The 13 best medications for arthritis

*Review of the best according to the editorial board. About the selection criteria. This material is subjective, not intended as an advertisement, and does not serve as a guide to purchase. Consultation with a health care professional is necessary before purchase.

The treatment for most arthritis is a “pure” therapy, since all but a very few arthritis are treated with conservative methods. Most often arthritis is treated by general practitioners, and more “narrowly” specialists – rheumatologists. Rheumatologists are needed when the inflammation of the joints is systemic in nature, and associated with connective tissue disorders and autoimmune pathology. Much less often inflammatory joint disease is the fate of infectious disease doctors and phthisiatricians, because there is, for example, brucellosis and even tuberculosis arthritis. For example, if an adult has isolated, unilateral, long-standing inflammation of the knee joint, that is, asymmetrical gonitis, it is almost always a tuberculous process.

Before we talk about the drug treatment of arthritis, let us remind you what it is, how arthritis differs from arthrosis, and what it is. After all, when talking about arthritis, we are referring to a whole group of different diseases.

What is arthritis and what is it?

Arthritis is an inflammatory lesion of the joints, in which the main signs are the classic symptoms of inflammation. These symptoms have been known since ancient times, and their significance for the doctor has not changed until now. The classic inflammatory signs that can be fully attributed to any arthritis are:

  1. Redness or redness of the local area, which indicates hyperemia, or inflammatory blood flow to the joint area.

  2. swelling, which also indicates inflammatory edema, which is caused by the reaction of the tissue to the release of biologically active substances in the focus of inflammation;

  3. Localized fever, or a feeling of heat over the affected joint. This is a very characteristic component of inflammation, and indicates an increase in metabolic processes in the lesion;

  4. Local soreness is one of the most important symptoms of arthritis, but pain in the affected joint will not only occur with arthritis, but also with arthrosis. The following will tell you how easy it is to tell the difference between arthritis and osteoarthritis;

  5. Finally, the last, the fifth big symptom of inflammation characteristic of arthritis, is the dysfunctional. Impaired function is lameness, limitation of mobility, development of stiffness in the joint, and so on.

All the symptoms of arthritis are extremely simple and straightforward, and all of them can be identified on their own, and very quickly. But sometimes they talk about osteoarthritis of the joint. What is the difference between arthritis and arthrosis, and how not to confuse these diseases?

The differences between arthritis and osteoarthritis

First of all, the end of the medical term. All noun medical terms that end in “-it” are the name of inflammatory diagnoses: encephalitis, peritonitis, maxillary sinusitis, arthritis. All terms that end in “-osis”, are already diseases of non-inflammatory nature, in which there is pathological overgrowth and change in certain tissues. For example, sclerosis is a pathology of the blood vessels in which they become brittle and hard. Amyloidosis is a process of formation of pathological protein amyloid, chondrosis is a modification of cartilage tissue, in which cartilage becomes brittle, and loses elasticity.

Finally, osteoarthritis is a joint pathology in which the articular surfaces change, a crunch occurs when moving, the production of synovial fluid or lubricant decreases, and all this also leads to limited mobility in the joints and the occurrence of pain syndrome. But at the same time, arthritis does not have such pronounced inflammatory signs. On the contrary, an attentive physician can distinguish between arthritis and arthrosis from the complaints even if there is no obvious redness of the skin and local increase in temperature over the affected joint.

Here are the typical signs of this distinction. In a patient with arthritis, pain in the joint occurs as soon as the patient begins to move, and then the joint gradually “gets used up”. A very characteristic symptom is an elderly person limping right after getting out of bed in the morning, he needs to separate, and he gets better in the afternoon. In the case of arthritis, the situation is reversed, the joint needs rest, and rest reduces the severity of the inflammation, the swelling decreases, and then it becomes easier to walk, although this does not last long.

Arthritis and osteoarthritis have characteristically different symptoms on radiographs, and on ultrasound examinations, as well as on tomography, but we won’t dwell on that.

Arthritis can be classified in different ways. If one joint is affected, this is monoarthritis; if several joints are affected, this is oligoarthritis; if many, this is polyarthritis. Also, arthritis can be primary or secondary, depending on what process led to the inflammation. Inflammatory joint damage can be of an infectious nature, for example, with the same brucellosis, or Lyme disease, the inflammation can also have a metabolic nature. A classic example is an attack of gout, affecting the base of the big toe. A large number of arthritis is a systemic disease of the connective tissue, and can have an autoimmune, rheumatic origin. A classic example is rheumatoid arthritis.

If arthritis has a systemic origin and is a symptom of connective tissue damage, there may be other signs. There are vascular lesions, hemorrhagic syndrome, vascular thrombosis, peripheral nervous system affection in the form of mononeuritis or polyneuropathy. The patient may have concomitant eye involvement, the presence of dry or effusion pleurisy and pericarditis, and other severe symptoms. Such diffuse lesions are treated with serious drugs. These are corticosteroid hormones, cytostatics and immunosuppressants, which will be discussed below. But in most cases, the treatment of simple arthritis, which is not complicated by pathology of internal organs, is much easier.

Pharmacotherapy, or medications for arthritis

Since arthritis as an inflammation of the joints has been known since ancient times, and unlike inflammatory processes in internal organs, all symptoms can be seen with the eyes, the very first treatment of arthritis was carried out with folk remedies. There is still a folk custom of applying burdock, or cold to the site of inflammatory swelling and redness, which leads to relief. But this mode of treatment is purely symptomatic in nature. Yes, symptom relief is a very important stage of treatment, especially at the beginning.

