Metho-what?! Get the low-down on the medicines you're taking...
There are dozens of different arthritis medicines – but don’t worry, you won’t have to take all of them!
There are different types of medicines for different types of arthritis. You may need to take a combination of these to treat your symptoms and the disease itself. Your consultant will decide which are best for you – and if you have problems with them, you can always talk to your rheumatology nurse.
There are a number of basic categories of medicines – each category works in a different way. These are explained below, along with an A-Z of arthritis medicines.
Remember that medicines have a pharmaceutical name and a brand name. Your doctor may talk to you using the pharmaceutical name but the box of medicine may have the brand name more prominently displayed. On Arthursplace.co.uk we refer to the pharmaceutical name, but we often put the brand name in brackets.
The source of the information on this page is Arthritis Research UK, used with kind permission.
Analgesic is another word for painkiller. Paracetamol is a common analgesic. It can be used to treat mild to moderate pain, and is sometimes used in addition to other medicines.
You can buy some analgesics, like paracetamol, over the counter in pharmacies or supermarkets, but as this drug may be part of the chemical make-up of other stronger analgesics it is always advisable to check if you are safe to take paracetamol with your other prescribed medication, to reduce risk of overdose.
Stronger analgesics, such as compound analgesics (for example co-codamol and tramadol) and opioid analgesics, for treating more severe pain, are prescribed by a doctor.
Analgesics shouldn’t be taken in high doses or for long periods of time. If you are requiring analgesics regularly in high doses or for long periods of time, it is advisable to ask your GP or rheumatology doctor to review your symptoms and medication to help you get a better response, and gain greater control of symptoms.
It is also valuable to be mindful that in some situations tablets aren’t always the best answer for pain relief. There are many other options that may help you gain relief, including heat or cold packs, ointments and muscle rubs, TENS machines, and even hydrotherapy and exercise.
It is helpful to gain a little knowledge about types of pain and what options may give effective relief. Your doctor, nurse or physiotherapist may be able to advise other options depending on your symptoms.
Drugs in this group help to reduce pain, stiffness and swelling. There are loads of different NSAIDs but common ones include ibuprofen, naproxen and diclofenac. They have to be taken regularly to get the full effect.
If NSAIDs are to be taken for a length of time some people may benefit from also taking a proton pump inhibitor ( PPI), a drug which reduces stomach acid, to help protect the lining of the stomach. Examples of PPIs are Omeprazole and Lansoprazole.
Following medical advice they may be taken regularly to get the best effect.
These act by altering the underlying disease rather than treating symptoms, which is really clever. They’re not painkillers, but they’ll reduce pain, swelling and stiffness over a period of weeks or months by slowing down the disease and its effects on the joints.
Conventional DMARDs are slow to act and can take several weeks to work, so you need to keep taking them even if they don’t seem to be doing anything at first. As long as you have no side effects you need to keep taking them as prescribed to get the best out of them.
The most common DMARD is methotrexate. You have to take this for a while before it kicks in – but it does reduce inflammation and reduces joint damage. Patients commonly take methotrexate for many years to help protect their joints over the long term.
These are newer drugs which have only been around for the last decade or so. They’re commonly used with patients who don’t respond to methotrexate or similar drugs. They may also be used in combination with conventional DMARDs.
Biological therapies slow down the progress of arthritis and also reduce pain, swelling and stiffness. Common biological therapies include etanercept and infliximab.
Some biological therapies are called anti-TNF drugs. They target a protein called tumour necrosis factor, which increases inflammation when excess amounts are present in the blood or joints. Other biological therapies target different proteins.
Young people with arthritis may benefit on occasion from steroids. Like other drug therapies, this reduces inflammation, pain and stiffness, but it is a short term solution to treat symptoms and doesn’t control the inflammatory process in the way that DMARDs or biologics do.
Steroid tablets (Prednisolone) are sometimes prescribed. A doctor would always advise on how to take them, and if taken for a length of time you may have the dose gradually reduced rather than immediately stopping them, to reduce the risk of a negative reaction, so it is always important to discuss this with your GP so that you are clear on your plan of action. You are often given a patient alert card to carry as a precaution to advise other medical professionals of your medication.
