An Overview of Arthritis Medications

Arthritis medications have long been considered the "traditional" treatment option. Since individual response to drugs can vary and because potential side effects and adverse reactions are also a factor, finding the most effective combination of arthritis medications can be a more difficult process than you might expect. You should become knowledgeable about various arthritis medications so that you can make an informed decision with your doctor.

NSAIDs (nonsteroidal anti-inflammatory drugs) are among the most commonly prescribed and widely used arthritis drugs. There are three types of NSAIDs: salicylates (both acetylated [e.g., aspirin] and non-acetylated [e.g., Disalcid {salsalate}]), Trilisate (choline magnesium trisalicylate), and Doan's Pills or Novasal (magnesium salicylate); the traditional NSAIDs; and COX-2 selective inhibitors. NSAIDs work by blocking the activity of the enzyme, cyclooxygenase, also known as COX. Research has revealed that there are two forms of cyclooxygenase, known as COX-1 and COX-2. NSAIDs affect both forms. COX-1 is involved in maintaining healthy tissue, while COX-2 is involved in the inflammation pathway. COX-2 selective inhibitors became a subset of NSAIDs—with Celebrex (celecoxib) being the first to be FDA-approved in the late 1990s.

Traditional NSAIDs include:

• Ansaid (flurbiprofen)
• Arthrotec (diclofenac/misoprostol)
• Cataflam (diclofenac potassium)
• Clinoril (sulindac)
• Daypro (oxaprozin)
• Dolobid (diflunisal)
• Feldene (piroxicam)
• Ibuprofen (brand Motrin, Advil)
• Indocin (indomethacin)
• Ketoprofen (brand Orudis, Oruvail)
• Lodine (etodolac)
• Meclomen (meclofenamate)
• Mobic (meloxicam)
• Nalfon (fenoprofen)
• Naproxen (brand Naprosyn, Aleve)
• Ponstel (mefenamic acid)
• Relafen (nabumetone)
• Tolectin (tolmetin)
• Vimovo (naproxen-esomeprazole)
• Voltaren (diclofenac sodium)

COX-2 Inhibitors include:

• Celebrex (celecoxib)

DMARDs (disease-modifying anti-rheumatic drugs) are also referred to as "slow-acting anti-rheumatic drugs" because they typically take weeks or months to work and "second-line agents." Research has confirmed the effectiveness of DMARDs in the treatment of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis as well as the importance of early, aggressive treatment using DMARDs. The goal of being treated with DMARDs is to stop disease progression and halt joint damage.

DMARDs include:

• Arava (leflunomide)
• Auranofin (brand Ridaura, Oral Gold) and Myochrysine (Injectable Gold)
• Azulfidine (sulfasalazine)
• CellCept (mycophenolate)
• Cyclosporine (brand Neoral, Sandimmune)
• Cytoxan (cyclophosphamide)
• Imuran (azathioprine)
• Leukeran (chlorambucil)
• Methotrexate (brand Rheumatrex, Trexall)
• Minocin (minocycline)
• Penicillamine (brand Cuprimine, Depen)
• Plaquenil (hydroxychloroquine)

Xeljanz (tofacitinib citrate), an oral DMARD, was approved by the FDA on Nov. 6, 2012, to treat adults with moderately active to severely active rheumatoid arthritis who have had an inadequate response, or intolerance, to methotrexate. Xeljanz is the first in a class of drugs known as JAK (Janus kinase) inhibitors.

Corticosteroids or glucocorticoids, often called "steroids," are potent drugs which can reduce swelling and inflammation quickly. These drugs are closely related to cortisol, a hormone produced by the cortex of the adrenal glands. They are prescribed in widely varying doses depending on the condition and goal of treatment. While steroids may be used to control inflammation of the joints and organs in inflammatory diseases, such as rheumatoid arthritis, lupus, polymyalgia rheumatica, and vasculitis, it has been determined that the potential for serious side effects increases at high doses or with long-term use. Doctors may prescribe short-term, high-dose intravenous steroids in some situations, or your doctor can administer a local steroid injection into a specific joint, such as Kenalog (triamcinolone), to help you get some relief from pain and inflammation.

Corticosteroids include:

• betamethasone (brand Celestone)
• cortisone (brand Cortone)
• dexamethasone (brand Decadron)
• hydrocortisone (brand Cortef)
• methylprednisolone (brand Medrol)
• prednisolone (brand Prelone)
• prednisone (brand Deltasone)

Analgesics are pain-relieving drugs. Controlling pain is a vital part of treating arthritis. However, unlike NSAIDs, analgesic medications do not relieve inflammation. Acetaminophen (Tylenol) is the most commonly used analgesic. Narcotic analgesic drugs may also be prescribed for more severe pain.

