-lowering drug that may help uric acid levels.
  • Uloric (febuxostat), lowers serum uric acid levels by blocking xanthine oxidase.
  • Krystexxa (pegloticase), a biologic drug that works by breaking down uric acid.

Osteoporosis Drugs

Osteoporosis is a condition of weakened, porous bones most common to the elderly but also problematic for people who have taken corticosteroids (steroids) longterm. There are several categories of drug options for osteoporosis: estrogens, parathyroid hormones, bone formation agents, bisphosphonates, and selective receptor molecules. Depending on what drug is used you can slow bone loss, promote bone growth, and reduce the risk of fractures.

Drugs for osteoporosis include:

  • Actonel (risedronate)
  • Boniva (ibandronate)
  • Didronel (etidronate)
  • Estrogens (Hormone Therapy)
  • Evista (raloxifene)
  • Forteo (teriparatide)
  • Fosamax (alendronate)
  • Miacalcin (calcitonin)
  • Reclast
  • Prolia

Learn more: Osteoporosis Risk Factors

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