Medicines Discover more about the different kinds of medication available to people suffering from arthritis

In this article

Pain-relieving medicines (analgesics) Anti-inflammatory medicines Disease-modifying medicines

Biologic response modifiers Using medicines carefully

Side-effects Medicines and pregnancy

If you have arthritis, your family doctor or hospital doctor is likely to prescribe medication to help relieve the pain and discomfort and reduce future damage. Always follow the doctor's or pharmacist's instructions, as written on the medicine label.

There are four main types of medicine used to treat arthritis.

The best-known pain-relieving medicines are:

• aspirin
• paracetemol
• ibuprofen

Strictly speaking, aspirin and ibuprofen are anti-inflammatory medicines (see below), but in small doses they have pain-killing qualities. Analgesic tablets and gels are available over the counter at chemists without a prescription. You should talk to your doctor before using them for your arthritis. You may be prescribed stronger versions of these medicines, or medicines such as codeine or diamorphine that block pain signals to the brain.

These can reduce inflammation as well as pain and so lessen the damage done to joints. There are two types:

• Non-steroidal anti-inflammatory drugs (NSAIDs) - these are the most commonly prescribed arthritis medicines. They usually need to be taken over a long period to have any effect, but continued use can also cause stomach problems. Common NSAIDs include: ibuprofen, indomethacin, naproxen, fenbufen, piroxicam and diclofenac. A new type of NSAIDs, called Cox-2 inhibitors, and are recommended to treat some types of arthritis, for example, osteoarthritis.
• Steroids - steroids such as cortisone are manufactured versions of the body's natural hormones. They can be very effective in reducing inflammation, but can cause side-effects if taken long term, so they're usually used to bring severe arthritis under control before using other treatments.

These medicines (known as disease-modifying antirheumatic drugs or DMARDs) are used for types of arthritis that involve problems with the immune system, such as rheumatoid arthritis and juvenile idiopathic arthritis. They act on the immune system itself rather than the symptoms of the disease. Some are taken by mouth, some by injection.

Types of disease-modifying medicines include: methotrexate, sulfasalazine, gold (sodium aurothiomalate), penicillamine and azathioprine.

Biologic response modifiers (or BRMS) are a new class of drug once reserved for only very severe rheumatoid arthritis but now increasingly used in early disease because they can be so effective in preventing the long term damage to the joints. Many people find their rheumatoid arthritis responds very well to biologicals, as they are known, but they don't suit everyone.

BRMs inhibit proteins called cytokines which are the chemical messengers of inflammation in the body. Different BRMs target different messengers. For example etanercept, infliximab and adalimumab block an important chemical called tumor necrosis factor-alpha (TNF-α) while anakinra blocks interleukin-1.

Unfortunately these drugs are expensive, and must be given as an injection or infusion.

Some of the worry can be taken out of using new medicines if you know exactly what they are and how they should be used. When your doctor prescribes you a medicine, you should be absolutely clear about:

• what it is and how it should help
• how much to take, how often and when
• whether there are special circumstances for taking it - for example, after meals
• whether it will act immediately or only after some time
• if there are any side-effects and what to do if they occur
• whether it's all right to take it with other medication you have been prescribed
• whether you should avoid alcohol or activities such as driving when taking it

You may like to check whether your doctor has a medicine information sheet. If not, you can ask your pharmacist or contact Arthritis Care on 0808 800 4050 (Monday to Friday, 12pm to 4pm).

All medicines produce side-effects. Reactions vary hugely from person to person and medicine to medicine. Many people taking arthritis medicines do report side-effects, but they are usually minor - the odd stomach pain, for example. On the other hand, arthritis medicines are usually powerful, and some can produce unpleasant and damaging effects.

When making decisions on medicines you should remember the following:

• The likelihood of side-effects is far less if medicines are taken exactly according to instructions - for example with food, if that is specified.
• Your doctor should be regularly supervising your treatment - mainly to check whether the medicines you're taking are effective and agree with you. If not, they can be changed.
• The risk of taking medicines needs to be weighed against the adverse effects of not taking them.Without treatment arthritis can become increasingly painful and disabling.

If you do find that a medicine is causing unwanted effects, such as a rash, headaches, indigestion, stomach upsets or pains, consult your doctor immediately.

Women who are on medication for their arthritis must talk to their doctor if they're thinking of starting a family. Some medicines can be harmful in pregnancy and it may be necessary to adjust medication.

This article was last medically reviewed by Dr Rob Hicks in July 2008.
First published in October 1999.