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Arthritis
Medications other than standard NSAIDS
There are many medications used for treatment of arthritis
many of which are what are called NSAIDS which stands for non-steroidal anti
inflammatory drugs, as well as steroids, and pain relievers. I focused my
attention on medications that related to the information that was requested by
one of our patients.
BMR's (biological response modifiers)
| If you've
tried any number of drugs for your rheumatoid arthritis (RA) and
just can't seem to get the relief you need, one of a new class of
medications, called biologic response modifiers, just might help -
and in more ways than one. Research shows that these agents not
only relieve the signs and symptoms of arthritis, they also
inhibit the damage to the joint structures that arthritis can
cause. For many people, these drugs have helped when nothing else
could.
Biologic response modifiers are medications derived from living
sources (as opposed to synthesized chemicals), and designed to act
on specific components of the immune system called cytokines that
either heighten or suppress inflammation.
 The
two biologic response modifiers in the chart - etanercept (Enbrel)
and infliximab (Remicade) - have been available for a
couple of years now. Both of these agents work, though in
different ways, to suppress an inflammatory cytokine called tumor
necrosis factor (TNF).
Despite the benefits of these agents, they have their
downsides. They must be infused or injected and they are
expensive. Researchers believe that future agents, still in the
early development stages, may be less expensive and can be taken
orally.
 A
third biologic agent, anakinra (Kineret), was approved by
the FDA in November 2001 for the treatment of rheumatoid
arthritis. Anakinra works by blocking the action of an
inflammatory cytokine, interleukin-1, which plays a role in
inflammation and destruction. It requires daily injections with a
special injecting device. Because this medication is so new, there
is no listing in the USP DI detailing side effects and
other information. (USP DI is the source for dosage and
side effects for all drugs in our chart.) Please see your doctor
for further information.
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| Drug |
Brand Name(s)
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Dosage
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Special Instructions
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Possible Side Effects
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Be Aware
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Etanercept |
Enbrel |
25 mg twice per week, given by subcutaneous (beneath the
skin) injection |
Drug must be refrigerated prior to use. Mix
prior to injection. Do not shake. May be injected into the thigh, abdomen or
upper arm. |
Pain or burning in throat; redness, itching,
pain and/or swelling at the site of the injection; runny or stuff nose
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For etanercept and infliximab: Let your doctor know
if you have one of the following: active infection, exposure to tuberculosis
or if you have a central nervous system disorder, including demyelinating
disorders such as multiple sclerosis, myelitis or optic neuritis.
Administration of these agents should be discontinued if you develop a
serious infection. Live vaccines should not be given concurrently with these
drugs.
For etanercept (Enbrel): Because supplies of Enbrel
may be limited until mid-2002 (when a new manufacturing plant will open)
people taking Enbrel or wanting to take Enbrel should call
and register with the manufacturer to help ensure access. Call 888/4-ENBREL.
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Infliximab |
Remicade |
Range based on body weight, initial dose repeated at 2 and 6
weeks and once every 8 weeks thereafter |
Drug is infused intravenously (IV) during a
2-hour procedure. It is administered in conjunction with methotrexate.
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Abdominal pain; cough; dizziness; fainting;
headache; muscle pain; nasal congestion; nausea; runny nose; shortness of
breath; sneezing; sore throat; tightness in chest; unusual tiredness or
weakness; vomiting; wheezing |
DMARDS
| If you have
rheumatoid arthritis (RA), psoriatic arthritis or ankylosing spondylitis, a
disease-modifying antirheumatic drug (DMARD) could very well be one of the
first medications your doctor prescribed. And that's a good thing. For many
people, these drugs can actually stop disease progression before it can
cause irreparable joint damage.
Over the course of your disease, you may take one DMARD (pronounced DEE-mard),
you may take several in succession or you may take two or more in
combination. Research shows that for some people, two is better than one.
Your doctor will work with you to find the drug or the combination that
works best for you.
 While DMARDs
are powerful arthritis fighters, don't expect instant results from them.
