The new JointHealth™ web site “About Medications” page provides people with arthritis and their health care providers the latest science-based information on the most commonly used medications to treat both osteoarthritis and inflammatory arthritis, such as rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis and lupus.
The information found on the "About Medications" pages is not "medical advice". Always speak with your health care providers about starting or stopping any prescription or non-prescription medication, including those discussed below.
Medication treatments
Because there are no known causes or cures for any of the over 100 different types of arthritis, many people living with the disease need medication therapies to help with disease suppression and daily management of symptoms. For inflammatory (or “autoimmune”) forms of arthritis – diseases where the immune system is triggered and begins to mistakenly attack joints in the body leading to pain and swelling – prescription medications are a critical part of a successful treatment plan. When used early, within weeks or a few months of disease onset and diagnosis, the right medications increase the chances of stopping the disease process that causes joint damage and resulting deformity and disability.
Until the mid 1980s, highly effective arthritis treatment options were scarce. Often, doctors would take a slow approach to treatment, putting patients on symptom management medications like acetaminophen (such as Tylenol®) or non-steroidal anti-inflammatory drugs (NSAIDs, such as Naprosyn®) for a long period of time before prescribing more aggressive treatments known as disease modifying anti-rheumatic drugs, or “DMARDs”.
Glucocorticoids (steroids such as prednisone), conventional synthetic DMARDs, such as methotrexate, sulfasalazine, and hydroxychloroquine, have been around and prescribed the longest and have the most evidence to guide their use. Conventional synthetic DMARDs work by quieting the immune system to reduce inflammation. They help to modulate the immune system, slowing or halting the underlying processes that cause inflammation.
With the arrival of new medication treatments over the past 23 years, people living with arthritis and their health care providers have an expanded range of options available to them when making decisions about a medication treatment plan. Originator and biosimilar biologics (complex, large molecule medicines) and targeted synthetic DMARDs (small molecule medications) have improved the treatment for people living with disabling and life-threatening types of inflammatory arthritis like rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and lupus.
The “Window of Opportunity”
Today, the approach to the treatment of arthritis, particularly for inflammatory arthritis, has changed significantly over the past 20 years. Instead of having people struggle on a medication that simply provides symptom relief, doctors, backed by scientific evidence, have started to treat people early and aggressively, with a view to reducing medications if the person goes into remission.
We now know that in many forms of inflammatory arthritis there is a "window of opportunity" at the beginning of the disease process when appropriate treatment has the best chance to stop the progression of the disease and prevent joint damage and disability. For the treatment of rheumatoid arthritis, as an example, a person should start treatment within six weeks of symptom onset and be monitored closely, increasing the dose of treatment if required, or adding additional therapies. If a person does not respond to conventional synthetic DMARD treatment, the expert consensus is for a person to start on biologic (originator or biosimilar)/ targeted synthetic DMARD therapy, which tend to work rapidly (within two to six weeks).
People diagnosed with inflammatory arthritis, however, continue to experience significant delays in starting first line conventional synthetic DMARDs within three months of symptoms first appearing or starting biologic or targeted synthetic DMARDs therapies as soon as the rheumatologist has determined conventional synthetic DMARDs have not worked well enough to control inflammatory arthritis symptoms. These delays in receiving advanced therapy result in fatigue, pain that limits sleep and movement and can lead to unnecessary joint damage, increased disability, and difficulty in doing simple daily tasks like preparing meals, caring for family, and holding down a job.
Treatment options
Essentially, there are two categories of arthritis medications: medications to treat symptoms and advanced therapies to treat the underlying disease.
The arthritis medications to treat symptoms have their own set of benefits and risks. NSAIDs and pain relievers are often effective for mild to moderate pain, while steroids are reserved for temporary, short-term relief at disease onset when inflammation and pain are typically most active. Careful consideration and medical guidance are crucial to finding the most appropriate and safe treatment for each individual. In that symptom treating medications do not slow down or stop the disease progression, they are considered at best supplementary medications. Many people may never require them or require them only for more powerful medications to control the disease.
Medications to treat symptoms include:
Medications to treat the underlying disease include:
When starting a new medication regimen for inflammatory arthritis, the rheumatologist may order monthly lab tests to monitor a person’s response to the treatment and help make sure the treatment is working effectively while keeping any potential risks under control. These tests help check if inflammation is decreasing and ensure the medication is safe, keeping an eye on possible side effects, such as liver or blood cell issues. After about 6 to 12 months, if everything is stable, the frequency of these tests is usually reduced to every two or three months.
The information found on the "About Medications" pages is not "medical advice". Always speak with your health care providers about starting or stopping any prescription or non-prescription medication, including those discussed below.
