NSAIDS

Non Steroidal Anti-Inflammatory Drugs (or NSAIDS) are medications used to reduce pain and inflammation. Reduced inflammation may take a few days to a few weeks after the patient has begun usage.

Although NSAIDS can be very helpful, the chemicals in the body that work to reduce the inflammation are the same chemicals used in your stomach. As a result, NSAIDS can cause heartburn, indigestion or stomach ulcers. Often, doctors prescribe supplementary medications like antacids along with NSAIDS.

Many drug companies are working to lessen the side effects of NSAIDS but have had little success. The difficulty lies in the fact that in general, the more successful the NSAID is with inflammation, the more stomach problems arise.

NSAIDS can be taken orally (by mouth), by injection, or in the form of suppositories, creams, gels, and foams. However, many people have found the topical solutions to be both less effective and detrimental to the stomach.

There are also some limitations about when NSAIDS can be used. If you are pregnant, breast feeding, have an ulcer, are on a medication that thins your blood, have a tendency towards blood clotting, or are allergic to aspirin or any other NSAID, than these types of medications should not be used.

Common NSAIDS:

Motrin (ibuprofen, advil), Aleve (naprosyn, naproxen), Aspirin, Relafen (nabumetone), Cataflam (diclofenac potassium), Voltaren (diclofenac sodium), Lodine (etodolac), Ansaid (flurbiprofen), Indocin (indomethacin), Mobic (meloxicam), Daypro (oxaprozin), Feldene (piroxicam), Clinoril (sulindac), Tolectin (tolmetin), Celebrex (celecoxib), ketoprofen (orudis)

DMARDS

Disease-modifying Anti-rheumatic Drugs (or DMARDS) are used to control joint pain, inflammation, and disability. They
are frequently taken by RA patients when weaker drugs, such as NSAIDS, prove to be ineffective alone.

NSAIDS and DMARDS typically work together to fight inflammation. NSAIDS work to reduce daily inflammation, while DMARDS aim to minimize the underlying causes of inflammation by interacting with the immune system. However, DMARDS are slow-acting drugs, meaning they are engineered to delay the development of the disease but typically cannot terminate it.

Doctors are unclear how or why DMARDS work. They do know that it can take up to six to eight months for the patient to know whether the medication will be effective. In addition, finding the appropriate medication and dosage can take time.

Continual inflammation can be very harmful to joints. Studies have shown that most of the damage occurs in the first few years. Therefore, DMARDS are now being given to patients much earlier than in the past in order to reduce the amount of long-term damage.

DMARDS are most frequently taken orally but can sometimes be injected. Some side effects can occur such as: mouth sores, nausea, diarrhea, and flu-like symptoms. However, these side effects are usually minimal.

Common DMARDS:

Rheumatrex (methotrexate), Plaquenil (hydroxychloroquine), Sulfasalazine (azulfidine), Arava (leflunomide), Neoral/sandimmune (cyclosporine), Imuran (azathioprine), Gold: Myochrysine (aurothioglucose), Ridaura (auranofin), Penicillamine (cuprimine), Rituxan (rituximab), Cytoxan (cyclophosphamide)

Biologics:

In 1998, a type of drug called biological response modifiers or biologics were released onto the market. They are more advanced than DMARDS because they are designed to target specific problems within the immune system, not the immune system as a whole.

Biologics also work faster than DMARDS. Patients can usually notice decreased pain and inflammation within the first or second injection/ infusion, but significant effects usually occur around 5 weeks. Most often, patients will continue to take the NSAID and/ or corticosteroid (prednisone) previously prescribed.

Unlike other RA drugs, biologics must be given only by injection or by intravenous infusion. Infusions can take up to 2 hours to complete and must be performed in a hospital. Injections can be either self-administered, or given by a partner, friend, or nurse.

In some cases, injections can cause a skin rash that results in a burning or itching sensation near the entry point of the needle. Other disadvantages of biologics are the high cost and unknown long-term side effects. Biologics’ biggest risk, however, is the body’s increased susceptibility to diseases and infections, small and large.

Biologics are typically used when patients are unresponsive to DMARDS. Doctors usually encourage their patients to try methotrexate first, but if it is ineffective or a patient cannot take methotrexate for other medical reasons, than taking a biologic is the next step.

Common Biologics:

Enbrel (etanercept), Remicade (infliximab), Humira (adalimumab), Kineret (anakinra), Orencia (abatacept), and Rituxan (rituximab).

With any medications, it is best to talk with your doctor about which drugs are right for you along with discussion of potential risks.