Various Medications For Arthritis

Various Medications For Arthritis

There are several types of medications that alleviate the symptoms of arthritis, prevent further damage to joints, and improve function and mobility. The five main classes of medications used in arthritis are: (1) Nonsteroidal anti-inflammatory drugs (NSAIDs), (2) Analgesics (painkillers), (3) Corticosteroids (or simply called steroids), (4) Disease-modifying antirheumatic drugs (DMARDs), and (5) Biologic response modifiers (or biologics). Biologics are the newer forms of treatment for arthritis.
Various Medications For Arthritis


Medications For Arthritis

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

NSAIDs relieve pain, fever and inflammation. They do this by preventing the synthesis of prostaglandin, a chemical which is released when cells are damaged and is responsible for the symptoms of arthritis.

In general, they provide only symptomatic relief from pain and inflammation associated with arthritis, and do not arrest the progression of the disease. They fall into 3 subgroups: salicylates, traditional NSAIDs and selective COX-2 inhibitors.


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Salicylates

These include aspirin and diflunisal. They are best taken with food or antacid.

Aspirin (acetylsalicylic acid)

The dose is 325 to 650 mg every 4-6 hrs. The main side effects are allergy, abdominal cramps or discomfort, nausea and vomiting, stomach ulcers and bleeding.

Diflunisal

It is 4 to 5 times more potent than aspirin and has fewer side effects than aspirin. The dose is 250 to 500 mg every 8-12 hrs.

Traditional NSAIDs

Various Medications For Arthritis This group includes nearly 20 drugs. You should choose that drug to which you are responsive as there are individual differences. The dosage varies from drug to drug. They are best taken with food or antacid. Their side effects can be abdominal cramps, stomach upset, nausea and vomiting, ringing in the ears and gastrointestinal bleeding.

Examples of these drugs are diclofenac, etodolac, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, mefenamic acid, meloxicam, nabumetone, naproxen, oxaprozin, piroxicam, sulindac, and tolmetin.

Selective COX-2 Inhibitors

These drugs have fewer side effects compared to salicylates and traditional NSAIDs. Celecoxib and valdecoxib are the drugs being used. Parecoxib, etoricoxib and lumiracoxib have not been approved in most countries due to their unacceptable side effect profile.

Celecoxib

The dose is 100 to 200 mg twice a day. It should not be taken in advanced pregnancy. It can cause acid reflux, abdominal pain, stomach upset, nausea and vomiting.

Valdecoxib

Its dosage is 20 mg twice per day. Those who are elderly or have liver impairment should exercise caution in taking this drug.


Analgesics (Painkillers)

As the name suggests, these mainly relieve pain, and have almost no anti-inflammatory activity in contrast to NSAIDs. They are preferred in patients who cannot take NSAIDs due to stomach problems or allergies. Acetaminophen is prescribed most commonly.

Acetaminophen

Various Medications For Arthritis This is a very safe drug with hardly any side effects. This may be used as a first-line option in arthritis. It can be taken in combination with NSAIDs or narcotic analgesics.

The dose is 500 to 1000 mg every 6 hrs on an as needed basis, but you should not exceed 3000 mg per day. Combining it with alcohol use can cause liver failure.

Narcotic Analgesics

These are generally reserved for more intense pain. They can cause constipation, lightheadedness, dizziness, drowsiness, mental confusion, nausea and vomiting, and urinary retention. Exercise caution while driving because these drugs can impair the ability to do so. The drugs in this group are – buprenorphine, codeine, hydrocodone, methadone, morphine, oxycodone, oxymorphone and tramadol.


Corticosteroids (Steroids)

Various Medications For Arthritis Corticosteroids reduce the inflammation and swelling associated with arthritis. They are sometimes used along with disease-modifying antirheumatic drugs but usually not with biologic response modifiers. They are usually administered orally and sometimes in the form of injection, either into a vein or directly into the joint.

They are usually taken with food. They should not be stopped abruptly and must be tapered gradually. Some of their side effects are raised fat and sugar levels in blood, hardening of arteries, increased appetite, weight gain, ulcers, muscle weakness, decreased bone mass (osteoporosis), susceptibility to infections due to decreased immunity, thinning of skin, mood swings, insomnia and cataracts. The steroids in use are cortisone, dexamethasone, hydrocortisone, methylprednisolone, prednisolone and prednisone.


Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

Various Medications For Arthritis DMARDs are slow acting, taking weeks to months for the onset of their action. Hence, they are often combined with an NSAID or a corticosteroid. DMARDs can halt the progression of disease and consequent joint damage. They also suppress the immune system, so you are prone to infection. Some of the DMARDs in use are as follows.

Auranofin (Gold)

Dose is 6-9 mg/day in 1 or 2 divided doses. It should be taken with food or a glass of water or milk. Side effects are metallic taste, diarrhea, itching, ulcers, skin rash and sensitivity to sunlight.

Azathioprine

Dose is 50-150 mg per day in 1-3 doses. It should be taken with food. Chills, fever, loss of appetite, vomiting, weakness and liver problems are the side effects.

Chlorambucil and Cyclophosphamide

These drugs are best avoided as they are highly toxic. They should be reserved as a last resort in arthritis not responding to other drugs.

Cyclosporine

The dose is 2.5-4 mg/kg body wt/day in 2 doses. Loss of appetite, nausea, abdominal pain, inflammation of gums, increased blood pressure, numbness and tingling, and kidney problems are the side effects.

Hydroxychloroquine

Dose is 200-600 mg per day in 1-2 doses. It should be taken with milk or food. It can cause blurred vision, loss of appetite, nausea and vomiting, abdominal cramps, rash and sensitivity to sunlight.

Leflunomide

Dose is 10-20 mg daily. Headache, dizziness, hair loss, heartburn, high blood pressure, rash and liver problems are some of the side effects. Avoid in pregnancy as it can harm the fetus.

Methotrexate

It is taken only once a week. Dose is 7.5-20 mg. It should be taken with plenty of fluids. Abdominal discomfort, nausea, sensitivity to sunlight, headache, hair loss, rash, dizziness, itching and liver problems are some of the side effects.

Minocycline

Dose is 200 mg/day in 2-4 doses. It is taken on empty stomach with plenty of fluids. Nausea, vomiting, diarrhea, and stomach ulcers and bleeding are the side effects.

Mycophenolate mofetil

Dose is 500-2000 mg/day in 1-2 doses. Pregnant women should not take the drug because it can harm the fetus. Other side effects are diarrhea, sensitivity to sunlight, stomach ulcers and bleeding.

Sulfasalazine

Dose is 500-3000 mg/day in 2-4 doses. It is taken with food. Abdominal discomfort, joint pains, diarrhea, headache, itching, nausea and vomiting, rash and sensitivity to sunlight are some side effects.


Biologic Response Modifiers (Biologics)

Various Medications For Arthritis Biologic response modifiers are genetically modified medications derived from viruses, proteins or genes. While all biologics reduce the inflammation, they do so by different mechanisms. Some inhibit the production of chemicals like TNF-alpha or interleukin-1, and others work by reducing the production of white blood cells called B and T cells.

Biologics are often used in combination with DMARDs. The biologics in use are adalimumab, certolizumab, etanercept, golimumab, infliximab, belimumab, rituximab, anakinra, abatacept and tocilizumab. Almost all these drugs are given by injection. They are expensive drugs because most are under patent protection at present.

Photo Credit: http://www.orthopaedics.com.sg/conditions/joint-arthritis/psoriatic-arthritis

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