Rheumatoid arthritis is a chronic autoimmune condition in which the malfunctioning immune system attacks the body's joints causing pain, swelling, stiffness, decreased range of motion and ultimately degeneration. Combinations of medicines to treat rheumatoid arthritis ease the pain and stiffness. They also strike at the root of the problem by inhibiting the immune system to ease joint inflammation. Like all medicines, there are also associated side effects.
NSAIDs
Non-steroidal anti-inflammatory drugs (NSAIDs) ease pain and reduce inflammation by inhibiting a class of enzymes called cyclooxygenases (COX), but they cannot slow or halt the progression of rheumatoid arthritis. Possible side effects of NSAIDs include stomach upset, confusion, high blood pressure, swelling, decreased blood clotting and kidney malfunction. A more specific type of NSAID called coxibs are easier on the stomach.
Corticosteroids
Corticosteroids reduce inflammation, slow erosion of bone and ease the pain of rheumatoid arthritis. They can be directly injected into a particularly painful joint, or taken as a pill for widespread symptoms. Corticosteroids, however, have serious side effects such as diabetes, high blood pressure and osteoporosis, and they become less effective for rheumatoid arthritis over time. They are often used only until other medications start to take effect.
DMARDs
Disease-modifying antirheumatic drugs (DMARDs) slow the progression of rheumatoid arthritis; according to "Merck Manual," almost everyone with rheumatoid arthritis will take one of these drugs. DMARDs do not ease pain so they are often used in combination with NSAIDs or corticosteroids and other types of drugs to achieve the best outcome.
Methotrexate, hydroxychloroquine and sulfasalazine are commonly prescribed DMARDs. They can take several weeks to have a noticeable effect. They can cause side effects in your eyes (damage to your cornea or retina), liver and kidneys, skin, bone marrow and blood cells. Some of the effects will disappear if you stop taking the drugs but some are permanent.
Immune Modulators
Immune modulators such as azathioprine, cyclosporine and cyclophosphamide are as effective as DMARDs but they have more risk of side effects. Doctors generally do not prescribe these unless DMARDs are not effective, or you have other problems beyond your joints.
Other
TNF-alpha antagonists (infliximab, etanercept) reduce inflammation and stop the erosion of your joints. Not all patients respond to TNF-alpha antagonists, but according to "Merck Manual," those who do often experience a dramatic improvement after just one injection.
Anakinra antagonizes the actions of a receptor for an immune response agent called IL-1. Both anakinra and TNF-alpha can cause infections because of how they suppress the immune system.
