5 Main Drug Classes Used to Treat Arthritis

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5 Main Drug Classes Used to Treat Arthritis

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Nonsteroidal anti-inflammatory drugs, commonly referred to as NSAIDs, are a large group of drugs primarily prescribed to reduce inflammation, pain, and fever. They work by preventing an enzyme, called COX or cyclooxygenase, from making prostaglandins (hormone-like chemicals involved in the inflammatory process). There are two types of COX: COX-1 and COX-2. Older, traditional NSAIDs (e.g., aspirin, naproxen, ibuprofen) block both COX-1 and COX-2. Celebrex (celecoxib) is a COX-2 selective inhibitor, meaning, it only blocks COX-2. The COX-2 inhibitors were developed since COX-1 is known to have a beneficial effect of protecting the stomach lining.   

Certain NSAIDs are available over-the-counter in a reduced strength (e.g., Advil [ibuprofen], Aleve [naproxen]). The majority of NSAIDs require a prescription.

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Analgesics Are Used to Relieve Arthritis Pain

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Analgesics are drugs developed for the purpose of relieving pain. They are often called pain medications or painkillers. This class of drugs includes non-narcotic analgesics (e.g., acetaminophen [Tylenol]) and opioid narcotics (e.g., hydrocodone). There is also Tramadol (brand name Ultram) which is classified as an opioid narcotic but is thought to have less risk of physical dependence than other opioid narcotics.

Acetaminophen is available over-the-counter without a prescription. Acetaminophen is also found in combination with other opioid narcotics (e.g., Norco is a combination of hydrocodone and acetaminophen).

While opioid narcotics are effective pain relievers, there is increasing concern over accidental overdose and abuse by people without legitimate need for the drugs. Be sure you only take analgesics as directed by your doctor. Be aware of potential side effects and other warnings.  

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Corticosteroids Provide Quick Relief From Severe Inflammation

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Corticosteroids, also referred to as glucocorticoids, are synthetic drugs designed to mimic the effects of cortisol, a hormone naturally produced by the adrenal gland. Cortisol affects several functions in the body, including the immune system. Cortisol has the ability to quickly control inflammation by decreasing levels of prostaglandins, as well as inflammatory cytokines like TNF-alpha. Corticosteroids (e.g., prednisone) act on inflammation similarly.  

It must be noted, though, that while corticosteroids can have potent beneficial effects, there is also the potential for undesirable side effects, especially if the drugs are taken for a long period of time or at a high dose. Use only as directed and be aware of potential adverse effects and warnings.

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DMARDs Slow Progression of Inflammatory Arthritis

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Disease-modifying anti-rheumatic drugs (DMARDs) are prescribed for inflammatory types of arthritis, such as rheumatoid arthritis. DMARDs are slow-acting drugs. Quite possibly, you won't notice their effect for weeks, if at all. This class of drugs works behind the scenes to slow progression of the disease and reduce the risk of permanent joint damage.

The most commonly prescribed DMARD is methotrexate. Plaquenil (hydroxychloroquine), Arava (leflunomide), Azulfidine (sulfasalazine), and Xeljanz (tofacitinib) are among the other DMARD options. Oxtrexup is a single-dose autoinjector for injectable methotrexate.

As with all drugs, it is important to be aware of possible side effects. If you notice anything of concern, consult your doctor. You will also have blood tests periodically to monitor your liver enzymes while treated with a DMARD.

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Biologics Target Specific Proteins Associated With Inflammatory Arthritis

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Biologics, short for Biologic Response Modifiers, are the newest type of DMARD.  Biologics are genetically engineered from a living organism to provoke a particular response. In other words, biologics target a specific protein or cell which is associated with the symptoms and joint damage caused by inflammatory types of arthritis. There are several biologics which can be administered by intravenous infusion. Most are self-injectable.

Sources:

Kelley's Textbook of Rheumatology. Firestein et al. Ninth edition.

2014 Drug Guide. Arthritis Foundation.

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