Naturally the most important and most unpleasant symptom diminishing the quality of life is an inflammatory intense throbbing or persistent pain in the joint at rest and also when walking. Unfortunately, it is impossible to influence inflammation by pain elimination, so the main and basic group of drugs will be non-steroidal anti-inflammatory drugs, or NSAIDs. They arrest the inflammation itself, and are used extremely widely for arthritis. These are intramuscular injections, pills, intraarticular injections. To eliminate inflammation, especially chronic inflammation, patients can use topical medicines with NSAIDs – these are various ointments, creams and gels, liquid balsams, bischofit, ozokerite, and other means that improve the metabolism in the joints, and eliminate inflammation. You can use local remedies at the stage of stable remission, and in acute process.

In addition to classic arthritis treatment regimens, there are also those medications that cannot simply be bought in pharmacies. We are talking about a modern treatment for severe arthritis, which is treated for life. These are baseline drugs, cytostatics, complex agents and immunosuppressants widely used in rheumatology. An example of such severe arthritis would be rheumatoid arthritis, you can learn about it here.

A large group of the most modern drugs for the treatment of arthritis and systemic pathology are so-called monoclonal antibodies, created artificially by methods of molecular genetics. These are inhibitors of certain elements of inflammation, agents that fight immune aggression, blockers of pathogenic lymphocyte function, and interleukin. These can all already be called heavy artillery, and these drugs will be discussed at the end of the article.

It should be said that, in addition to the drugs of the main series, there are always auxiliary agents. So, if in addition to the inflammation of the joint, the muscles are affected, then central muscle relaxants are used, which reduce muscle spasms and reduce pain. If the arthritis develops against a background of stress and generalized anxiety disorder, taking antidepressants will help reduce pain. If a patient does not tolerate anti-inflammatory drugs and has a stomach ulcer or erosive gastritis, then modern drugs for the treatment of ulcers, i.e. proton pump blockers, are always used as a cover. In some cases, vitamins and micronutrients, physical therapy, and a change in exercise regimen of the joint are indicated.

This article will discuss medications that are among the major. We will not talk about gastroprotectors, antidepressants, there are separate articles for that, and we will start the drug review with a large group of non-steroidal anti-inflammatory drugs.

For each medication the international nonproprietary name (INN) is given first, followed by the name of the original drug and its generics or commercial copies. A range of prices from the most expensive to the cheapest denomination will be given. Prices are valid for retail sales of drugs for the beginning of 2021 in the Russian Federation. The order in which drugs are listed is not a rating scale or ranking; they are placed in random order according to their classes, or groups.

The list is also not an advertisement, or an invitation to buy. The use of arthritis remedies in the form of self-medication for long periods of time, more than 3-5 days is not acceptable. Only a doctor, taking into account the indications and contraindications, can prescribe a particular drug. All information about drugs was taken solely from public sources, and posted on the Internet the official instructions for the drugs. All of these drugs are recommended for use in the treatment of arthritis of different etiology, according to national and international clinical guidelines, as well as protocols for the treatment of patients with inflammatory joint damage.

Rating of the best drugs for arthritis

NSAIDs (non-steroidal anti-inflammatory drugs)1Meloxicam (Movalis,Amelotex, Arthrosan, Genitron, Melox, Movasin, Revmart)574 €
2Nimesulide (Nimesil,Aponil, Naise, Nemulix, Nimesan, Nimulide, Prolide)677 €
3Ketorolac (Ketanov, Dolac, Ketocam)52 €
4Lornoxicam (Xefocam, Zornica)220 €
5Diclofenac (Voltaren, Diclac, Diclofen)32 €
6Ketoprofen (Ketonal)134 €
Hormonal Intraarticular Drugs1Betamethasone (Dipropan)366 €
2Penicillamine (Couprenil)1 432 €
3Methotrexate300 €
4Leflunomide (Arava, Ralef, Elafra)1 142 €
Topical remedies for arthritis1Nayatox (cobra venom)151€
3Diclofenac (Voltaren Emulgel)294 €
4Ibuprofen (Dolgit)120 €

NSAIDs (Nonsteroidal Anti-inflammatory Drugs)

NSAIDs are a major, and virtually indispensable, group of medications. More than 239,000 original articles have been published on pabmed, the world’s largest server of research, articles and databases, clinical reviews, about non-steroidal anti-inflammatory drugs.

They fight both the symptoms listed above and block the mechanism of inflammation itself by inhibiting a special enzyme – cyclooxygenase. If a drug selectively blocks cyclooxygenase type 2, it is called a selective drug. It is safer, acts selectively, and causes fewer side effects common to older, “non-selective” drugs in this group. Generally, all anti-inflammatory nonsteroidal drugs act on the three “whales” of inflammation:

  1. Fever, or fever (antipyretics);
  2. pain;

  3. Inflammation itself as a pathophysiological process.

We are not interested in antipyretic properties, because arthritis rarely has a general fever. Therefore, agents like Aspirin, Paracetamol, and Ibuprofen are of little use in acute and chronic arthritis. Medicines that selectively reduce pain, decrease swelling and reddening, and restore function, however, are very helpful. The most popular ones are.