DMARDs work over time, often taking several weeks to several months before
their effects can be seen.
As widely used and effective as DMARDs are for rheumatoid arthritis, only
one - leflunomide (Arava) - was actually developed
for RA. Others were approved for RA only after years of use for other
purposes. For example, cyclosporine was used to prevent organ rejection in
people who had undergone transplants; hydroxychloroquine sulfate was used to
treat malaria; and methotrexate - one of the most widely used and effective
drugs for RA - was originally a cancer treatment.
The doses listed here are for RA, although some of these drugs are used
for other diseases. In that case your doctor will determine the dosage.
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| Drug |
Brand Name(s)
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Dosage
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Special Instructions
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Possible Side Effects
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Be Aware
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Auranofin
(oral gold) |
Ridaura |
6 to 9 mg per day in 1 or 2 doses |
Take with a glass of milk or water. If stomach
upset occurs, take with food. |
Skin rash or itching; ulcers, sores or white
spots on the lips or in mouth or throat |
Before taking this drug, let your doctor know if you have
or have had one of the following: adverse reaction to a gold-containing
medication, a history of blood-cell abnormality, inflammatory bowel disease,
or kidney or liver disease This drug can cause sun sensitivity, so
minimize exposure to sunlight and sun lamps and wear sunscreen when
outdoors. Your doctor may order periodic blood and urine tests to check for
effects on the blood and kidneys. |
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Azathioprine |
Imuran |
50 to 150 mg per day in 1 to 3 doses, based on body weight
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Take with food. |
Cough or hoarseness; fever or chills; loss of
appetite; lower back or side pain; nausea or vomiting; painful or difficult
urination; unusual tiredness or weakness |
Before taking this drug, tell your doctor if you use
allopurinol or have kidney or liver disease. This drug can reduce your
ability to fight infection, so call your doctor immediately if you develop
chills, fever or a cough. |
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Cyclophosphamide |
Cytoxan |
50 to 150 mg per day in a single dose (This drug may also be
given intravenously.) |
Take oral medication with breakfast. Drink lots
of fluids throughout the day and empty bladder before bedtime. |
Darkening of skin and fingernails; missing
menstrual periods; loss of appetite; nausea or vomiting |
Before taking this drug, let your doctor know if you have
kidney or liver disease or any active infection. This drug can reduce your
ability to fight infection, so call your doctor immediately if you develop
chills, fever or a cough, or if you have burning during urination or blood
in urine. |
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Cyclosporine |
Neoral, Sandimmune |
100 to 400 mg per day in 2 doses; dose is based on body
weight |
Be consistent: Take at the same time every day,
either with a meal or between meals. |
Bleeding, tender or enlarged gums; high blood
pressure; increase in hair growth; kidney problems; trembling and shaking of
hands |
Before taking this drug, tell your doctor if you have one
of the following: sensitivity to castor oil (if recieving the drug by
injection), liver or kidney disease, active infection or high blood
pressure. Because this drug's rate of absorption is unpredictable, your
doctor will monitor it through blood tests. Use of this drug may make you
more susceptible to infection and certain cancers. Do not get live vaccines
while on this drug. If you need a vaccine, stop taking cyclosporine for a
few days before and after having non-live vaccines. |
Hydroxychloro-
quine sulfate |
Plaquenil |
200 to 600 mg per day in 1 or 2 doses, based on body weight
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Take with food or a glass of milk or water.
