Medications used to manage rheumatoid arthritis

Treatment for rheumatoid arthritis has improved dramatically over the past 20 years. New medicines are effective in managing the disease, particularly in the early stages.

Paracetamol, codeine, and nonsteroidal anti-inflammatory drugs (NSAIDs) are sometimes called the 'first-line' medicines in management of rheumatoid arthritis, as these are the initial medicines provided for symptom relief [1].

Stronger medications such as corticosteroids, disease-modifying anti-rheumatic drugs (DMARDs) and biologic disease-modifying anti-rheumatic drugs (bDMARDs) may be prescribed when insufficient symptom control is obtained from first-line medicines. Corticosteroids and DMARDs are typically prescribed and monitored by specialist rheumatologists and require close medical monitoring to ensure effectiveness and to minimise side effects. Evidence suggests initiation of aggressive treatment with DMARDs within 12 weeks of symptom onset is associated with less joint destruction and a higher chance of achieving DMARD-free remission as compared with a longer delay in assessment [2].

bDMARDs are specialised immunosuppressant medications that have been shown to halt or slow the disease process sufficiently to reduce the joint destruction and disability associated with early rheumatoid arthritis [3]. bDMARDs are also used for other autoimmune conditions such as juvenile arthritis, psoriatic arthritis and Crohn's disease.

Since 2003, the availability of bDMARDs has broadened treatment options for rheumatoid arthritis, and their use is captured under specific Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) codes [4].

References

  1. AIHW (Australian Institute of Health & Welfare) 2010. Medication use for arthritis and osteoporosis. Arthritis series no. 11. Cat. no. PHE 121. Canberra: AIHW.
  2. Van der Linden MPM, le Cessie S, Raza K et al. 2010. Long-term impact of delay in assessment of patients with early arthritis. Arthritis and Rheumatism 62(12):3537–3546.
  3. Nam JL, Ramiro S, Gaujoux-Viala C et al. 2014. Efficacy of biological disease-modifying anti-rheumatic drugs: a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis. Annals of the Rheumatic Diseases 73 (3):516–528.
  4. AIHW (Australian Institute of Health & Welfare) 2013. A snapshot of rheumatoid arthritis. Bulletin no. 116. Cat. no. AUS 171. Canberra: AIHW.