Meloxicam (Movalis, Amelotex, Arthrosan, Genitron, Melox, Movasin, Revmart)

Rating: 4.9

Meloxicam (Movalis, Amelotex, Arthrosan, Genitron, Melox, Movasin, Revmart

Movalis is a highly effective German medicine that is available in ampoules for intramuscular injection and in tablets. In acute arthritis, especially those of a rheumatic or systemic nature, the drug is first used intramuscularly, in parenteral form, on the first day, and then switched to tablets for maintenance therapy. It goes without saying that if we are talking about acute infectious, or purulent arthritis, then the treatment should begin with antibiotics and antibacterial drugs, but not with the relief of secondary inflammation.

Movalis is good for relieving pain, reducing fever, and inhibiting prostaglandin synthesis. In addition to acute and chronic arthritis, it is indicated for lower back pain, disc protrusion and herniated discs, rheumatoid arthritis, and ankylosing spondylitis, or Bechterew’s disease. It is prescribed usually for acute pain syndrome 1 tablet 15 mg, once a day. After the effect is achieved, the dose is halved. The maximum dosage should not exceed 15 mg per day, that is, one tablet is the maximum daily dose. Produces Movalis the company Berlin-Chemie, and the cost of a pack of 10 tablets of 15 mg ranges from 370 to 540 rubles. The cheapest domestic analogue by Pranapharm will cost from 43 rubles. up to 100 rubles. In other words, the domestic analogue is 16 times cheaper than the original drug. We hope that the quality of treatment is not 16 times worse after all.

Advantages and disadvantages

This is a highly active drug, and although it belongs to the selective, it should still be taken in the shortest possible courses, and immediately reduce the dose. It is contraindicated, as many NSAIDs, when nasal polyposis is combined with bronchial asthma and aspirin intolerance. The main contraindications are active gastric ulcer, acute erosive gastritis, Crohn’s disease, or ulcerative colitis, severe liver damage, threatening gastric bleeding, pregnancy, lactation and age under 12 years. The drug has quite frequent side effects such as headache and gastrointestinal disorders, the drug can interact with other drugs, which should be taken into account when prescribing.

Nimesulide (Nimesil, Aponil, Naise, Nemulix, Nimesan, Nimulide, Prolide)

Rating: 4.8


Nimesulide is one of the few drugs from the group of NSAIDs that is not available in ampoules for parenteral administration. The most common are powders for solution in water and ingestion, tablets, as well as various creams and gels. One of the remedies indicated for joint pain, arthritis and back pain, even for muscle and tooth pain and soft tissue injuries is Nimesil. It has a milder effect than Movalis. Not only does it fight inflammation and relieve pain, but it also helps to lower the temperature, which can be useful for colds. The drug can even be used for painful periods, and although after its withdrawal the symptoms resume, it can be indispensable as part of complex therapy.

Nimesil and its analogues should be used one packet twice a day, the duration of intake should not exceed 2 weeks. Nimesil is also produced by the same company Berlin-Chemie and a pack of 30 pouches for a 2-week course costs between 600 and 750 roubles. Domestic sachets by Marbiopharm can be purchased at a price of 250 to 590 rubles., But the cheapest are the tablets of the same name. Even a dosage of 20 units is sold in pharmacies at a price of 40 rubles, and even lower.

Advantages and disadvantages

Nimesil has the same contraindications as Movalis. It is not recommended in cases of severe blood clotting disorders, alcoholism and drug addiction. It is also contraindicated in pregnant women and nursing mothers, and can cause side effects typical of NSAIDs, of which nausea, diarrhea or even vomiting are the most common. As in the previous case, any nimesulide should be used with minimal effective doses and a minimally short course. It is also undesirable to combine this drug with other drugs from the NSAID group.

Ketorolac (Ketanov, Dolac, Ketocam)

Rating: 4.8


Unlike the two drugs described above, ketorolac, or Ketanov, has a particularly, pronounced anti-pain orientation. It is not so good for the overall inflammation, and practically does not reduce the temperature, but the acute pain is significantly reduced after its use, or even completely goes away. The ability of Ketanov and its analogues to relieve pain is close to that of narcotic analgesics and Tramadol. Even severe toothaches and pain after surgery can be treated with it. The drug is a derivative of acetic acid, in very intense pain is used intramuscularly, but most often used in tablets, this is enough. The drug ketorolac can be considered the strongest analgesic of all other drugs in this group.

The drug should be used in tablets, one tablet daily, the maximum daily dose for very severe joint pain should not exceed 40 mg, and the course duration should not exceed five days, regardless of the dose. Thus, Ketorolac and its analogues are not a remedy for long-term treatment, but a drug for emergency therapy. All analogues are very inexpensive, for example, Indian Ketanov can be purchased at a price of 40 to 55 rubles., There are 20 tablets in a pack.

Advantages and disadvantages

Ketanov has a huge, significant advantage in the form of a powerful analgesic effect, and the Ministry of Health of the Russian Federation gets a huge and fat minus, because Ketanov without a prescription in the pharmacy you will not be sold, although it does not affect opioid receptors, and has nothing to do with drugs. Apparently, if you have a severe tooth or joint pain, then you must first beg for a prescription from your therapist, although until recently this drug was available as a lifesaving painkiller quite affordable. As for the other disadvantages, it is a standard set of contraindications, including pregnancy, lactation period and age under 16 years, and the same set of side effects. A very good plus is the low price, but this advantage is immediately lost because of the complete unavailability of the drug in the free market.

