Are the Newer Arthritis Drugs Always the Better Choice?
Arthritis drugs have long been considered the “traditional” treatment option. Since individual response to drugs can vary and because potential side effects and adverse reactions are also a factor, finding the most effective combination of arthritis drugs can be a more difficult process than one would expect. Patients should become knowledgeable about the various arthritis drugs so they can make decisions with their doctor.
NSAIDs / COX-2 Inhibitors
NSAIDs (nonsteroidal anti-inflammatory drugs) are among the most commonly prescribed and widely used arthritis drugs. There are three types of NSAIDs: salicylates (both acetylated, such as aspirin, and nonacetylated such as (Disalcid) salsalate, (Trilisate) choline magnesium trisalicylate and (Doan’s Pills, Novasal) magnesium salicylate), the traditional NSAIDs, and COX-2 selective inhibitors.
NSAIDs work by blocking the activity of the enzyme, cyclooxygenase, also known as COX. Research has revealed that there are two forms, known as COX-1 and COX-2. NSAIDs affect both forms. COX-1 is involved in maintaining healthy tissue, while COX-2 is involved in the inflammation pathway. COX-2 selective inhibitors became a new subset of NSAIDs born of this research.
Traditional NSAIDs include:
*Cataflam (Diclofenac potassium)
*Ibuprofen (Motrin, Advil)
*Ketoprofen (Orudis, Oruvail)
*Naproxen (Naprosyn, Aleve)
*Ponstel (Mefanamic Acid)
*Voltaren (Dicolfenac Sodium)
COX-2 Inhibitors include:
*Vioxx (Rofecoxib) – no longer on market
*Bextra (Valdecoxib) – no longer on market
DMARDs (Disease-Modifying Anti-Rheumatic Drugs) have also been labeled “slow-acting anti-rheumatic drugs” (because they take weeks or months to work) and “second-line agents”. However, research has shown the effectiveness of DMARDs in the treatment of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis and the importance of early, aggressive treatment with these drugs. For some, these drugs can stop disease progression and halt joint damage.
*Auranofin (Ridaura, Oral Gold)
*Myochrysine (Injectable Gold)
*Methotrexate (Rheumatrex, Trexall)
*Penicillamine (Cuprimine, Depen)
Corticosteroids or glucocorticoids, often called “steroids”, are potent drugs which can reduce swelling and inflammation quickly. These drugs are closely related to cortisol, a hormone produced on the cortex of the adrenal glands. They are prescribed in widely varying doses depending on the condition and goal of treatment. Used to control inflammation of the joints and organs in diseases such as rheumatoid arthritis, lupus, polymyalgia rheumatica, vasculitis, it has been determined that the potential for serious side effects increases at high doses or with longterm use. Doctors can prescribe short-term, high-dose intravenous steroids in some situations, or give shots or injections with drugs such as Triamcinolone (Kenalog) locally into a specific joint for relief.