Medications for Arthritis

Whether you have osteoarthritis, rheumatoid arthritis (RA), psoriatic arthritis or another of the 100 forms of arthritis and related diseases, you have medicines available to help. They can ease symptoms, slow the disease down and help you live a full and busy life. Some arthritis-related diseases — such as gout, fibromyalgia and osteoporosis — have medicines just for those diseases.

Here is a breakdown to help you sort out what is best for you.

Analgesics

General pain relievers (analgesics) ease mild to moderate pain but don’t do anything for inflammation (hot, swollen joints). Acetaminophen (Tylenol) is available over the counter and is often used for arthritis because it doesn’t hurt your heart and stomach the way nonsteroidal anti-inflammatory agents (NSAIDs) can. But too much can harm your liver so you need to be careful about how much you take. Also watch out for combination products — such as cold, allergy or sleep medicines — that have acetaminophen plus other active ingredients.

Opioids are pain killers that must be prescribed by a doctor. They are very strong and can work well for severe pain. But they do have more side effects than acetaminophen and people can become dependent on them or addicted. Donald Miller, PharmD, a professor in the Department of Pharmacy Practice at North Dakota State University in Fargo, warns they are not much more useful for long-term use than acetaminophen or NSAIDs.

Medicines that contain both acetaminophen and opioids are also available.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

NSAIDs relieve pain and inflammation by blocking hormone-like substances called prostaglandins.

Naproxen (Aleve), aspirin and ibuprofen (Motrin, Advil) are available over the counter. Others like indomethacin (Indocin) and celecoxib (Celebrex) require a prescription.

NSAIDS can increase your chances of having a heart attack, stroke or a stomach bleed.

Corticosteroids

Corticosteroids, sometimes called steroids or glucocorticoids, reduce inflammation by acting like your natural hormone cortisol. They work quickly so are good for short-term relief. But they can create problems like weight gain, cataracts and high blood pressure. If you need to take them for a long time, your doctor will have you take only a small amount each day.

Disease-Modifying Antirheumatic Drugs (DMARDs)

DMARDs are used to slow or stop the inflammation that causes your joints and disease to get worse. Although DMARDs technically refer to drugs used to treat rheumatoid arthritis, they are also an important tool for treating other inflammatory forms of arthritis, including ankylosing spondylitis, psoriatic arthritis, juvenile idiopathic arthritis and lupus. DMARDs weaken your ability to fight germs, so taking them raises your chances for getting infections.

It can take weeks or months for DMARDs to work. One DMARD might not do enough for you, so your doctor may combine two or three at a time. This is called combination therapy.

There are several subsets of DMARDs, including conventional synthetic DMARDs, which are commonly used to treat arthritis, often in pill form, but sometimes as an injectible. Methotrexate is the most well known and most used conventional synthetic DMARD. It is usually the first drug your doctor will give you after you’ve been diagnosed with RA. Two other subsets are biologics and targeted synthetic DMARDs, which include apremilast (Otezla) and three Janus kinase inhibitors — baricitinib (Olumiant), tofacitinib (Xeljanz) and upadacitinib (Rinvoq).

Biologics

Biologics are a special type of DMARD. These powerful drugs work very well for many people with RA and other forms of inflammatory arthritis. They are harder to make than conventional synthetic DMARDs, so they can cost more than many of the medicines you may take. Some come as a shot that you give yourself and some are given in the doctor’s office through an IV (intravenous infusion). They weaken your ability to fight germs, so you may be more vulnerable to infections while taking biologics.

One biologic may work very well for some people, but not for others. A biologic may work for you at first, but then stop working after a while. If the first one you try doesn’t work for you, your doctor has other options.

There are different types of biologics. Each works in a different way to stop or slow the disease process.

• Anti-TNFs. Also called TNF inhibitors or TNF blockers, they block tumor necrosis factor, an inflammatory protein, or “cytokine.”
• Interleukin inhibitors. Interleukins are types of cytokines that facilitate communication between cells and play a role in activating parts of the immune system. Different biologics target different interleukins (IL-1, IL-6, IL-17, IL-12 and IL-23) to disrupt the inflammatory process at the root of inflammatory arthritis.
• B-cell inhibitors. These maybe used to treat rheumatoid arthritis when other treatments don’t have the desired effect.
• Selective Costimulation modulators. These bind to certain cells, inhibiting the inflammatory process. Like B-cell inhibitors, they are usually used if TNF inhibitors and other options are not adequately effective.

Targeted DMARDs

Unlike conventional synthetic DMARDs that slow your disease by holding down your body’s whole immune system, the newer targeted synthetic DMARDs (also known as small molecule DMARDs) have more specific targets in the immune system. Unlike biologics (which have large molecules), these medicines are taken by mouth.

• Janus kinase (JAK) inhibitors: Several of these are now approved for either RA and/or PsA and juvenile idiopathic arthritis. Your doctor may recommend one of these if other options are inadequate.
• Phosphodiesterase 4 (PDE 4) inhibitors: Unlike other DMARDs, this medicine doesn’t increase your chance of getting a serious infection.

Reviewed April 21, 2021