Lornoxicam (Xefocam, Zornica)

Rating: 4.8

Lornoxicam (Xefocam

Lornoxicam has a fairly high safety profile, and also belongs to the class of oxycams, just like Movalis. This drug is a good pain reliever, relieves inflammation well. Lornoxicam does not depress breathing, and is excellent for back pain, musculoskeletal pathology, and inflammatory joint damage.

It is important to understand that Xefocam, as well as all other agents from the group of anti-inflammatory drugs, are symptomatic treatments. Yes, they relieve mild to moderate pain syndrome of muscular, and joint origin, in tendinitis, tendovaginitis, in arthritis and arthrosis. But they have no direct effect on the cause of pain. After all, arthritis can be caused by prolonged, monotonous and monotonous work, and then it would be aseptic reactive arthritis. In such a case, the joint will need to rest, and the drug from the NSAID group will help the patient to recover. But in the case of arthritis caused by tuberculosis or chlamydia, then this agent will not cure the patient. And here the etiotropic therapy, affecting the cause, should be specific antibiotics.

The drug is used in tablets, 8 mg, and one pack of 10 tablets will cost from 80 to 240 rubles. Xefocam is manufactured by the well-known pharmaceutical company Takeda, formerly Nicomed. The drug is used once, 8 mg, the maximum daily dose is 2 tablets, or 16 mg. The drug is also available in ampoules for intramuscular or intravenous administration, to achieve the quickest effect.

Advantages and disadvantages

Xefocam works quickly and is well tolerated. After taking Xefocam tablets or intramuscular injections, the pain in the inflamed joints may subside considerably, and the person can undergo the necessary X-ray examinations or procedures while taking the medicine, under “cover”.

However, this drug should not be taken permanently, because, like all drugs of the NSAID group, it can cause erosive-ulcerative bleeding, lead to anemia, heart palpitations, and often causes abdominal discomfort, diarrhea and even vomiting. The drug should not be taken in children under 18 years of age, people with aspirin intolerance, bleeding disorders, or immediately after an aortocoronary bypass, and people with severe hepatic impairment. Xefocam should also not be prescribed to pregnant and lactating women.

As in all other cases, it is highly undesirable to combine two drugs from the NSAID group at the same time. Although this leads to an increase in the therapeutic effect, it also leads to an even greater degree of side effects. But if Xefocam is used in short courses, with all precautions, and in conjunction with topical medications to treat arthritis, it will significantly improve quality of life, reduce pain, redness and swelling, and increase the range of motion in the joint.

Diclofenac (Voltaren, Diclac, Diclofen)

Rating: 4.8


None of the drug reviews can do without diclofenac. Diclofenac is truly a people’s favorite drug. Those patients who are little help from any other drugs from the group of NSAIDs, eagerly buy themselves preparations of diclofenac, and even overly keen on self-medication, injecting it into the intramuscular. This people’s love for him is justified: it is a well-known, very effective and inexpensive.

But Diclofenac, despite its effectiveness, is also one of the roughest drugs, with many side effects and contraindications. Diclofenac should be prescribed very short courses, preferably no more than 3-4 days, covering possible gastrointestinal complications with proton pump inhibitors, the same prophylactic taking omeprazole.

Diclofenac, due to its high effectiveness, and wide application, is also available in ampoules, in enteric-soluble tablets, and in suppositories, and even in eye drops. One of the most effective drugs diclofenak deservedly considered Voltaren, production of the famous pharmaceutical company Novartis. This is the most expensive diclofenac, for 20 tablets of 50mg you will have to pay from 240 to 308 rubles. Naturally, domestic pills are much cheaper. Diclofenac manufactured by Ozone will cost only 13 rubles for the same amount. But if you try hard, you can find very, very cheap Diclofenac of European quality. The same drug from Chemopharm from Southern Europe, will also cost less than 20 rubles.

Of course, Diclofenac is available in a variety of ointments, creams and gels, which are also used for the treatment of acute and subacute arthritis. Diclofenac itself is a derivative of phenylacetic acid, and its very high anti-inflammatory ability allows you to reduce joint pain, at rest and in motion, reduces morning stiffness and swelling.

Apply the drug in acute and subacute arthritis orally, preferably 100 mg once a day, that is two pills daily. If the patient develops morning stiffness or nighttime joint pain, in addition to this dosage, you can add rectal suppositories with diclofenac. But in any case, the daily dose should not exceed 150 mg. The duration of treatment for acute joint syndrome with diclofenac without medical supervision should not exceed 3-5 days, and in the case of independent intramuscular injection, the maximum daily dose remains the same. Diclofenac may not be administered intramuscularly longer than 3 days!

Advantages and disadvantages

Diclofenac can be considered a textbook example of contraindications and side effects for NSAIDs. There are quite a few restrictions on its use: it is aspirin triad, gastrointestinal erosive and ulcerative lesions, pregnancy, breastfeeding, age under 18 years, and other conditions. With extreme caution, the use of diclofenac and its analogues in elderly patients is required. Together with diclofenac it is undesirable to use alcohol. If prescribed along with diuretics, Diclofenac may decrease the effectiveness of.

