Medicines for inflammatory arthritis are used to relieve pain, reduce swelling and slow or stop joint damage. Each person responds differently to arthritis medicines. This means you need to work with your rheumatologist (a doctor who specialises in arthritis and related conditions) to identify the treatment that works best for you.
Your GP will probably monitor your treatment and refer you back to a rheumatologist if necessary.
Common medicines for rheumatoid arthritis include:
Disease-modifying anti-rheumatic drugs (DMARDs)
These medicines change the underlying condition rather than just treating the symptoms. They slow down the disease and its effects on your joints.
DMARDs should be started as early as possible after inflammatory arthritis has been diagnosed. They can only be started by a rheumatologist and you will need to have regular blood and urine tests to look for possible side effects and assess how well the medicine is working.
There are 2 main groups of DMARDs – conventional DMARDs and biological therapies.
- Conventional DMARDs include methotrexate, hydroxychloroquine, sulfasalazine, leflunomide and azathioprine. Most people are started on methotrexate because it is often the most effective and is well studied. It may take 2–6 months of treatment before the medicine is fully effective.
- Biological therapies, also called biologics, include tumour necrosis factor (TNF) inhibitors (infliximab, adalimumab, etanercept), rituximab, tocilizumab and secukinumab. They can be used if other treatments haven't worked well, and are usually used in combination with other DMARDs. See Biologics (TNF Inhibitors).
Pain relief medicines
Pain relief medicines such as paracetamol and codeine are often used along with other medication.
Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDs such as ibuprofen, diclofenac and naproxen reduce inflammation and swelling of your joints. They start working quickly and relieve pain and swelling but do not reduce damage to your joints.
Taking NSAIDs is safe, but extra care is needed if you have high blood pressure, high cholesterol, diabetes, stomach ulcers, kidney problems or if you smoke.
Corticosteroids (also called steroids)
Corticosteroids are used at the start of treatment to reduce the pain and swelling of your joints, while waiting for other medicines to take effect. They may also be used to treat sudden flare-ups.
You may take these as tablets, such as prednisone, or as injections directly into the joint or into a muscle or vein.
Important to know
If you take an ACE inhibitor or angiotensin II receptor blocker (ARB) (for example, cilazapril, enalapril, quinapril, losartan or candesartan) and a diuretic (for example, furosemide or bendroflumethiazide), taking a non-steroidal anti-inflammatory drug (NSAID) (for example ibuprofen or aspirin in high doses) could harm your kidneys. The term for this is "triple whammy". Read The Triple Whammy – Safe use of NSAIDs(external link) for more details. Check with your doctor, practice nurse or pharmacist if you're not sure if you're taking an ACE inhibitor or angiotensin II receptor blocker (ARB) and a diuretic.