Rheumatic Disease Drug Therapy
A variety of drugs - ranging from over-the-counter pain relievers to prescription steroids - are helpful in managing the pain and swelling associated with some rheumatic diseases. Treatments vary from person to person and change as the disease progresses. Even with the same diagnosis, two people may receive different treatments based on the severity and types of problems each individual experiences. Some people will experience bouts of severe symptoms followed by remissions.
Anyone whose doctor has recommended that they take certain drugs for rheumatic conditions should take them only as prescribed by their doctor. Early treatment can also reduce how much time you spend on higher doses of side-effect causing medications.
There are several categories of drugs that are used to treat many different rheumatic diseases. These include nonsteroidal anti-inflammatory drugs and corticosteroids. Other types of drugs are used to treat specific rheumatic diseases. For example, blood-thinning drugs may be used to treat Raynaud's phenomenon, which causes poor circulation in the hands and feet.
Several different types of medications may be prescribed to treat patients with rheumatic diseases.
Corticosteroids are usually given by injections, but sometimes can be taken by mouth. Drugs in this category include:
A shot of corticosteriods in a joint can offer some pain relief for four to six months. Knee joints may be treated with hylan G-F20 (Synvisc®) and hyaluronate (Hyalgan®), but treatment requires three to five weekly injections, depending on the preparation. Pain relief is usually achieved more slowly with these injected medications than with corticosteroids, but they can be effective longer.
Serious side effects can occur if a person takes these types of drugs for long periods of time, including the development of corticosteroid-induced osteoporosis. In such cases, the patient's bone density should be monitored before treatment starts and during the course of treatment to ensure no significant loss of bone mass.
Disease-modifying antirheumatic drugs (DMARDs) seem to affect immune systems that have gone out of control, but how exactly DMARDs work is not really known. Common DMARDs include:
- Hydroxychloroquine (Plaquenil®) was originally developed as a treatment for malaria. This drug has relatively few side effects. Apart from its apparent ability to affect the way immune cells work, scientists do not completely understand how it helps tame the disease process.
- Penicillamine (Cuprimine®) can reduce inflammation, but its full effect may require many months to develop. However, its beneficial effects may be longer lasting. Because of a relatively high incidence of adverse reactions to this drug and studies casting doubt on its effectiveness, its use has declined in recent years.
- Methotrexate (Rheumatrex®, Folex®)
Nonsteroidal anti-inflammatory drugs include aspirin, ibuprofen and acetaminophen. All of these are available without a doctor's prescription. For mild to moderate pain in the joints or back, these may be all that is needed, but possible side effects include:
- Bleeding in the stomach or intestines
- Changes in the ability to think, reason and be oriented (cognitive changes)
- Fluid retention
- Heart failure
- Kidney damage
- Ringing in the ears
Children who have rheumatic conditions, such as juvenile arthritis, can use the same nonsteroidal anti-inflammatory drugs that are given to adults. The doses must be adjusted for the size of the child. Liquid forms of the drugs or ones that do not need to be given as often are helpful in treating children.
Antidepressants can have several benefits for a person who has a rheumatic condition, including:
- Better sleep. Low doses taken before bed can improve sleep for persons with conditions like fibromyalgia syndrome.
- Pain relief. Antidepressants, particularly the tricyclic type, can help reduce chronic pain.
- Depression relief. Approximately one out of every five people who has a chronic disease and pain, such as arthritis, also has depression.
Common antidepressants used to treat arthritis and other rheumatic conditions include:
- Amitriptyline (Elavil®, Endep®)
- Desipramine (Norpramin®, Pertofrane®)
- Imipramine (Tofranil®, Norfranil®)
- Nortriptyline (Pamelor®, Aventyl®)
Immunosuppressants basically tame out-of-control immune systems. Some of these drugs are cytotoxic, meaning they attack and eliminate cells associated with the disease. Immunosuppressants that may be prescribed for rheumatic diseases include:
- Methotrexate (Rheumatrex®) affects cells that are responsible for some of the pain, inflammation and joint swelling that accompany scleroderma, but clinical trials have shown conflicting results regarding the effectiveness of methotrexate in treating scleroderma
- Cyclophosphamide (Cytoxan®) is an extremely potent medication that damages the genetic information of cells. In particular, it kills lymphocytes that are part of autoimmune disease. Cyclophosphamide may be used to treat lung inflammation.
New Drug Research
Newer agents and drugs being researched include:
- Tumor necrosis factor (TNF) blockers etanercept, adalimumab and infliximab. These have been approved by the FDA for treating rheumatoid arthritis. They are under investigation for treatment of other conditions with a similar inflammatory basis, such as ankylosing spondylitis and psoriatic arthritis.
Certain drugs, such as steroids (cortisones), must be used with caution on children because they can have a bad effect on growth or cause other side effects. Some drugs that adults can use have not been approved by the FDA for children to use.