But despite all the limitations, diclofenac, especially its inexpensive, domestic forms, will always be used to reduce joint pain, relieve arthralgia and improve quality of life, especially in the elderly.

Ketoprofen (Ketonal)

Rating: 4.8


Another modern drug that is used in inflammatory and dystrophic-degenerative diseases of the musculoskeletal system is ketoprofen in capsules, or Ketonal. Ketonal is produced by the Slovenian company Lek and its price is quite democratic: you will have to pay only 100 rubles for a pack of 25 x 50 mg capsules, but the price is only 100 rubles for European quality.

Ketonal is available not only in tablets, but also in ampoules, its task is to quickly relieve pain, and restore the amount of movement. In addition to its anti-inflammatory action and analgesic, that is, analgesic, the product has a slight antipyretic effect.

Ketonal is indicated for a variety of arthritis, spondylitis, psoriatic joint damage, Reiter’s syndrome in complex therapy with antibiotics. Treat rheumatoid arthritis, osteoarthritis, and osteoarthritis with ketonal. The drug can be administered for migraine, headaches, and suppresses not only mild and moderate, but also severe pain in cases of neuralgia, radiculitis, and any musculo-articular pain. It is also used to relieve painful periods, and even to relieve pain in oncology. A single dose of Ketonal 1-2 tablets, but you can not exceed 200 mg per day, that is four tablets. The number of times it can be taken. As always, the course should be as short as possible, and without a doctor’s prescription should not exceed 5 days for the treatment of acute pain in arthritis of various etiologies.

Advantages and disadvantages

But in this case Ketonal is the drug of choice, which can be initially administered intramuscularly for one or two days in acute arthritis, and then, after the acute pain subsides, you can transfer the patient to tablets together with local remedies. The contraindications for Ketonal are standard, like all NSAIDs. It is used with caution in the presence of Helicobacter infection. But this caution is understandable, since Helicobacter is a predictor of ulcers. If the patient has gastric and duodenal ulcer disease or erosive ulcerative gastritis, then it is best to use this medication together with proton pump inhibitors for covering, and then only if the ulcer or gastritis is in remission, and with great caution.

Hormonal intra-articular medications

And what to do if intramuscular and tablet preparations from the group of non-steroidal anti-inflammatory drugs do not help? Then, in special indications, hormonal agents are used, and when it comes to intra-articular injections, hormones are primarily meant.

Betamethasone (Dipropane)

Rating: 4.9

Betamethasone (Dipropane

The best known and most widely used topical glucocorticosteroid is betamethasone. It is administered as a sterile suspension. This is a fairly strong glucocorticosteroid hormone that is used in the form of intra-articular and peri-articular injections. This drug is administered both intramuscularly, in a dose of 1 to 2 ml, and intraarticularly. Intra-articular injection of 0.5 to 2 ml quickly and permanently eliminates pain, restores joint mobility, and the effect of only one injection can be long-lasting: up to 1 month, and even longer.

Dipropan is produced by the well-known company Schering-Plough from Belgium, and the drug can be purchased in a small package of 1 ml, which may be enough in the case of small joints for four joints, and in the case of a large joint – for one joint. The cost of such a package ranges from 230 to 300 rubles. There is also an analogue, Betaspan Depo, manufactured in Ukraine. There will be as many as five ampoules in a pack at a price of 450 to 500 rubles. per pack. Accordingly, the cost of this tax will be about 4 times cheaper if we consider the price of a single ampoule.

Advantages and disadvantages

Dipropan’s advantages are its fast and long action, western quality, low price. However, this medication cannot be given intravenously or subcutaneously, but it is not advisable to prescribe it immediately, after all, it is a strong, reserve medication. Like any glucocorticosteroid, it can cause increased potassium excretion, sodium retention and edema, weight gain, a rise in blood pressure, and osteoporosis. With prolonged use, it can induce steroid diabetes mellitus, aggravation of various manifestations of gastritis, aggravation of peptic ulcer disease, and other complications and side effects characteristic of glucocorticoids.

Dipropan is also contraindicated in acute infectious arthritis, since, as mentioned above, infectious arthritis is not treated with pathogenetic agents that affect the inflammatory mechanism, but with etiotropic therapy, that is, it affects the direct cause of arthritis – pus flora.

Current treatment for severe arthritis

But there are forms of arthritis that require lifelong treatment and that require long-term medication. The goals of these drugs are already different – to affect the autoimmune process, reduce the rate of cell division, and thus eliminate inflammatory symptoms. Simply fighting the inflammation by blocking cyclooxygenase and disrupting the inflammatory cascade is no longer a sufficient solution. Such drugs are called basal agents, and belong to the classes of complexing agents, cytostatics, and immunosuppressants. No one will prescribe such drugs to a patient with symptomatic arthritis, which can be cured by other means, such as infection control for tuberculous arthritis or a rational work and rest schedule for occupational joint inflammation. Baseline medications are prescribed for those systemic processes where patients may be given a disability. The classic diagnosis is severe, progressive forms of rheumatoid arthritis, or ankylosing spondylitis (Bechterew’s disease). Let’s list the most well-known drugs from the group of basal drugs.

Penicillamine (Cuprenil)

Rating: 4.9


Penicillamine (not to be confused with penicillin!), which is sold under the commercial name Cuprenil, is available in tablets, and refers to complexing compounds. This means that it forms large molecular structures with atoms of copper, iron, cobalt, calcium, and other trace elements. This drug belongs to the antirheumatic specific drugs.

