Symptom control - use of analgesics and NSAIDs

Symptomatic treatment of rheumatoid arthritis is primarily achieved through the use of non-steroidal anti-inflammatory drugs. There may be the need for a further drug, e.g. paracetamol, to be used specifically as an analgesic.

If there are acute exacerbation, or chronic active disease that is difficult to control, then there may be a role for short-term corticosteroid therapy in symptomatic management.

NICE state that (1):

• consider oral non-steroidal anti-inflammatory drugs (NSAIDs, including traditional NSAIDs and cox II selective inhibitors), when control of pain or stiffness is inadequate
  • take account of potential gastrointestinal, liver and cardio-renal toxicity, and the person's risk factors, including age and pregnancy
    
    
• when treating symptoms of RA with oral NSAIDs: offer the lowest effective dose for the shortest possible time offer a proton pump inhibitor (PPI), and review risk factors for adverse events regularly
  
  
• if a person with RA needs to take low-dose aspirin, healthcare professionals should consider other treatments before adding an NSAID (with a PPI) if pain relief is ineffective or insufficient

If NSAIDs or COX-2 inhibitors are not providing satisfactory symptom control, review the disease-modifying or biological drug regimen

Reference:

• 1. NICE (July 2018). Rheumatoid arthritis- The management of rheumatoid arthritis in adults