Arthritis drugs
There are 3 major classifications of drugs used to treat arthritis. They are:
Analgesics. These drugs block pain without reducing inflammation. They fall into non-narcotic and narcotic categories. Obviously the narcotic category is reserved for patients with very severe pain unresponsive to lesser analgesics. Non-narcotic analgesics are drugs like acetaminophen. Narcotic analgesics are medicines like Darvocet, oxycodone, etc. A drug that falls midway between is tramadol which has minimal to mild narcotic properties.
Anti-inflammatory drugs. Also known as NSAIDS (non-steroidal anti-inflammatory drugs), these drugs block inflammation and secondarily reduce pain. Most of these drugs work by blocking an enzyme called cyclooxygenase (COX). Since cyclooxygnease comes in at least two varieties (COX 1 and COX 2), the question is which cyclooxygenase do NSAIDS block. The answer for most of the older NSAIDS is both of them... which is why the older NSAIDS have both anti-inflammatory effects as well as less desirable side effects such as stomach ulcers.
COX 2 inhibitors block only COX 2 which allows them to block inflammation without leading to the increased incidence of ulcers seen with the older drugs. Unfortunately, COX 2 inhibitors may also, because of their mode of action, lead to an increased incidence of cardiovascular events (heart attacks and strokes) in susceptible patients.
Disease-modifying drugs. These drugs act on the underlying arthritis process and by selectively blocking certain immune targets, can actually slow the process of destructive change down. Examples are drugs like methotrexate, azathioprine, sulfasalazine, cyclosporine, and hydroxychloroquine. Older DMARDS such as gold and penicillamine are rarely used any more.
Newer DMARDS known as biologics are probably even more effective. However, these drugs by suppressing the immune response also leave the patient open to more serious infectious complications. While DMARDS are effective for inflammatory forms of arthritis, very few DMARDS exist for the most common form of arthritis, osteoarthritis. Fortunately, new drug research is targeting this most common affliction.
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