Penicillamine is indicated in severe forms of rheumatoid arthritis, in the presence of systemic scleroderma, as well as Wilson’s disease, when the body accumulates too much copper, and it must be bound and eliminated from the body. Cuprenil is also indicated for severe metal poisoning, such as lead, or mercury. The drug is used only by prescription of a rheumatologist, half an hour before a meal or after a meal after two hours in the presence of such a diagnosis as rheumatoid arthritis.

The starting dose starts at 250 mg per day, then the dose is slowly doubled according to a special scheme, until a significant improvement is achieved, and then the dose is gradually reduced. Thus, the minimum effective dose is achieved. If the medication has not helped within 6 months of starting treatment, the remedy is considered ineffective. Usually the maintenance dosage is 600-750 mg per day. The drug is available in tablets of 250 mg, in a bottle of 100 tablets. Cuprenil is produced in Poland by the pharmaceutical company Polfa, and a pack costs an average of 1300 rubles, which is not cheap, considering the duration of use.

Advantages and disadvantages

As with any serious drug, Cuprenil is contraindicated in renal failure, in children, pregnant and lactating women, in the presence of agranulocytosis in the blood, and in renal failure. Cuprenil “does not like” combinations with cytostatics. The big disadvantage may be considered unpredictability; in about 30% of patients the drug may not be effective, but this will be known only after several months of treatment. Because this drug doesn’t “work” right away, and even a week or two after starting treatment, you can’t tell if it will help or not.

In addition, Cuprenil can cause a large number of side effects, such as vomiting and stomatitis, skin rashes and taste distortions, eosinophilia, and interstitial pneumonitis. When prescribing Cuprenil it is important to remember that it is a vitamin B6 antagonist, so with long-term treatment it can cause pyridoxine deficiency and peripheral nervous system disorders, up to polyneuritis, which disappears after stopping treatment.


Rating: 4.8


Methotrexate is the next baseline cytostatic drug, which is used in various forms of arthritis, including severe rheumatoid arthritis, psoriatic arthritis. In addition, it is indicated in various malignant tumors, lymphogranulematosis. It relates to folic acid antimetabolites, so it is mandatory that while taking methotrexate, the patient should take a fairly high dose of folic acid to avoid complications, according to specific regimens. It’s also prescribed under a special regimen, and it does slow the progression of rheumatoid arthritis.

Methotrexate is available in tablets of 5 mg, and one of the best known and most effective is Methotrexate produced in Austria by Ebeve Pharm. 50 pills will cost between 300 and 380 rubles.

Advantages and disadvantages

Methotrexate can cause both early and delayed side effects. Various gastrointestinal symptoms develop early, ulcerative stomatitis of the oral mucosa is possible, headache occurs. As for the late, or delayed, side effects, up to a third of all patients experience them. It is the development of anemia, a decrease in white blood cells, a drop in platelets. 1% of patients suffer from drug-induced pneumonitis, and this is a severe complication that can even be life-threatening. A significant decrease in immunity against a background of methotrexate leads to the development of opportunistic infections, fungal lesions occur, and even pneumocystis pneumonia. Methotrexate is harmful to the liver, so you need to monitor the liver enzymes during treatment.

Leflunomide (Arava, Ralef, Elafra)

Rating: 4.8


Arava is a modern immunosuppressant that also belongs to the baseline drugs. This medication is indicated primarily for rheumatoid, and secondarily for severe psoriatic arthritis. Arava is available in tablets, and is initially taken at 100 mg daily for 3 days, and then switched to a maintenance dosage of a low dose, 10 to 20 mg per day. As in the case of Cuprenil, the initial therapeutic effect does not appear until a month and a half after the start of therapy, and the patient in the case of successful therapy feels better and better, this therapeutic effect may build up over six months, gradually reaching a maximum.

Manufactured by Sanofi Aventis. One pack of 30 10 mg tablets will cost from 1,200 to 3,500 rubles., This is enough for one month of maintenance therapy. If the patient is just starting treatment, then during the first three days he will consume the entire vial, as he takes 10 tablets a day. But there is a way out – it is domestic leflunomide, which is produced, for example, by the company Canonfarma Production: the same package will cost less than 1000 rubles, in the range of 950 rubles.

Read more about treating rheumatoid arthritis with Arava here.

Advantages and disadvantages

Like all baseline drugs, it is contraindicated in pregnant, lactating women and people under 18 years of age, you should not take Arava with severe liver and kidney function disorders, severe infections, leukopenia, suppression of bone marrow function and severe immunodeficiencies. In addition, it has embryotoxic effects, and if a man taking this medicine will conceive a child, he should be warned of the high risk of intrauterine deformities.

The drug also produces significant side effects, ranging from diarrhea and nausea to tenovaginitis and possible ligament tears, and hair loss. The content of leukocytes in the blood decreases, anemia develops, and sometimes allergic reactions occur. Therefore, it is necessary to take such drugs only under the control of specialists and test data.

Modern Monoclonal Antibodies

Finally, to conclude this review, it is necessary to recall modern drugs that require modern molecular genetic technology to produce. The result is exactly the same, or monoclonal antibodies that humans help produce special microorganisms, such as production strains (races) of special yeasts.

