Rheumatoid Arthritis Antiinflammatory Medications

Aka: Rheumatoid Arthritis Antiinflammatory Medications

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II. Indications: Rheumatoid Arthritis

  1. Symptom relief and improved function
  2. These agents do NOT change Rheumatoid Arthritis progression
    1. Used as adjuncts to DMARDs
  3. DMARDs are first line agents
    1. See Rheumatoid Arthritis Disease Modifying Drug
    2. The anti-inflammatory agents shown here are adjuncts to DMARD therapy
    3. Limit use of NSAIDs and COX2 Inhibitors once on DMARD >1 month
      1. Decrease to lowest effective dose (preferably use only as needed)
      2. Best use is limiting NSAIDS and COX2 Inhibitors for exacerbations

III. Management: First Choice

  1. NSAID (Propionic Group)
    1. Naproxen
    2. Ibuprofen
    3. Fenoprofen
  2. NSAID (Heterocyclic Group)
    1. Tolmetin
    2. Sulindac
  3. NSAID (Oxicam/Indole Group)
    1. Piroxicam
    2. Indomethacin
  4. Aspirin
  5. Prednisone 10 mg qd
    1. Use as bridge therapy to DMARDs
    2. Consider Osteoporosis prophylaxis for longterm use

IV. Management: Second Choice: Non-acetylated Salicylates

  1. Trilisate
  2. Salsalate

V. Management: Local remittive agents

  1. Indicated for Rheumatoid Arthritis flares
  2. Corticosteroid Injection

VI. References

  1. Pincus (1993) Rheum Dis Clin North Am 19:123-151 [PubMed]
  2. Scott (2010) Lancet 376(9746):1094-108 [PubMed]
  3. Wasserman (2011) Am Fam Physician 84(11): 1245-52 [PubMed]

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