You leave the rheumatology clinic with a new prescription and a leaflet full of frightening side effects. It is no wonder many people feel anxious. NICE estimates that between a third and a half of all medicines prescribed for long-term conditions are not taken as recommended (NICE, 2009).
But untreated inflammatory arthritis is not neutral. If rheumatoid arthritis is not treated early or well controlled, inflammation can cause significant and permanent damage to your joints (NHS, n.d.b). This guide explains what your medicines actually do.
The four pillars of defence
1. Painkillers: the bucket under the leak
Painkillers such as paracetamol or co-codamol (paracetamol with codeine) dull the pain signal (NHS, n.d.a). They can make life more bearable, but they do nothing to stop the disease. It is like putting a bucket under a leaking roof without fixing the hole.
2. NSAIDs: the fire extinguishers
Non-steroidal anti-inflammatory drugs, such as ibuprofen, naproxen, diclofenac and etoricoxib, reduce inflammation as well as pain. Because they can irritate the stomach lining, you will often be given a stomach-protecting medicine called a proton pump inhibitor (PPI), such as omeprazole, to take with them (NHS, n.d.a). NICE advises using the lowest effective dose for the shortest possible time (NICE, 2018). They are useful during a flare, but rarely a long-term answer on their own.
3. DMARDs: the engine room
Disease-modifying anti-rheumatic drugs, such as methotrexate, leflunomide, sulfasalazine and hydroxychloroquine, calm the immune system error that causes your body to attack your joints (NHS, n.d.a). NICE recommends starting one as soon as possible, ideally within 3 months of persistent symptoms (NICE, 2018).
Methotrexate may sound scary because it is also a cancer drug, but the dose used for cancer is usually much higher than for arthritis (Arthritis UK, n.d.b).
Key insight: be patient
DMARDs take time. It can be up to 12 weeks before you notice methotrexate working (Arthritis UK, n.d.b). Many people give up too soon because they don't feel better straight away. Keep going, and talk to your team if you're worried.
4. Biologics and JAK inhibitors: the precision tools
Biological medicines, such as adalimumab, etanercept and infliximab, are made from proteins that target specific parts of the immune system. Anti-TNF drugs, for example, block an inflammatory protein called tumour necrosis factor. Because they are proteins, they cannot be swallowed and are given by injection or drip. JAK inhibitors are a newer type of targeted medicine taken as tablets. Both are usually used alongside or after methotrexate when DMARDs alone are not enough (NHS, n.d.a). For many people, they bring the disease under control when other treatments have not.
The side effect elephant in the room
It helps to weigh up two risks:
| Risk A: possible side effects | Risk B: untreated arthritis |
|---|---|
| Side effects are possible, which is why you are closely monitored. Regular blood tests help spot changes, for example in your blood cells or liver, before you feel unwell (NHS, n.d.a). | Permanent joint damage, and a higher risk of cardiovascular disease, including heart attack and stroke (NHS, n.d.b). |
Why "Dr Google" can be dangerous
Search online and you will find worst-case stories, out-of-date experiences and "natural cures" that claim to replace your medicine. This can lead people to cut their dose without telling their doctor, skip their folic acid, or delay treatment until damage has been done. Look for information that is:
- evidence-based: rooted in clinical trials, not anecdotes
- UK-specific: relevant to medicines available on the NHS
- up to date: reflecting the latest safety advice.
Where to find reliable information
Arthritis UK's A to Z of arthritis medicines has a page for each drug, plus advice on pregnancy and vaccinations (Arthritis UK, n.d.a). You can also order or download free drug information booklets, including on painkillers and NSAIDs, methotrexate and adalimumab (Arthritis UK, n.d.c).
The bottom line
Your medication is not a punishment. It is a tool that keeps you moving. If you have concerns about side effects, talk to your rheumatology team or pharmacist, and never stop or change a medicine without advice.
References
Arthritis UK (n.d.a) Arthritis medication and medical treatments. Available at: https://www.arthritis-uk.org/information-and-support/understanding-arthritis/arthritis-treatments/drugs/
Arthritis UK (n.d.b) Methotrexate. Available at: https://www.arthritis-uk.org/information-and-support/understanding-arthritis/arthritis-treatments/drugs/methotrexate/
Arthritis UK (n.d.c) Drugs (free information booklets). Available at: https://shop.arthritis-uk.org/collections/drugs
NHS (n.d.a) Rheumatoid arthritis: treatment. Available at: https://www.nhs.uk/conditions/rheumatoid-arthritis/treatment/
NHS (n.d.b) Rheumatoid arthritis: complications. Available at: https://www.nhs.uk/conditions/rheumatoid-arthritis/complications/
NICE (2009) Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence (Clinical guideline CG76). Available at: https://www.nice.org.uk/guidance/cg76/chapter/introduction
NICE (2018) Rheumatoid arthritis in adults: management (NICE guideline NG100). Available at: https://www.nice.org.uk/guidance/ng100/chapter/Recommendations
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Important medical disclaimer
The content provided in this blog post is for educational and informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your GP, psychiatrist or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Never start, stop or change a prescribed medicine without speaking to your prescriber first.
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