But in order for yeast to begin producing monoclonal antibodies in addition to alcohol, special genes, sections of nucleic acids that are artificially formed and not previously found in yeast, must be introduced into their genetic code, their hereditary information. It takes a very high-tech industry to create such an artificial gene that encodes the creation of the desired antibody proteins. And this gene must not just be created, it is implanted into a yeast cell and then multiplied and maintained by this clone. After that, the antibodies produced are collected in “pure form”. Thus, yeast becomes a supplier of an extremely important product, a kind of “medical animal.

There are several known drugs that are used in rheumatology, including for the treatment of arthritis. These are Remicade and its analogues, which inhibit tumor necrosis factor (TNF) and are classified as immunosuppressants. This is rituximab, or Mabthera. Mabthera is an antitumor drug that alters B-lymphocyte function, and is used in the active form of severe rheumatoid arthritis. It’s a drug like Orencia, or a blocker of T-lymphocyte stimulation. The latter drug is also used to improve activity in adult patients with severe active rheumatoid arthritis.

It should be recalled that all these drugs are prescribed only when the patient poorly tolerates the baseline drugs, or does not respond to them actively enough. There are many such situations, because many of the baseline drugs are aggressive and cause a large number of side effects, such as the same Methotrexate.

All monoclonal antibodies are usually administered intravenously as an infusion, and their cost is very, very high, so patients have to literally fight with officials for many of them, despite the fact that many of them should be given to the patient for free. Thus, the cost of the cheapest infliximab (generic Remicade) is from 11 to 26 thousand rubles per vial, and in the case of Remicade, that is the original product, the price can be up to 53 thousand rubles. Mabthera also costs in the range from 13 to 45 thousand rubles, and if it is a solution for subcutaneous administration with a high dosage, the cost can go up to 120 thousand rubles. The drug Orencia, or abatacept, is also quite expensive, and the interleukin receptor blocker, or Actemra, can also in its price up to several tens of thousands of rubles.

Why are these drugs so expensive? First of all, they are very difficult to get, even the most advanced pharmaceutical production is not enough for that, it is molecular genetic, biotechnological production. Monoclonal antibodies are very selective, so although they have side effects, the therapeutic process can still be controlled with a high level of prediction.

That is why all these modern remedies are extremely effective, and in patients with severe arthritis and high risk of rapid disability monoclonal antibodies, if not stop the process, can still significantly delay the onset of disability, for example, by making it half as long. Therefore, if statistically a person becomes disabled in 7 years, with the use of monoclonal antibodies this person will be able to look after himself or herself for the full 14 years, or even longer, and be able to look after himself or herself and lead an active life. Believe me, it’s not a small term at all.

Local remedies for arthritis

Despite the abundance of the most modern drugs of the XXI century, our story about the treatment of acute and subacute, chronic arthritis would be incomplete if we did not talk about local remedies. There are a lot of them: these are warming compresses, belts and knee pads made of dog and camel hair, ebonite circles, Kuznetsov or Lyapko applicators, and devices for home physiotherapy. People apply bishofit to their joints, warm them with ozokerite and paraffin, make Dimeksid compresses.

We will tell you about several ointments, creams and gels, which are sold in abundance in any drugstore without a prescription, and often serve as an emergency aid, being in any medicine cabinet. What is the difference between an ointment, a cream and a gel? When to apply them?

  1. The ointment is best applied at night. It is a greasy substance, usually on petroleum jelly or lanolin. It takes a very long time to be absorbed, stains clothing, but has a long lasting healing effect. So it is wise after applying at night to give the ointment time to soak for a few hours, you can under an occlusive dressing, for example, under parchment.

  2. A cream is an emulsion, a suspension of fat in water, or a solvent. The most popular known cream can be considered mayonnaise sauce, in which tiny droplets of vegetable oil are distributed in the egg white or yolk. The cream is absorbed much faster than the ointment, literally within a few minutes, and if you carefully massage the desired location.

  3. Gel is no longer an emulsion of a fat-soluble nature, but an aqueous-alcoholic mass which evaporates very quickly, and leaves a protective film on the skin. Gel penetrates deep into the tissues the least, so it is wise to apply anti-inflammatory gels in the projection of large joints, where they are least covered by the skin, such as on the knee or elbow area. You can apply the gel to the intercostal area, but the attempt to apply it to an obese person’s buttock to get it “through it” to the sciatic nerve is doomed to failure.

Of course, there are a huge number of ointments, gels, creams “from joints” and inflammatory lesions of the musculoskeletal system. There are warming ointments and cooling ointments. Here is one representative each of the ointment, cream and gel used to treat arthritis.

Nayatox (cobra venom)

Rating: 4.9


Nayatox is a Vietnamese ointment (Vietnam is the largest supplier of medicinal snake venom), and the main active ingredient is cobra venom, along with camphor, methyl salicylate and eucalyptus oil. This remedy irritates the skin, cools and relieves pain, and is best suited for diseases of the musculoskeletal system. It is arthritis, radiculitis, neuralgia, sciatic nerve inflammation or sciatica. This ointment should be applied to the skin in small amounts, one or two teaspoons, rubbing into the skin once a day. For severe pain syndrome, it can be applied twice a day. The drug can be used for up to 10 days without a doctor’s prescription. A small package of this ointment weighing 20 g will cost from 200 to 250 rubles.

