From the Guidelines
The best medication for arthritis is methotrexate, as it is considered the anchor drug and should be part of the first treatment strategy in patients at risk of persistent disease 1, 2.
Key Points
- Methotrexate is the preferred conventional synthetic disease-modifying antirheumatic drug (csDMARD) for patients with polyarthritis or those with monoarthritis/oligoarthritis and poor prognostic factors, especially in those with clinically relevant skin involvement 1.
- Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to relieve musculoskeletal signs and symptoms, and local injections of glucocorticoids may be considered as adjunctive therapy 1, 3.
- Biologic disease-modifying antirheumatic drugs (bDMARDs), such as tumor necrosis factor (TNF) inhibitors, may be considered in patients with peripheral arthritis and an inadequate response to at least one csDMARD 1, 2.
- Janus kinase inhibitors (JAKis), such as tofacitinib, may be considered in patients with peripheral arthritis and an inadequate response to at least one bDMARD or csDMARD, but caution is needed due to potential safety risks 1.
Treatment Approach
- The treatment approach should be individualized, taking into account the patient's disease activity, comorbidities, and preferences 2, 4.
- The goal of treatment is to achieve clinical remission or low disease activity, and regular monitoring of disease activity and adverse events should guide treatment decisions 1, 2.
- Non-pharmacological interventions, such as dynamic exercises and occupational therapy, should be considered as adjuncts to drug treatment 4.
- For osteoarthritis, paracetamol and topical NSAIDs are recommended as first-line treatments, with oral NSAIDs or COX-2 inhibitors considered if pain relief is insufficient 5.
From the Research
Medication Options for Arthritis
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are effective in treating rheumatoid arthritis, with ibuprofen being as effective as aspirin and other NSAIDs in doses of 1,200 mg/day or more 6.
- Conventional synthetic disease-modifying antirheumatic drugs (DMARDs) like methotrexate, injectable biologic DMARDs, and targeted synthetic DMARDs are also effective treatments for rheumatoid arthritis 7.
- Janus kinase (JAK) inhibitors are another option for treating rheumatoid arthritis, offering a different route of administration and mode of action compared to biologics, and are useful in cases where patients have inadequately responded to treatment with methotrexate and/or biologic DMARDs 8.
Considerations for Treatment
- The use of NSAIDs should be carefully considered, as they can have adverse effects related to inhibition of prostaglandin production, and patients with risk factors for NSAID toxicity should use the lowest dose of a drug with a short half-life only when needed 9.
- Predicting the best treatment for rheumatoid arthritis is an area of ongoing research, with advances in precision medicine and machine learning predictive models showing promise in identifying gene signatures that predict response to therapy and the refractory state 10.