Rather than having tablets, if you have just one or two joints affected, a steroid injection to the localised area may be an alternative that your doctor could consider. To get the best response from this injection you will be advised by your nurse to rest the joint for a period of time. The injection can be done under general anaesthetic for young children, but as you get older you can have the injection with a local anaesthetic. The benefit of this injection, in particular for knees, is that if there is a lot of fluid that is adding to your discomfort it will be drained away quite simply via the one injection. For many this will give some immediate relief.
There is also the option of an injection into a large muscle. This will circulate around the whole body to help settle down several joints. The benefit of this type of injection is that it is not necessary to rest the joint.
Either type of injection can be very effective. The length of time will vary from person to person but for many it can be effective for several months and have few side effects.
Antiemetics are tablets taken to reduce nausea. They can be helpful to reduce side-effects from certain medicines. Metoclopromide is one often prescribed.
This drug is an infusion (given through a drip) used to treat rheumatoid arthritis. It’s a biological therapy which works by stopping the function of a particular cell in the immune system (called a T-cell). This prevents the inflammation and immune activity which cause the symptoms of rheumatoid arthritis.
Adalimumab is used to treat rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, and children with juvenile idiopathic arthritis (JIA). It’s an anti-TNF (anti-tumour necrosis factor) drug, which reduces inflammation.
Amitriptyline is used to treat chronic pain – that’s pain which lasts for a long time – caused by arthritis, spinal problems, fibromyalgia, chronic headaches and peripheral neuropathy (damage to nerve endings in your upper and lower limbs). Depending on the dose prescribed, it can act as an analgesic (a fancy word for painkiller) or an anti-depressant.
Azathioprine is used to treat rheumatoid arthritis. It’s one of those clever drugs called disease-modifying anti-rheumatic drugs (DMARDs). These drugs actually dampen down the underlying disease, rather than simply treating the symptoms.
Ciclosporin is used to treat rheumatoid arthritis, psoriatic arthritis and systemic lupus erythematosus (SLE). It’s a disease-modifying anti-rheumatic drug (DMARD) which targets the underlying disease.
Cyclophosphamide is used to treat several different types of rheumatic disease, including systemic lupus erythematosus (SLE), and diseases where there’s inflammation of blood vessels (vasculitis) or muscles (myositis). Occasionally it’s used for severe rheumatoid arthritis. It’s a powerful disease-modifying anti-rheumatic drug (DMARD).
Etanercept is an injection used to treat rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and juvenile idiopathic arthritis (JIA). It’s a type of drug known as anti-TNF (anti-tumour necrosis factor), which reduces inflammation.
Gold injections (Myocrisin)
Gold injections are used to treat auto-immune conditions such as rheumatoid arthritis and psoriatic arthritis. The drug is made from a compound that contains gold, and it’s a type of disease-modifying anti-rheumatic drug (DMARD).
Golimumab is an injection used to treat rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. It’s an anti-TNF (anti-tumour necrosis factor) drug, which reduces inflammation.
Hydroxychloroquine is used to treat rheumatoid arthritis and lupus. It goes by the trade name Plaquenil and is a type of drug known as a disease-modifying anti-rheumatic drug (DMARD).
Infliximab is an infusion (drip) used to treat rheumatoid arthritis, psoriatic arthritis and occasionally severe ankylosing spondylitis. It’s an anti-TNF (anti-tumour necrosis factor) drug, which reduces inflammation
Leflunomide is used to treat rheumatoid arthritis and other auto-immune diseases. It’s a type of disease-modifying anti-rheumatic drug (DMARD) which targets the disease itself rather than just the symptoms.
Local steroid injections
Steroid injections are used to target inflamed joints that have been affected by different types of arthritis. They give short term relief of sypmtoms but don’t control the disease process.
Methotrexate is used to treat auto-immune conditions such as rheumatoid arthritis, psoriatic arthritis and vasculitis. It’s a type of disease-modifying anti-rheumatic drug (DMARD) which targets the disease itself rather than just the symptoms. Methotrexate is most commonly given as a tablet or injection (Metoject).
Mycophenolate is used to treat lupus and vasculitis. It’s a type of drug known as a disease-modifying anti-rheumatic drug (DMARD). These drugs have the effect of dampening down the underlying disease process, rather than simply treating symptoms.
Sulfasalazine is used to treat rheumatoid arthritis, psoriatic arthritis, reactive arthritis and arthritis associated with bowel inflammation. It’s a type of disease-modifying anti-rheumatic drug (DMARD) which targets the disease itself rather than just the symptoms