Advantages and disadvantages

Nayatox cannot be used in cases of individual intolerance, fever, active tuberculosis or infectious diseases, exhaustion, insufficient cerebral circulation, patients who have recently suffered a heart attack or have unstable angina. Do not apply ointment with snake venom to pregnant and lactating women, as well as persons with skin lesions in the projection of the application. However, Nayatox, applied correctly, on the second or third day after the onset of arthritis symptoms, intensely helps to dissolve the inflammatory focus, and due to the irritating, distracting influence of camphor, slightly cools and soothes.

Diclofenac (Voltaren Emulgel)

Rating: 4.8


Above we have already described Diclofenac in its different forms. Now Novartis, continuing the “line” of Voltaren in different forms, produces Voltaren Emulgel, in the form of gel for external use. The most expensive tube, 2% diclofenac weighing 100 g will be expensive: from 580 to 750 rubles, but this amount is enough for a long time. Tube of 1% diclofenac weighing 50 g will already cost 356 rubles. And a small tube of 20 g can be purchased even cheaper than 200 rubles. Yes, this remedy is not cheap, but Diclofenac when used topically, especially when combined with tablet form, intensely relieves pain, swelling, inflammation, reduces fever in the joint, eases sleep in nighttime pain and improves range of motion.

It is indicated for a variety of pain due to musculoskeletal disorders, rheumatoid arthritis, muscle bruises and sprains. Apply the product 3 times a day, the size of the dose – no larger than a large cherry or walnut. It is advisable to wash your hands after rubbing, because the gel has a specific smell. In the event that small finger joints need to be treated, it goes without saying that you don’t need to wash your hands.

Advantages and disadvantages

We wrote above that Diclofenac is one of the most active and unsafe NSAIDs. So you should not use it without a doctor’s recommendation for more than 7 days. The drug is usually not absorbed into the blood in large quantities, unless, of course, you smear too large areas of skin. Very rarely and with local application there can be urticaria, Quincke’s edema, and contact dermatitis and rash can develop quite often, but still less often than one case per 10 uses. The product is contraindicated for use on the skin with a tendency to aspirin asthma, intolerance to aspirin, pregnant and lactating women, children under 12 years of age, as well as in the presence of wounds and scratches in the area of application. You need to be very careful when using this remedy in chronic hepatic and renal failure, and avoid getting the gel on the mucous membranes, and in the eyes.

Ibuprofen (Dolgit)

Rating: 4.8

Dolgit cream (ibuprofen)

Dolgit cream contains five percent ibuprofen, and a 50-g tube will cost 120 to 140 rubles. Dolgit-cream is produced in Germany, and is used to treat pathology of the musculoskeletal system. It is a rheumatic pain, arthritis, arthrosis, lumbago (lumbar arthritis), and radiculitis. The cream has a pronounced anti-inflammatory and analgesic effect. It reduces swelling, redness, improves the amount of movement in the joints, the temperature over the surface of the inflamed joint is reduced. Apply the drug should be 3 to 4 times a day, and rub lightly in the desired location. A 4-6 cm long strip of cream is enough. Do not forget that the cream, unlike the ointment, is absorbed quite well if you massage the affected area actively enough.

Advantages and disadvantages

The cream is contraindicated in case of hypersensitivity to ibuprofen, in pregnant women and during breast-feeding; it cannot be used in children under 14 years of age, though ibuprofen in the form of Nurophen is prescribed for children as an antipyretic. But the fact is that in this cream, in addition to pure ibuprofen, there are auxiliary additives, such as solketal, isopropanol, poloxamer, and other additives, to which children may be intolerant.

But if you have Dolgit cream in your home medicine cabinet, know that in cases of sprains, strains, bruises, or arthritis symptoms, it can briefly reduce pain, swelling, swelling, lower the temperature over the affected joint, and increase the range of motion. This is just enough time to visit an emergency room or doctor, get qualified medical care, go to the pharmacy, return home, and begin treatment with whatever the doctor prescribes.

Conclusion: cooling or warming?

At the very beginning of the inflammatory process, when inflammation progresses in the joint, when pain increases, redness and swelling intensify, then by no means should you immediately apply warming ointments, apply heat, take a steam bath or conduct a rough, warming massage with rubbing.

After all, this is the period when the blood rushes into the joint as it is, and an additional increase in blood circulation in the joint will lead to even more swelling and a rapid increase in pain, since the inflammation is still developing, and you are helping it.

At this point, just help cooling ointments containing peppermint oil. You can even simply anoint a joint that is beginning to hurt with peppermint essential oil, diluting it with basic vegetable oil, such as sunflower oil, in the consistency of one to ten. This composition will be pleasantly cold and distracting, and you can put a wet or cold compress on the joint. Not for nothing our ancestors ply on the painful joints with arthritis leaves fresh burdock. Hot joint wrapped with a cool burdock leaf, from the burdock intensely evaporated water, the burdock leaf stopped cooler, and reduced the pain.

But after 2-3 days, when the maximum phase of inflammation has passed, it is necessary to use both warming ointments and dry heat. They will have a resolving effect, improve the outflow of blood from the joint, reduce swelling and rasping pain, increase the amplitude of movement. It must be remembered: it is when the improvement begins, when the increase in swelling and pain ends, then you can carefully start “steaming the bones”. If this is done at the beginning, it will lead to a sharp increase in pain symptoms.

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