Find out more about your medicines from your pharmacist
Taken from: NRAS magazine, Autumn 2010
There are approximately 400,000 people living with rheumatoid arthritis across the UK and the majority take a variety of medicines. Some are used only for pain relief, others are used to reduce inflammation and to slow the course of the disease. The newest medicines help reduce both inflammation and structural damage to the joints.
Everyone experiences RA differently, so it may take time to find the best combination of medicines for your needs. Even before you were diagnosed, you may have been visiting your pharmacist for pain-relief.
“Pharmacists are experts in medicines and can really help you to manage your condition,” says Professor Roger Knaggs, an advanced pharmacy practitioner in pain management from Nottingham. For example, they can advise you on the different types of pain relief you may be using.
Reducing pain and stiffness
“Painkillers will make you feel more comfortable but they don’t tackle the underlying reasons for the pain. Although paracetamol does not treat inflammation, it can be a very useful and safe painkiller if taken as recommended and no more than eight tablets are taken each day.
“Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen and diclofenac, reduce inflammation in the joint lining and relieve pain and stiffness and reduce swelling. It is important to take NSAIDs with food, as they can cause stomach problems and stomach bleeding. You may need to be prescribed an anti-ulcer medication at the same time.
“Both paracetamol and NSAIDs can either be taken when needed or regularly if you are experiencing a flare-up of your condition.”
The Pain Ladder
"The successful management of pain with medicines relies on selecting the most appropriate medicine at the correct dosage and balancing pain relief against side effects. A pain ladder has been developed to help find the right treatment and is now widely used for the management of all types of pain,” explains Professor Knaggs.
“The ladder recommends a stepped approach to the use of painkillers from these analgesic groups starting with simple analgesics (paracetamol and NSAIDs), progressing through weak opioids such as codeine, and tramadol to strong opioids (morphine). At every step of the pain ladder, simple analgesics form the basis of the pain management,” adds Professor Knaggs.
Decreasing disease activity and preventing joint damage
“Medicines that reduce disease activity are called disease-modifying antirheumatic drugs (DMARDs). Examples include methotrexate, sulphasalazine and azathioprine. DMARDs ease symptoms but also reduce the damaging effect of the disease on the joints.
“DMARDs have no immediate effect on pain or inflammation and it can take several weeks or months before you notice any effect. Therefore, it is important to keep taking DMARDs as prescribed, even if they do not seem to be working at first.
“Each DMARD has different possible side effects. If one does not suit, a different one may be fine. Some people need to try several DMARDs before finding one that is right for them. While taking DMARDs it is usual to have regular blood tests to look for some of the possible side effects before they become more serious.
“Because DMARDs affect your immune system, you may be more susceptible to infection. Anyone taking DMARDs should have flu vaccinations every year and pneumonia vaccinations as recommended by your doctor. Other vaccinations may be dangerous if you are taking DMARDs, so it is very important to discuss immunisation requirements with your doctor or pharmacist.”
Medicines Use Review
Community pharmacists across the UK offer a free NHS service called a Medicines Use Review which provides an opportunity for you to discuss your medicines privately and confidentially with a pharmacist. You may feel that you no longer need all of your medicines, the dose might need adjusting, or you may be experiencing certain problematic side effects. Your pharmacist may be able to suggest some changes to your medication which you can discuss with your GP and help you get the most benefit out of your medicines.
As well as medicines there are other things that you can do to help RA. “As far as possible, try to keep active as the muscles around your joints will become weak if they are not used. Regular exercise may also help to reduce pain and improve joint function. Swimming is a good way to exercise many muscles without straining joints too much. Where possible, protect your joints from unnecessary strain using supports and other aids,” explains Professor Knaggs.
The Royal Pharmaceutical Society believes that the most important thing for RA patients is to have access to information about their medication. Pharmacists are highly trained health professionals on the high street who can talk to you in confidence about any of your health concerns.