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Medicines to treat rheumatoid arthritis

Key points about medicines for rheumatoid arthritis

Medicines for rheumatoid arthritis (RA) are used to relieve pain, reduce swelling and slow or stop joint damage.
Each person responds differently to arthritis medicines.
Find out how to take medicines for rheumatoid arthritis safely and possible side effects.

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Medicines for rheumatoid arthritis (RA) 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. You may need to try different treatments before finding the one that is right for you.

Common medicines for rheumatoid arthritis include:

Disease-modifying anti-rheumatic drugs (DMARDs)
Pain relief medicines (paracetamol and codeine)
Non-steroidal anti-inflammatory drugs (NSAIDs)
Corticosteroids (also called steroids)

These medicines change the underlying condition rather than just treating the symptoms. They slow down the disease and its effects on your joints.

DMARDs are most effective when started early on in the disease.
They start working gradually over a few weeks to months.
While taking DMARDs you will need to have regular blood and urine (pee) 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.

Types of DMARDS
Conventional DMARDs include methotrexate, hydroxychloroquine, sulfasalazine, leflunomide and azathioprine. The choice of medicine depends on you and your illness. Your specialist will discuss the choices so you get the medicine best suited for you. Most people are started on methotrexate. It is often the most effective and is well studied. Some people are only prescribed one DMARD. Others try several before one or more are found to suit. Your doctor will advise if it is better for you to take 1 or 2 DMARDs and what dose to take. It may take 2–6 months of treatment for a full response. If you don't get a good enough response from the first DMARD/s, new DMARDS are generally added to your treatment.
Biological therapies include TNF inhibitors (infliximab, adalimumab, etanercept), rituximab and tocilizumab. These are also called biologics. They can be used if other treatments have not worked well, but they don’t work for everyone. Mostly they are used in combination with other DMARDs. In New Zealand, TNF inhibitors are funded with restrictions (PHARMAC subsidy restrictions). To qualify for subsidy, the initial application for treatment must come from a specialist rheumatologist.

Types of DMARDS

Conventional DMARDs include methotrexate, hydroxychloroquine, sulfasalazine, leflunomide and azathioprine.

The choice of medicine depends on you and your illness.
Your specialist will discuss the choices so you get the medicine best suited for you.
Most people are started on methotrexate. It is often the most effective and is well studied.
Some people are only prescribed one DMARD. Others try several before one or more are found to suit.
Your doctor will advise if it is better for you to take 1 or 2 DMARDs and what dose to take.
It may take 2–6 months of treatment for a full response.
If you don't get a good enough response from the first DMARD/s, new DMARDS are generally added to your treatment.

Biological therapies include TNF inhibitors (infliximab, adalimumab, etanercept), rituximab and tocilizumab.

These are also called biologics.
They can be used if other treatments have not worked well, but they don’t work for everyone.
Mostly they are used in combination with other DMARDs.
In New Zealand, TNF inhibitors are funded with restrictions (PHARMAC subsidy restrictions). To qualify for subsidy, the initial application for treatment must come from a specialist rheumatologist.

Examples of pain relief medicines include paracetamol and codeine. They are used to relieve pain but do not treat rheumatoid arthritis. They are often used with other medication and are generally used until an effective DMARD is found.

Examples of NSAIDs include ibuprofen, diclofenac and naproxen. These medicines reduce inflammation and swelling of your joints. They start working quickly. They relieve pain and swelling but do not reduce damage to your joints.

For most people, taking NSAIDs is safe. However, extra care is needed if you have high blood pressure, high cholesterol, diabetes, stomach ulcers, kidney problems or if you smoke. Discuss with your doctor whether taking NSAIDs is suitable for you. NSAIDs should be used until an effective DMARD is found and then the dose reduced or stopped if possible.

Read more about the safe use of NSAIDs.

Corticosteroids are used at the start of treatment to reduce the pain and swelling of your joints, while waiting for other medication to take effect. They may also be used to treat sudden flare-ups but are not usually needed after the flare-up has settled. These may be given as tablets, such as prednisone, or as injections directly into the joint itself or into a muscle or vein.

Read more about prednisone and cortisone injections (into joints).

Rheumatoid arthritis | Mate rumatiki

The following links provide further information about managing your pain when you have arthritis. Be aware that websites from other countries may have information that differs from New Zealand recommendations.

Managing your pain (English)(external link) Arthritis NZ
Managing your pain (Hindi)(external link) Arthritis NZ

The following links provide further information about medicines for arthritis. Be aware that websites from other countries may have information that differs from New Zealand recommendations.
Adalimumab(external link) Azathioprine(external link) Cyclophosphamide(external link) Ciclosporin(external link) Etanercept(external link) Hydroxychloroquine(external link)	Leflunomide(external link) Methotrexate(external link) NSAIDs(external link) Rituximab(external link) Sulfasalazine(external link) Tocilizumab(external link)