Rheumatology Medications
The types of medication include:
- Pain killers and NSAIDs
- Disease-modifying anti-rheumatic drugs (DMARDs)
- Biologics and Biosimilars
- Corticosteroids
More information is available at:
Non-steroidal anti-inflammatory drugs (NSAIDs) are used to reduce inflammation as well as pain and may be prescribed for many types of arthritis. They are usually given in tablet or capsule form, often as a slow-release preparation to ensure stable levels of the drug within the body. NSAIDs may also be given in the form of suppositories or as gels and creams for topical application to the skin overlying affected areas. Examples of NSAIDs include Ibuprofen, Naproxen, Meloxicam, Etodolac, Celecoxib, Diclofenac and Nabumetone. There are many different brand names for some of these drugs.
NSAIDs may not be prescribed if you are taking certain other drugs such as Warfarin or if you have, or have had gastric (stomach) ulcers in the past. If you are in any doubt, please discuss this with your GP. Should you experience dyspepsia (heartburn) or indigestion whilst taking NSAIDs you may require additional medication (PPIs) to protect your stomach. Again you should discuss this with your GP. NSAIDs should not be taken on an empty stomach but always with, or immediately after, food.
Some NSAIDs are available over the counter as pain relief medications. Check you are not already taking a prescribed one before buying pain relievers.
These are used for most types of arthritis, including osteoarthritis. Examples include Paracetamol and mild opioids such as Codeine and Dihydrocodeine or combination products such as Paracetamol and Codeine (Co-codamol) or, Paracetamol and Dihydrocodeine (Co-dydramol). Tramadol is also sometimes prescribed. Very occasionally, stronger opioid analgesia such as morphine is required for very severe pain. This may be given in liquid or tablet/capsule form such as oramorph or MST. Very strong opioids are also available as patches e.g. Fentanyl. Simple analgesia such as Paracetamol rarely cause any side effects and may be used safely with most other medication, however it is important not to exceed the maximum recommended dose of any medication. Opioid-based drugs may cause drowsiness in some people. if you are affected in this way you should avoid driving or operating machinery. Please read the information on the packaging or prescription.
Blood Monitoring
All disease-modifying anti-rheumatic drugs (DMARDs) have the potential to cause adverse effects and thus require regular monitoring to detect these and ensure your safety.
Regular blood tests are important both to check for adverse effects on your kidneys, liver and blood cells and to monitor how active your disease is and how well you are responding to treatment by checking your inflammatory markers. This can be done at the hospital pathology department by a phlebotomist but many GP practices also provide a phlebotomy service. If this would be more convenient for you please check if your surgery offers this service.
For patients on DMARDs regular blood tests usually include the following: full blood count (FBC), erythrocyte sedimentation rate (ESR) and biochemical profile (liver function tests / LFTs), C-reactive protein (CRP) and renal (kidney) function tests.
A full blood count includes the haemoglobin, white cell count and platelet count. These are briefly explained below.
Haemoglobin
If you become anaemic your haemoglobin level will decrease. Anaemia is common in many forms of arthritis and may be due to a number of reasons. Iron deficiency is a common cause and iron or dietary supplements may be necessary. Non-steroidal anti-inflammatory drugs (NSAIDs) are known to cause stomach irritation (gastritis) and ulceration in some people. This may lead to bleeding from the stomach or bowel resulting in anaemia.
Other causes of anaemia include mal-absorption (where certain nutrients are poorly absorbed via the bowel) – this may occur if you have other conditions such as Crohn's disease or Coeliac disease. Some people have a form of anaemia called Pernicious Anaemia, which requires regular injections of Vitamin B12. Anaemia commonly occurs as a symptom of long term inflammation however and is not always helped by iron supplements. As your arthritis becomes better controlled the haemoglobin often improves and the anaemia resolves. Very occasionally severe anaemia requires a blood transfusion or an iron injection/infusion.
White cell count (WCC)
The white blood cells may be affected by both your disease and its treatment. The number of white cells often increases when infection is present or with long-term use of corticosteroids. However, drugs which suppress the immune system may reduce the number of white cells.
White cells help to fight infection so the number of white cells is checked to ensure that you retain sufficient to be able to fight infection. There are different types of white cells, the most important being neutrophils. If the level of neutrophils falls too low you may need to stop treatment.
Platelets
The number of platelets in the blood is also monitored. These are cells involved in blood clotting and may increase in number when there is active inflammation. Some drug treatments may cause a reduction in platelets which could increase the risk of bleeding, making it necessary to stop treatment.
We also measure important inflammation markers (ESR and CRP) which enable us to assess the activity of your condition.
C-reactive protein (CRP)
This is an enzyme produced by the liver which increases in response to inflammation- it is not specific to arthritis so may be raised even if your arthritis is stable i.e. due to infection. It is usually included with other liver tests to provide an additional means of assessing the extent and activity of your disease.
Erythrocyte sedimentation rate (ESR)
The ESR is a simple test which indicates the level of inflammation in the blood and may increase when your arthritis is more active, but this is not always the case. In some conditions the ESR remains normal despite ongoing inflammation. The ESR may also be affected by concurrent illness or infection. The 'normal' ESR varies: it is often higher in women and increases with age and body mass index.
Some hospitals use a different test, plasma viscosity, which also measures the level of inflammation in the body.
Both CRP and ESR are often referred to as 'markers of inflammation'.
Biochemistry Tests (LFTs, U&Es, Creatinine)
These check how well your liver and kidneys are working as these are the organs predominantly concerned with getting rid of the drug from the body. They assess the balance of salts and calcium levels in the body. These can be affected by many conditions and by drug treatments.
