Non-Steroid anti-inflammatory drugs (NSAIDs)  

The first drug in this group was aspirin, which used to be given in very large doses to treat arthritis (10-20 tablets a day). There are now about 20 drugs of this kind available. They reduce pain and swelling and start working within a few hours. The effect of some will only last a few hours but others are effective all day.

These drugs can cause indigestion that on occasions can cause bleeding from the stomach.

Disease modifying anti-rheumatic drugs (DMARDs)

As their name suggests, these drugs do not treat the symptoms of rheumatoid arthritis but reduce the effects of the disease itself. They do improve symptoms over time, but they are not painkillers - they only reduce pain and stiffness by reducing the underlying rheumatoid process in the joints. They also appear to slow down the effects of the disease on the joints, especially if they are taken early in the course of the disease.

A few of the more commonly used ones are listed below:

• Sulphasalazine
• Gold (injections)
• Penicillamine
• Methotrexate
• Azathioprine
• Leflunomide

Biological Therapies

The most recently introduced disease-modifying treatments for rheumatoid arthritis are known as biological therapies. This name is used because they have been developed through an increasing understanding of the processes in the body, which lead to inflammation and damage in joints. This knowledge has enabled scientists to develop drugs that target individual molecules, which are involved in these processes. This has led to some new and very effective treatments for rheumatoid arthritis.

Anti- TNF drugs

These drugs target a substance called TNF that has a key role in the complicated process of inflammation. The drugs are sometimes referred to as “anti-TNF” therapies. Examples of this type of biological therapy are listed below:

Infliximab (given by intravenous “drip”)

Etanercept

These are both new drugs, so many long-term side effects are not yet known. In some people these drugs have proved very effective in improving their arthritis and in producing a feeling of well-being. Other anti -TNF therapies are due to become available in the next few years. A drug called adalimumab was introduced in 2003.

Anti-IL- 1 drugs

These drugs work in a different way from the anti-TNF drugs in that they inhibit one of the messenger substances in the body called interleukin-1 (IL-1).

An example of this type of biological therapy is:

Anakinra (given by daily injection under the skin)

Corticosteroids

Corticosteroids are often called “steroids” for short. They are not the same as the “steroids” used by athletes to build up their bodies properly known as “anabolic steroids”. Corticosteroids (steroids) have a very powerful effect on inflammation, reducing it more than any other drug used. There are quite a lot of side effects if high- dose steroids are given for long periods of time, and these can cause problems such as osteoporosis.

Used properly, steroids can be a very valuable treatment for rheumatoid arthritis and can help to control the symptoms of the disease.

New medication

In August 2007, the National Institute for Clinical Excellence, (NICE) approved 2 new drugs called Rituximab (MabThera) and Abatacept (Orencia) for NHS use in the treatment of Rheumatoid Arthritis. These drugs are most likely to be prescribed by a hospital Consultant.

Rituximab or Abatacept in combination with methotrexate is recommended as an option for the treatment of adults with severe active rheumatoid arthritis who have had an inadequate response to or intolerance of other disease-modifying anti-rheumatic drugs (DMARDs).