How medicines fit in

The sooner someone with rheumatoid arthritis can gain access to specialist rheumatology care, the sooner their rheumatoid arthritis can be effectively managed and an appropriate treatment plan started.

There are a range of treatments available for rheumatoid arthritis. The treatment prescribed will depend on each person's condition. These treatments may help to:

• Relieve painful symptoms
• Slow down how quickly the disease develops
• Reduce fatigue
• Maintain mobility

Generally, treatment for rheumatoid arthritis comes as a combination of physical therapy such as special exercises, and medication.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs, or NSAIDs as this group of drugs are often called, are usually the first treatment you are given for your rheumatoid arthritis.

• Traditional NSAIDs

There are a number NSAIDs - such as Ibuprofen - that reduce pain by calming inflammation.  NSAIDs work by blocking the activity of the enzyme involved in inflammation, cyclooxygenase, also known as COX.  Traditional NSAIDs are widely prescribed in the UK and are often the first choice for doctors; however, they are linked with stomach-related side effects including indigestion, ulcers as well as other serious complications.

• COX-2 selective inhibitors

Studies have shown that there are two forms of COX, simply known as COX-1 and COX-2.  COX-2 is more closely linked with inflammation, where as COX-1 is more closely associated with tissue repair.  By predominantly targeting COX-2, these medications provide pain relief without hindering the actions of COX-1.  As a result, studies have shown that there are less stomach-related side effects associated with COX-2 selective inhibitors compared to NSAIDs.

By reducing inflammation, NSAIDs can help to control pain and joint stiffness. This group of drugs are more effective in relieving peripheral symptoms (such as those affecting joints of fingers, wrists, hips and ankles) and may have a limited effect on spinal symptoms.

There are a number of different NSAIDs available. People's responses to NSAIDs vary, so more than one NSAID may be tried before one that works best for you is found. NSAIDs generally come in tablet or capsule form and are usually taken by mouth.

Some patients with heart conditions are not suitable for all NSAIDs.  Your doctor will consider the benefits versus the risk before recommending a treatment.

Disease modifying anti-rheumatic drugs (DMARDs)

Disease modifying anti-rheumatic drugs, or DMARDs as they are also known, are a type of medication that may be prescribed to treat the symptoms of rheumatoid arthritis. Examples of DMARDs include sulfasalazine and methotrexate and they may also be prescribed at the same time as an NSAID.

These drugs might have positive effects on rheumatoid arthritis symptoms in some people. It can take a number of months for these drugs to work and they are not usually chosen as a first treatment for rheumatoid arthritis.

DMARDs are generally taken by mouth, but some forms can be given via a subcutaneous injection (an injection just under the skin).  Close monitoring by your healthcare professional is required while you are on some DMARDs, which may include regular blood tests.

Potential side effects of DMARDs include diarrhoea, nausea, skin rash, mouth sores, changes to liver function and hair loss. As side effects are specific to individual treatments, it is important to check the patient information leaflet for any medication you use or talk to your healthcare team.

People taking DMARDs will often be provided with a patient held monitoring card to be carried at all times.

Corticosteroids

These are another group of medicines that you might be prescribed if standard painkillers and NSAIDs haven't worked. They can be taken either as daily tablets or as an injection directly into the arthritic joint.

Corticosteroids help reduce pain, stiffness and swelling but they are generally prescribed for a short time only, because they can have potentially serious side effects, such as weight gain and bone thinning, if they're taken over a long period.

Anti-TNF therapies (a type of biologic therapy)

Anti-TNF (anti-tumour necrosis factor) therapies may be prescribed to people with rheumatoid arthritis (by their rheumatologist) if other therapies have failed or are unsuitable.

These therapies target part of the immune system that is responsible for causing an excessive inflammatory response in rheumatoid arthritis, They act by re-balancing this response.

There are a number of available anti-TNF therapies. If these are prescribed, a healthcare professional will discuss the different options available to help find the best therapy for you. The healthcare professional will also give you information about the benefits and side effects and discuss any increased risks associated with the different anti-TNF therapies available.

Anti-TNF therapies are taken either by subcutaneous injection (an injection just under the skin) or by intravenous infusion (via a needle into a vein). Taking anti-TNF therapy can help to improve rheumatoid arthritis symptoms such as:

• Joint pain and stiffness
• Joint swelling and flexibility
• Fatigue

The most common side effect of these therapies is a reaction at the site where the injection or infusion is given e.g. redness, swelling or infection etc. Some people can also experience an allergic reaction at the beginning of treatment and may be given other medication to reduce this effect. Because anti-TNF therapies act on the immune system you could be more likely to get an infection while on this treatment and even for some months after stopping it.

Your doctor or nurse will screen you for any risk factors prior to starting you on this medication. You will have blood tests and these will be repeated at regular intervals while you receive this treatment.

Full details of potential side effects are available in the patient information leaflets for these medications.

Don't forget...

…Whatever medicines you take, it's always a good idea to read the information leaflet inside the packet to make sure you understand what you are taking and any side effects that might affect you.

Taking medicine for rheumatoid arthritis can make a big difference to your quality of life but you need to be absolutely clear about how you should take it, what to expect and any possible side effects. If you are using non-prescription medicines, such as everyday painkillers, it's important to discuss these with your doctor, especially if you are taking them regularly.

Stick with it

The inflammation and pain of rheumatoid arthritis can come and go and you may find that there are times when you're feeling good and don't think you need to take your medicine. It's important to remember that you should not stop taking it without discussing it with your doctor first.

Pregnant?

If you are pregnant or thinking of starting a family, it's important you let your doctor know, as some medicines can be harmful during pregnancy.