Benefits and Risks of Arthritis Medicines
All medicines have risks and benefits to weigh before you take them.
There is no cure for rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS) or other inflammatory diseases, but there are treatments. An ever-increasing collection of drugs, used alone or together, have made low disease activity or remission possible.
The goal is to treat these diseases aggressively right after diagnosis to prevent joint and organ damage before it starts. Along with medicines that slow or stop the disease, you may take medicines to ease your pain and other symptoms. You and your doctor will have to weigh the risks and benefits of each drug before you decide to take it. Here’s a snapshot of the medicines your doctor will most likely prescribe for you or that you’ll buy over the counter.
Benefits: Acetaminophen relieves mild-to-moderate pain and reduces fever. It is cheap, easy on the stomach and does not increase your chances of having heart problems (as some other painkillers can).
Risks: This medicine is found in hundreds of prescription and over-the-counter (OTC) drugs, making it easy to take too much by mistake. Too much acetaminophen can damage your liver. Drinking more than two alcoholic drinks a day for men and more than one glass per day for women can add to the chance of harming your liver. Acetaminophen does not treat inflammation.
Benefits: These prescription-only medicines are strong painkillers. Some are also used to soothe a bad cough or stop severe diarrhea.
Risks: Taking opioid medicines can make you dizzy, sleepy and constipated. If you take them for more than a short time, you may need to take more to get the same pain relief (this is called tolerance). If you stop taking them all at once, you may go into withdrawal and feel sick (this is called physical dependence). Some people can become addicted to opioids, but this is not the same as tolerance or dependence.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Benefits: NSAIDs relieve pain, reduce fever and fight inflammation. They are available in over-the-counter and prescription strengths. Aspirin is an NSAID that can reduce your chance of having a heart attack or stroke if you have cardiovascular disease.
Risks: NSAIDs other than aspirin can increase your chances of having a heart attack or stroke. All NSAIDs can be hard on the stomach and can sometimes result in a stomach bleed.
“We shy away from these if someone has a history of heart disease or chronic gastrointestinal issues; but if someone has mild stomach symptoms with use, we can prescribe these drugs with a proton pump inhibitor to protect the stomach,” says Melissa Bussey, MD, an assistant professor in the Division of Allergy/Immunology/Rheumatology of Loyola University Chicago Stritch School of Medicine.
Benefits: Corticosteroids work in the same way as your natural hormone cortisol to reduce inflammation. Steroids give quick pain and inflammation relief, such as during a flare. They also slow down your immune system, which can help control autoimmune diseases.
Risks: The side effects of steroids depend on how you take them, how long you take them, and how much you take. Some possible side effects include glaucoma (increased pressure in the eye), cataracts (clouding of the lens of the eye), fluid retention, mood and behavior changes, higher blood fat and blood sugar levels, increased appetite, and thinning bones and skin.
Benefits: Traditional disease-modifying antirheumatic drugs (DMARDs) suppress your immune system and are used to fight inflammatory forms of arthritis. They ease symptoms, slow the disease down and slow joint damage. They can be taken in pill form, but some are also available in a shot that you give to yourself.
Risks: Because DMARDs hold back your immune system from overacting, they make it harder for you to fight infections. They also may slightly increase your chance of having certain cancers. Other side effects that could happen depend on which drug you take, but could include liver problems, low blood cell counts, diarrhea, headache, hair loss, lack of energy, rash or itching, upset stomach and weight loss. They can take several weeks to work, so your doctor may also prescribe an NSAID or corticosteroid along with a DMARD so you’ll feel better right away.
Benefits: Drugs in this subset of DMARDs work on specific parts of the immune system and do a good job of stopping inflammation and slowing the disease down.
Risks: Biologics are not available as pills; they come as shots or intravenous (IV) infusions. Biologics weaken your ability to fight germs so you may get infections while taking biologics and "silent" infections (like tuberculosis and hepatitis B) may come back. Some biologic drugs may increase your chance of getting certain types of cancer, cause heart failure or cause multiple sclerosis. Side effects that some people get include headache, injection site reaction (itching, redness, swelling) and infusion reaction (difficulty breathing, rapid or weak pulse, rash, nausea, vomiting).
Benefits: Targeted DMARDs work in very specific ways instead of suppressing the body's entire immune system. This means you may have fewer side effects than when you take traditional DMARDS. These medicines come in pill form, which is good for people who don’t like needles or can’t get to the doctor’s office for an IV (intravenous infusion).
Risks: Side effects of targeted DMARDs include mood changes, diarrhea and upset stomach. Any medicine that holds down your immune system can decrease your ability to fight germs. One of the targeted DMARDs, apremilast, does not appear to increase your chance of getting a serious infection.