Medications used to treat rheumatoid arthritis (RA) can be divided into two groups: those that may help relieve your RA symptoms and those that may help modify the disease. Your physician may recommend using two or more medications at a time, each serving a distinct purpose in the treatment of RA. Careful monitoring of your treatment is important since some medications may affect your immune system or have other side effects.

All drugs (even over-the-counter medications) have side effects. However, if left untreated, RA may cause serious problems, including joint destruction. Therefore, it's important for you to be as informed as possible about available drugs to treat RA. You and your doctor may want to weigh the benefits of treatment (relieving pain, preventing disability) against the risks and even the costs of using certain drugs.

Nonsteroidal Anti-inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin, have been the traditional first-line treatments for RA. These drugs are used to relieve pain and reduce inflammation in the affected joints. In addition, NSAIDs may cause severe stomach irritation and even ulcers when used for an extended period. Newer NSAID therapies, such as COX-2 inhibitors, may provide the same benefits as existing NSAIDs, with less stomach irritation and ulcers.

Analgesics

Analgesics, such as acetaminophen and narcotic pain medications, help relieve pain but do not slow joint damage or reduce inflammation. Today, many physicians prescribe products combining acetaminophen and prescription analgesics, like codeine.

Corticosteroids

Corticosteroids, like prednisone, are anti-inflammatory drugs that may help relieve RA symptoms. Although corticosteroids usually are not prescribed as the only form of treatment, they can be helpful and often are used in combination with other drugs such as NSAIDs, analgesics and disease-modifying agents. However, corticosteroids may have long-term side effects, including bone loss, cataracts, weight gain, diabetes and high blood pressure.

Disease-Modifying Antirheumatic Drugs

In the past disease-modifying antirheumatic drugs (DMARDs) usually were used to treat RA after NSAID therapy failed. However, now rheumatologists are beginning to use DMARDs earlier in the course of the disease because studies have suggested that early intervention with DMARDs offers important benefits.

DMARDs and NSAIDs often are used in combination with each other. Examples of DMARDs that have been available for many years include antimalarial drugs, gold salts and methotrexate. Arava is a newer DMARD shown to have important benefits. Individuals on DMARDs may demonstrate improvement in weeks to months after initiating therapy, and DMARDs have the potential to reduce the progression of joint damage.

How to Choose a Medication

The following suggestions may help you and your doctor determine which therapy options may be best for you.

• Determine your expectation level. Discuss with your doctor the results you expect from a medication before you commit to a specific therapy. Setting unreasonably high expectations for a medication may lead to disappointing results. You and your doctor may decide that using timelines is beneficial so you can judge the benefits of a treatment over a specified time period. For example, you both may decide that if your pain level does not decrease in 2 months, your doctor will investigate other therapy options.

  Typically, an individual may need to take many medications over time before noticing results. Self-education also may help people avoid disappointment and discouragement.

• Filter advice from others. Choosing your medication based on other individuals' results may lead to problems. Often a person must discontinue medication because of side effects or other complications, but this does not mean that the medication will affect you in the same way. It is important to discuss the risks of all therapy choices with your doctor. Medication side effects may be only temporary, but sometimes they do not cease, and your doctor must terminate the medication. However, some medication side effects may be so minor that you choose to remain on the therapy. These are decisions that you and your doctor should make together to ensure that you receive appropriate therapy.

  You also may find that other people have experienced better results than expected from a particular medication. After hearing that someone has done extremely well on a particular medication, you may be very tempted to try this medication. And you may find another person who has had great results on an entirely different medication. Keep in mind, however, that people respond differently to medications. Because many RA medications take time to become most effective, you may be shorting yourself from the benefits of a medication if you are continually trying new ones based on other individuals' experiences.

• Track your progress. It is important to set measurable standards with the help of your doctor. Maintaining a diary of your pain, inflammation and other symptoms often can help your doctor assess the effectiveness of your medication. This diary also may serve as an overall guide to your health and well being, allowing you to reflect on the progress you are making. You even may want to consider keeping track of your exercise schedule and nutrition habits; this may help you notice trends in your RA symptoms that are consistent with certain trends in your exercise and diet routines. Logging your symptoms in a diary also may help your doctor determine if medication changes are necessary.