The 5 Main Classes of Arthritis Drugs

An Overview of Everything From Acetaminophen to Norco

Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s immune system mistakenly attacks joints, causing inflammation of the synovium—the tissue that lines the inside of joints. The pain and swelling that result can be severe and debilitating. Fortunately, there are a variety of medications for treating inflammation caused by RA and relieving the discomfort it causes. Here's an overview of the five main classes of drugs used for RA and the role each can play in treating this painful joint disease.

Non-Steroidal Anti-Inflammatory Drugs

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Nonsteroidal anti-inflammatory drugs, commonly referred to as NSAIDs, are a large group of drugs primarily prescribed to reduce inflammation, pain, and fever.

They work by preventing an enzyme called cyclooxygenase (COX) from making prostaglandins— hormone-like chemicals involved in inflammation. COX-1 and COX-2 are the two types of these enzymes. Traditional NSAIDs, such as aspirinnaproxen, and ibuprofen block both COX-1 and COX-2. Newer NSAIDs, such as Celebrex (celecoxib), block only COX-2 and were developed because COX-1 is known to have a beneficial effect of protecting the stomach lining.

Although most NSAIDS require a prescription, certain ones are available over the counter in a reduced strength, such as Advil (ibuprofen) and Aleve (naproxen).

Analgesics

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Analgesics are medications that relieve pain. They often are referred to as pain medications or painkillers. This class of drugs includes non-narcotic analgesics such as Tylenol (acetaminophen) as well as opioid narcotics such as hydrocodone. An opioid narcotic called Ultram (tramadol) is thought to have a lower risk of becoming addictive than other opioid narcotics.

Acetaminophen is available over the counter, as well as by prescription combined with opioid narcotics. Vicodin, Lortab, and Norco are brand names of medications that contain both hydrocodone and acetaminophen.

Corticosteroids

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Corticosteroids, also called glucocorticoids, are synthetic drugs that mimic the effects of cortisol, a hormone naturally produced by the adrenal gland that affects several functions in the body, including the immune system. Cortisol has the ability to quickly control inflammation by decreasing levels of prostaglandins as well as inflammatory cytokines.

Corticosteroids such as prednisone have a similar effect on inflammation. It's important to note that despite their benefits, corticosteroids have the potential for undesirable side effects such as increased appetite, weight gain, fluid retention, and high blood pressure—especially if they're taken for a long period of time or at a high dose. If your doctor puts you on a corticosteroid, it's important to take it exactly as prescribed.

Disease-modifying Anti-rheumatic Drugs

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 Disease-modifying anti-rheumatic drugs (DMARDs) are slow-acting medications that work behind the scenes to slow progression of rheumatoid arthritis and reduce the risk of permanent joint damage.

The most commonly prescribed DMARD is methotrexate (sold under the brand names Rheumatrex and Trexall). Other DMARDs include Plaquenil (hydroxychloroquine), Arava (leflunomide), Azulfidine (sulfasalazine), and Otrexup, a single-dose injectable form of methotrexate.

As with all drugs, it is important to be aware of possible side effects. If you notice anything of concern, consult your doctor. You will also have blood tests periodically to monitor your liver enzymes while treated with a DMARD.

Small molecule DMARD including JAK inhibitors are among the newer options. Xeljanz (tofacitinib) is one of these. It works by inhibiting the JAK pathway inside cells that plays a significant role in inflammation associated with rheumatoid arthritis.

Biologics

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Biologics, short for biologic response modifiers, are the newest type of DMARD. They're genetically engineered from a living organism to provoke a particular response. In other words, biologics target a specific protein or cell that's associated with symptoms and joint damage caused by inflammatory types of arthritis. Most biologics are self-injectable, but some are given intravenously (through a needle into a vein). 

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