Medication treatments
Because there are no known causes or cures for any of the over 100 different types of arthritis, many people living with the disease need medication therapies to help with disease suppression and daily management of symptoms. For inflammatory (or “autoimmune”) forms of arthritis – diseases where the immune system is triggered and begins to mistakenly attack joints in the body leading to pain and swelling – prescription medications are a critical part of a successful treatment plan. When used early, within weeks or a few months of disease onset and diagnosis, the right medications increase the chances of stopping the disease process that causes joint damage and resulting deformity and disability.
Until the mid 1980s, highly effective arthritis treatment options were scarce. Often, doctors would take a slow approach to treatment, putting patients on symptom management medications like acetaminophen (such as Tylenol®) or non-steroidal anti-inflammatory drugs (NSAIDs, such as Naprosyn®) for a long period of time before prescribing more aggressive treatments known as disease modifying anti-rheumatic drugs, or “DMARDs”.
Glucocorticoids (steroids such as prednisone), conventional synthetic DMARDs, such as methotrexate, sulfasalazine, and hydroxychloroquine, have been around and prescribed the longest and have the most evidence to guide their use. Conventional synthetic DMARDs work by quieting the immune system to reduce inflammation. They help to modulate the immune system, slowing or halting the underlying processes that cause inflammation.
With the arrival of new medication treatments over the past 23 years, people living with arthritis and their health care providers have an expanded range of options available to them when making decisions about a medication treatment plan. Originator and biosimilar biologics (complex, large molecule medicines) and targeted synthetic DMARDs (small molecule medications) have improved the treatment for people living with disabling and life-threatening types of inflammatory arthritis like rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and lupus.
The “Window of Opportunity”
Today, the approach to the treatment of arthritis, particularly for inflammatory arthritis, has changed significantly over the past 20 years. Instead of having people struggle on a medication that simply provides symptom relief, doctors, backed by scientific evidence, have started to treat people early and aggressively, with a view to reducing medications if the person goes into remission.
We now know that in many forms of inflammatory arthritis there is a "window of opportunity" at the beginning of the disease process when appropriate treatment has the best chance to stop the progression of the disease and prevent joint damage and disability. For the treatment of rheumatoid arthritis, as an example, a person should start treatment within six weeks of symptom onset and be monitored closely, increasing the dose of treatment if required, or adding additional therapies. If a person does not respond to conventional synthetic DMARD treatment, the expert consensus is for a person to start on biologic (originator or biosimilar)/ targeted synthetic DMARD therapy, which tend to work rapidly (within two to six weeks).
People diagnosed with inflammatory arthritis, however, continue to experience significant delays in starting first line conventional synthetic DMARDs within three months of symptoms first appearing or starting biologic or targeted synthetic DMARDs therapies as soon as the rheumatologist has determined conventional synthetic DMARDs have not worked well enough to control inflammatory arthritis symptoms. These delays in receiving advanced therapy result in fatigue, pain that limits sleep and movement and can lead to unnecessary joint damage, increased disability, and difficulty in doing simple daily tasks like preparing meals, caring for family, and holding down a job.
Treatment options
Essentially, there are two categories of arthritis medications: medications to treat symptoms and advanced therapies to treat the underlying disease.
The arthritis medications to treat symptoms have their own set of benefits and risks. NSAIDs and pain relievers are often effective for mild to moderate pain, while steroids are reserved for temporary, short-term relief at disease onset when inflammation and pain are typically most active. Careful consideration and medical guidance are crucial to finding the most appropriate and safe treatment for each individual. In that symptom treating medications do not slow down or stop the disease progression, they are considered at best supplementary medications. Many people may never require them or require them only for more powerful medications to control the disease.
Medications to treat symptoms include:
- non-steroidal anti-inflammatories ("NSAIDs")
- pain relievers, like acetaminophen (Tylenol®)
- steroids
- opioids (sparingly)
Medications to treat the underlying disease include:
- disease modifying anti-rheumatic drugs (DMARDs)
- targeted synthetic molecules (tsDMARDs)
- biologic DMARDs, also known as biologic response modifiers or “biologics” (originator and biosimilar)
When starting a new medication regimen for inflammatory arthritis, the rheumatologist may order monthly lab tests to monitor a person’s response to the treatment and help make sure the treatment is working effectively while keeping any potential risks under control. These tests help check if inflammation is decreasing and ensure the medication is safe, keeping an eye on possible side effects, such as liver or blood cell issues. After about 6 to 12 months, if everything is stable, the frequency of these tests is usually reduced to every two or three months.
Arthritis Consumer Experts
ACE thanks Arthritis Research Canada (ARC) for its scientific review of ACE and JointHealth™ information and education programs.