If you have arthritis, you're probably aware that there are a variety of different medicines available for the disease. But do you know which one is best for you? Learning the basics about arthritis medications can help you make more informed decisions about your treatment options.
Medications for both rheumatoid arthritis and osteoarthritis
The following medications may be used for the two most common types of arthritis—rheumatoid arthritis and osteoarthritis:
Analgesics (pain relievers). These medications help relieve mild to moderate pain, though they don't affect swelling.
Analgesics can be taken orally or applied to the skin over sore joints as a cream.
The most common oral analgesic is acetaminophen.
Topical analgesics can be taken in combination with oral pain relievers or used alone.
Most analgesic creams contain one or more of the following active ingredients, according to the Arthritis Foundation:
- Counter-irritants. These ingredients—which include menthol, oil of wintergreen, eucalyptus oil or camphor—irritate the nerve endings of the skin. As a result, they distract the brain from the main source of pain.
- Salicylates. Similar to aspirin in how they work, salicylates block chemicals in the body that cause us to feel pain.
- Capsaicin. A natural ingredient found in cayenne peppers, capsaicin depletes a neurotransmitter that sends pain messages to the brain.
Never use a topical analgesic with a hot pack—this could cause serious burns.
Nonsteroidal anti-inflammatory drugs (NSAIDs). This class of drugs is considered a staple in treating the pain and inflammation of arthritis.
NSAIDs work by blocking a chemical called prostaglandin, which causes pain and swelling in the body.
Over-the-counter (OTC) NSAIDs include ibuprofen, naproxen sodium and ketoprofen. Prescription NSAIDs include COX-2 inhibitors.
Side effects of OTC NSAIDs include upset stomach and stomach bleeding.
Stomach irritation is less common with COX-2 inhibitors. But all NSAIDs, including COX-2 inhibitors, are associated with an increased risk for hypertension, heart and kidney problems.
The U.S. Food and Drug Administration warns against long-term use of OTC and prescription NSAIDs because of an increased risk of heart attack or stroke. People 65 and older and those with a history of gastrointestinal bleeding or heart disease should talk to their doctor before using these medicines.
Medications for rheumatoid arthritis
Disease-modifying antirheumatic drugs (DMARDs). These drugs relieve pain and swelling by slowing or stopping the immune system's attack on the joints in people with rheumatoid arthritis.
Commonly prescribed DMARDs include methotrexate and hydroxychloroquine.
Frequent blood tests are needed to watch for possible side effects, such as infection.
Biologic response modifiers. Often given in combination with DMARDs, biologic response modifiers also suppress the immune system, blocking specific pathways of the immune system that are responsible for inflammation. They are generally given by injection or intravenous infusion.
Because biologic response modifiers suppress the immune system, they could be problematic for people who are prone to frequent infections, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Research also suggests that some of these drugs may increase the risk of cancers, such as lymphoma—which begins in immune system cells.
Tofacitinib is in a newer class of medicines recently approved to treat RA. It also suppresses the immune system by blocking a specific protein. Tofacitinib, a pill, may be an option for adults who don't have a good response to methotrexate or cannot tolerate its side effects.
Corticosteroids. This class of drugs suppresses the immune system and reduces inflammation.
Commonly used corticosteroids include prednisone, cortisone and hydrocortisone.
Some possible long-term side effects include osteoporosis, high blood pressure and infections.
Medications for osteoarthritis
Injectable glucocorticoids. These are injectable steroids used for moderate to severe pain. The drugs usually provide fast relief because they are injected directly into the affected joint.
Injectable glucocorticoids are recommended as an initial treatment for people who have swelling in a joint but haven't gotten relief from acetaminophen.
Side effects include softening of the cartilage and weakening of tendons near the injection site. Infection at the injection site may also occur in rare cases.
Hyaluronic acid substitutes. Approved for osteoarthritis of the knee, hyaluronic acid substitutes lubricate the joints and can increase movement and provide temporary pain relief. They are similar to a naturally occurring substance called hyaluronic acid. Researchers believe people with osteoarthritis don't make enough of this substance.
Hyaluronic acid substitutes are injected directly into the knee—a procedure called viscosupplementation.
Side effects include a local reaction of pain, warmth and slight swelling immediately after the injection. These symptoms usually don't last long.
Talk with your doctor
Your doctor can help you choose the right medicine to manage arthritis symptoms. Make sure you take all medicines as directed. Report any side effects to your doctor right away.
Reviewed 9/8/2023