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Diarrhea; difficulty in seeing to read;
headache; itching; loss of appetite; nausea or vomiting; stomach cramps or
pain |
Before taking this medication, let your doctor know if you
have an allergy to any antimalarial drug or if you have a retinal
abnormality. Because vision may be damaged with long-term therapy (given
over several years), have an eye exam before starting this drug and 12
months thereafter to detect retinal changes. |
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Leflunomide |
Arava |
10 to 20 mg per day in a single dose |
Treatment starts with a loading dose of 100 mg
per day for 3 days. |
Bloody or cloudy urine; congestion in chest;
cough; diarrhea; difficult, burning or painful urination; dizziness; fever;
frequent urge to urinate; hair loss; headache; heartburn; loss of appetite;
nausea and/or vomiting; skin rash; stomach pain; sneezing; sore throat
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Before taking this medication, let your doctor know if you
have one of the following: active infection, liver disease, known immune
deficiency, renal insufficiency or underlying malignancy. Either member of a
couple who is taking leflunomide and is ready to conceive should go through
an elimination process using the cholesterol-lowering drug cholestyramine
prior to conception. |
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Methotrexate |
Rheumatrex, Trexall |
7.5 to 15 mg per week in a single dose or divided into 3
doses (This drug may also be given by injection.) |
Take with food or a glass of milk or water.
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Abdominal discomfort, black tarry stools,
chest pain, chills, dizziness, general feeling of illness, nausea, mouth
sores, painful or difficult urination, sore throat, swollen glands, unusual
bleeding or bruising, unusual tiredness or weakness |
Before taking this medication, let your doctor know if you
have one of the following: abnormal blood count, liver or lung disease,
alcoholism, immune-system deficiency or active infection. Chest X-rays,
liver tests and blood counts are advised before starting this drug and
throughout treatment to monitor side effects. Alert your doctor immediately
if you have a dry cough, fever or difficulty breathing. Methrotrexate may
temporarily reduce fertility in men and women and can cause birth defects if
taken during pregnancy. |
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Minocycline |
Minocin |
200 mg per day in 2 doses |
Take on an empty stomach with water.
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Cramps or burning of the stomach; diarrhea;
dizziness, lightheadedness or unsteadiness |
This drug is not yet FDA-approved for arthritis. It is an
antibiotic. Before taking this medication, let your doctor know if you have
a sensitivity to tetracycline medications. |
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Penicillamine |
Cuprimine,
Depen |
125 to 250 mg per day in a single dose to start, increased to
not more than 1,500 mg per day in 3 doses |
Take on an empty stomach, at least 1 hour
before or 2 hours after any food, milk or medicine. |
Diarrhea; fever; joint pain; lesions on face,
neck, scalp and/or trunk; lessening or loss of taste; loss of appetite; skin
rash, hives, itching; nausea or vomiting; stomach pains; swollen and/or
painful glands; ulcers, sores or white spots on lips or in mouth.
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Before taking this medication, let your doctor know if you
have any of the following; penicillin allergy, blood disease, kidney disease
or lupus. Because this drug can cause blood abnormalities and kidney damage,
your doctor will order periodic blood and urine tests to check for unwanted
effects. Take consistently; stopping and starting can worsen side effects.
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Sulfasalazine |
Azulfidine, Azulfidine EN-Tabs |
500 mg to 3 grams per day in 2 to 4 doses |
Take with food or a glass of milk or water.
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Abdominal or stomach upset; aching of joints;
diarrhea; headache; increased sensitivity of skin to sunlight; itching; loss
of appetite; nausea or vomiting; skin rash |
Before taking this medication, let your doctor know if you
have any of the following: allergy to sulfa drugs or aspirin, kidney or
liver disease or blood disease. Failure to drink adequate fluids while on
this medication can lead to the formation of urine crystals. This drug can
lower sperm counts in men and may interfere with the ability to conceive.
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Aurothioglucose; Gold sodium thiomalate
(both injectable) |
Solganal |
10 mg in a single dose the first week, 25 mg the following
week, then 25 to 50 mg per week thereafter. Frequency may be reduced after
several months. |
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Irritation or soreness of tongue; metallic
taste; skin rash or itching; redness, soreness, swelling or bleeding of
gums; ulcers, sores or white spots on lips or in mouth or throat
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Before taking these medications, let your doctor know if
you use penicillamine or have any of the following: lupus, skin disease,
kidney disease, blood disease or colitis. Increased joint pain may occur for
one or two days after injection, but it usually disappears after the first
few injections. Your doctor will order periodic urine and blood tests to
check for side effects. |
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Myochrysine |
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