Medicines and arthritis

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The information below is about the main types of medicines used for arthritis. It also gives tips on the safe use of medicines and where to go for further information. This sheet does not cover the full range of possible side effects for each medicine and you should discuss this further with your doctor or pharmacist.

Analgesics (pain relievers) Pain relievers are often the first medicine your doctor will recommend to help with pain. Some pain relievers are available without a prescription, while others must be prescribed by a doctor.

Types: Paracetamol is a simple pain reliever that may ease mild to moderate pain. There are also stronger pain relievers, such as a combination of paracetamol and codeine, tramadol and a range of morphine-like medicines (opiates).

Effects: Pain relievers act on the nervous system to reduce pain. They do not affect other symptoms such as joint swelling or stiffness.

How are they used: In some cases pain can be controlled by using an analgesic just when it is needed. Sometimes pain is better controlled by taking an analgesic regularly, for example four times a day. Ask your doctor or pharmacist for advice on the best way to take analgesics for your condition.

Risks: Paracetamol has few side effects when taken at the recommended dose. However taking more than the recommended daily dose can potentially cause severe liver problems. Be careful when taking pain relievers with over-the-counter medicines, such as ‘cold and flu’ medicines. These medicines may also contain paracetamol and you may accidentally take more than the recommended daily dose. Always ask your pharmacist for advice before taking any over-the-counter medicines. Stronger pain relievers may cause constipation, nausea, vomiting and drowsiness.

Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs reduce inflammation, joint swelling and stiffness. They are often used to treat inflammatory forms of arthritis, such as rheumatoid arthritis. They can also relieve pain that is not controlled by analgesics alone. Some NSAIDs are available without a prescription, while others must be prescribed by a doctor.

Types: There are many different types of NSAIDs available, such as naproxen and ibuprofen. There is a certain group of NSAIDs called COX-2 inhibitors that are slightly less likely to cause stomach problems.

Effects: NSAIDs stop the body producing substances (prostaglandins) that cause inflammation. This reduces symptoms such as pain and swelling. NSAIDs do not cure or have a long-term effect on your arthritis.

How are they used: Some conditions can be effectively controlled by using NSAIDs only when needed. Other conditions may require more regular use of NSAIDs. Ask your doctor or pharmacist for advice on the best way to take NSAIDs for your condition and how to reduce the dose of NSAIDs if your pain has eased.

Risks: Always talk to your doctor or pharmacist before taking NSAIDs as they may cause serious side effects. If you have problems with your blood pressure, kidneys or heart then the risk of heart attack, stroke and kidney failure may be increased in a small number of people. One of the most serious side effects of NSAIDs is bleeding of the stomach and upper intestine. Signs of bleeding include stomach pain, blood in your stools (or dark stools) and coffee-coloured vomit. You should see your doctor as soon as possible if you have any of these signs while taking NSAIDs. Even though some NSAIDs are available without prescription, your doctor can advise which of the NSAIDs and dosage are best for you.

Corticosteroids Corticosteroids are used to treat inflammatory forms of arthritis, such as rheumatoid arthritis. They can also be used to treat a single inflamed joint.

Types: Corticosteroids can be taken by mouth as tablets or liquid. They can also be given by injection into a joint, muscle or soft tissue.

Effects: These medicines have a strong anti-inflammatory effect and reduce pain and swelling. However they do not cure the disease.

How are they used: Your doctor will prescribe the lowest possible dose for the shortest time, due to the risk of side effects. You may need to restart corticosteroids again during a ‘flare’ (when symptoms worsen for a period of time).

Risks: Corticosteroids can have serious side effects if taken in high doses or for a long time (more than a few weeks). Your doctor will monitor you for side effects while you are taking corticosteroids. Common side effects include weight gain, thinning of the bones (osteoporosis), high blood pressure and increased susceptibility to infection. Corticosteroid injections usually produce fewer side effects than tablets.

Disease-modifying anti-rheumatic drugs (DMARDs)  DMARDs are used to treat inflammatory forms of arthritis, such as rheumatoid arthritis and ankylosing spondylitis. Many DMARDs act on the immune system to cause ‘immunosuppression’. This reduces the activity of the immune system which is attacking and damaging healthy joints. This can not only relieve symptoms but also reduce the risk of long-term damage to your joints. DMARDs may be used on their own or combined with other DMARDs or medicines to gain the best control of your arthritis. There is also a specific group of DMARDs available, known as ‘biological DMARDs’. These block certain substances in the blood and joints that cause inflammation. This reduces inflammation and halts joint damage. Biological DMARDs can only be used if other DMARDs have not worked. DMARDs and biological DMARDs are usually only prescribed by specialists. Regular blood tests are usually necessary to test the effectiveness of these medicines and to check for any unwanted side effects.

Important medicine tips

  • Understand why you are taking the medicine and what the possible side effects are. Ask your pharmacist for the Consumer Medicines Information (CMI) leaflet for your medicine. See the Australian Rheumatology Association’s Patient Medicine Information or ask your rheumatologist for a copy.
  • Always read all medicine labels and take your medicines as directed. If you have any questions check with your doctor or pharmacist.
  • Keep a personal record of all your medicines with you, including doses and allergies. This can be useful when you are talking to your doctor or pharmacist.
  • Always talk to your doctor or pharmacist before taking any over-the-counter medicines, including natural medicines, as some medicines cause problems if taken together.
  • Do not share your medicines with friends or relatives – the medicines you are taking may be harmful to them.

Talk to your doctor or pharmacist about the right medicine for your arthritis. Learn about your medicines, including how to take them and possible side effects.

For more information:

The Australian Rheumatology Association has information sheets on NSAIDs, corticosteroids and each of the DMARDs and biological DMARDs. The sheets cover detailed information about how to take the medicine, side effects and precautions. These are available online at: www.rheumatology.org.au

Call the Medicines Line, a telephone service provided by the National Prescribing Service and healthdirect Australia, for independent information about prescription, over-the-counter and natural medicines from a registered nurse. Your question may be answered on the spot, or you may be referred to your GP or pharmacist, or put through to a NPS  pharmacist. Phone: 1300 633 424 Monday to Friday 9am to 5pm EST. Web: www.nps.org.au

Books:

Kippel, John (editor) 2006, The essential guide to arthritis medications: Prescription and over the counter treatments for your joint pain from A to Z, Arthritis Foundation USA, Atlanta, GA.