Narcotics include:

• Codeine (Tylenol #3)
• Duragesic (Fentanyl Skin Patch)
• Hydromorphone (Palladone) - no longer on market
• MS Contin (morphine sulfate)
• OxyContin (oxycodone)
• Percocet (oxycodone/acetaminophen)
• Percodan (oxycodone/aspirin)
• Talwin NX (pentazocine/naloxone)
• Ultracet (tramadol/acetaminophen)
• Ultram (tramadol)
• Vicodin (hydrocodone/acetaminophen)

Biologic Response Modifiers (BRMs), more commonly referred to as biologics, stimulate or restore the ability of the immune system to fight disease or infection. Biologics are drugs derived from living sources as opposed to being synthesized chemicals.

Enbrel (etanercept), Remicade infliximab), Humira (adalimumab), Cimzia (certolizumab pegol), and Simponi (golimumab) target TNF-alpha, one of the most important cytokines involved in rheumatoid arthritis. TNF blockers (biologic drugs that bind to TNF-alpha) render it inactive, thereby interfering with inflammatory activity and ultimately decreasing joint damage.

Kineret (anakinra), also a biologic drug, is an IL-1 antagonist. Kineret was the first selective blocker of interleukin-1 (IL-1), a protein that is found in excess in some people with rheumatoid arthritis. By blocking IL-1, Kineret inhibits inflammation and pain associated with rheumatoid arthritis. Kineret can be used alone, or in combination with other DMARDs, except anti-TNF drugs. While Kineret is an option, it rarely is prescribed.

Orencia (abatacept) was the first T-cell co-stimulation modulator to be approved for the treatment of rheumatoid arthritis.

Rituxan (rituximab), the world's best-selling cancer drug, was FDA approved in March 2006 to be used in combination with methotrexate to treat rheumatoid arthritis by reducing the signs and symptoms in adults who have moderately-to-severely active rheumatoid arthritis and have failed one or more anti-TNF drugs. Rituxan is the first treatment for rheumatoid arthritis that selectively targets the CD20-positive B-cells.

Actemra (tocilizumab) is a monoclonal antibody that inhibits the interleukin-6 (IL-6) receptor, thereby blocking interleukin-6. Actemra was approved by the FDA on Jan. 8, 2010 for the treatment of adult rheumatoid arthritis in people who have failed one or more TNF blockers.

Until 2007, there were no drugs approved by the FDA for the treatment of fibromyalgia. Doctors treated fibromyalgia with a variety of drugs developed and approved for other indications. In 2007, Lyrica (pregabalin) was approved to treat fibromyalgia. In 2008, Cymbalta (duloxetine HCl) was approved for fibromyalgia. In 2009, Savella (milnacipran HCl) was approved for the condition.

Gout is one of the most acutely painful forms of arthritis. It can be managed with medication, diet, and lifestyle changes. There are three aspects of gout treatment with medication: analgesics, anti-inflammatory medications, and drugs to manage uric acid levels and gout attacks.

Drugs for gout include:

• Acetaminophen (Tylenol), or other analgesic painkillers, for pain relief
• NSAIDs (nonsteroidal anti-inflammatory drugs), usually Indocin (indomethacin), for inflammation
• Colchicine, to prevent or relieve gout attacks
• Corticosteroids, for quick anti-inflammatory response
• Probenecid (Benemid, Probalan), to decrease uric acid blood levels
• ColBenemid (Col-Probenecid and Proben-C) has anti-gout properties
• Allopurinol (zyloprim), to lower blood uric acid by preventing uric acid production
• Losartan (Cozaar, Hyzaar), not specifically a gout drug, but is an anti-hypertensive drug that may help control uric acid levels
• Fenofibrate (Tricor), not a specific gout drug, but is a lipid-lowering drug that may help uric acid levels
• Uloric (febuxostat), lowers serum uric acid levels by blocking xanthine oxidase
• Krystexxa (pegloticase), a biologic drug that works by breaking down uric acid

Osteoporosis is a condition characterized by porous, brittle bones, which is most common to the elderly, but also may be problematic for people who have taken corticosteroids (steroids) longterm. There are several categories of drug options for osteoporosis: estrogens, parathyroid hormones, bone formation agents, bisphosphonates, and selective receptor molecules. Depending on which drug is used, you can slow bone loss, promote bone growth, and reduce the risk of fractures.

Drugs for osteoporosis include:

• Actonel (risedronate)
• Boniva (ibandronate)
• Didronel (etidronate)
• Estrogens (hormone therapy)
• Evista (raloxifene)
• Forteo (teriparatide)
• Fosamax (alendronate)
• Miacalcin (calcitonin)
• Reclast (zoledronic acid)
• Prolia (denosumab)

The underlying goals of treating arthritis and rheumatic diseases with medication include controlling pain, decreasing inflammation, slowing progression of the disease, and managing disease activity. There are many types of arthritis and many drugs in each drug class. That makes choosing a treatment regimen somewhat complicated. Deciding which medication or combination of medications is right for you can be daunting. It likely will take trial and error—and you will keep trying until you feel you have achieved an adequate response. Verywell has compiled the facts you need to know about arthritis medications. The information Verywell has provided will help you understand why you are taking the medication you are taking and will help you formulate questions for your doctor.