All about rheumatoid arthritis

Two relatively new NSAIDs are targeted more directly at neutralising an enzyme called COX-2, which triggers pain and inflammation, while sparing an enzyme called COX-1, which helps maintain the normal stomach lining. The pills are celebrex, which is approved for both osteoarthritis and rheumatoid arthritis, and vioxx, approved for osteoarthritis, acute pain and menstrual pain.

These drugs come with the same potential side effects but they may be less than those of other NSAIDs. They are only recommended for UK patients who are intolerant of other NSAIDs, or if they have a history of gastro-intestinal bleeding.

DMARDs are used to alter the course of the disease and prevent joint and cartilage destruction. They can produce significant results, but no one is sure exactly how they work. You may need to wait weeks - perhaps even months - before seeing any effect, and you may use some or all of the drugs, depending on the specifics of your condition.

DMARDs include gold salts, traditionally given by injection but now available in tablet form. Antimalarials (such as hydroxychloroquine) can also be used, as can penicillamine, which has been prescribed for over 50 years and is taken by mouth. Sulfasalazine, a drug distantly related to the antibiotic penicillin (also taken by mouth) may be helpful.

Pay attention to how your body responds to these drugs. Not only do you need to make sure the medications are effective (efficacy may diminish over time), but you need to be alert to any problems arising from the drugs.

Gold salts can cause skin rash, mouth sores, upset stomach, kidney problems and low blood count. Antimalarials are associated with upset stomach and - in rare instances - eye problems, and sulfasalazine can also cause an upset stomach.