Medications for rheumatic diseases 4/5 (6)

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This page contains a brief description that does not cover the medication. For more information read the review in for the respective drug.



Treatment of rheumatic connective tissue disorders and other rheumatic diseases with medication may be crucial to the prognosis. However, drug use is associated with uncertainty and opposition among many. Studies have shown that 4% never start treatment and 40% stop within one year, even though continued treatment was planned (reference: Blascke TF, 2012). Good information about the purpose of the treatment, possible side effects and follow-up is therefore important (reference: Arians H, 2019)

Before any treatment is started

It is important to be clear about the disease, what the target is and the side effects that can occur.

Four important questions one should patiently ask for treatment:

  1. Do I need this treatment?
  2. What is the risk of side effects?
  3. Is there an alternative?
  4. What if I do not do anything?


When disease-inducing drugs, Biological drugs or cortisone (high doses) is started by the rheumatologist / rheumatology department and continues to be used, it is common for the specialist / department to follow up in collaboration with the GP until treatment can be terminated. This ensures proper treatment and good patient safety.

  • Please read more about the control plan here.

Medical treatment principles in rheumatic diseases

  • Against rheumatic pain is often paracetamol drugs first choice (Paracet, Pinex, Panodil, Paracetamol and more)
    • Caution, among other things, in liver disease
  • Other choices are NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). Examples are Ibux, Ibuprofen, Voltaren, Voltarol, Diclofenac and more
    • Caution in cases of ulcers or at the same time «blood-thinning drugs»
    • Prolonged use may increase the risk of acute myocardial infarction (reference: Masclec GMC, 2018)
  • Some combine paracetamol and NSAIDs, but the Medicines Agency does not recommend this because of increased risk of side effects
  • Before stronger painkillers (Nobligan, Tramadol, Paralgin Forte with more), other treatments must first be considered. Prolonged use causes less impact and risk of addiction
  • In joint inflammation, joint puncture and cortisone injection can be a better solution.
  • If there is a lot of rheumatic inflammation, can Prednisone and / or other disease-inducing drugs (Methotrexate with more) be a better solution. However, if an infection is present, antibiotics (Penicillin with other) are essential
  • Biological drugs is a group of medicines that can be given if other treatment is not sufficient
  • In arthritis, data suggest that the need for hip replacement was 3 times higher and knee prostheses 14X times higher before more extensive use of antidepressant treatment began (1996 versus 2011 in Denmark, r: eference Cordtz RL, 2018)
  • Disease-suppressing / immunosuppressive drugs can be classified according to mechanisms of action
    • B-cell inhibitors:
      • Azathioprine (Imurel)
      • Mycophenolate (CellCept)
    • T-cell inhibitors
      • Ciclosporin A (Sandimmun Neoral)
      • Tacrolimus (Prograf, Advagraf)
    • Folate inhibitor
      • Methotrexate (inhibiting actively dividing cells)

Monitoring of blood samples and follow-up

Pregnancy and medication

In pregnancy or planning for pregnancy, proper use of drugs is particularly important: current information is on the separate page concerning pregnancy.

Treat against a goal (Treat to target)

Prior to starting treatment, a realistic treatment goal should be established.

  • The goal may be to achieve less disease activity as measured by symptoms and medical examinations, fewer swollen joints in arthritis, lesser signs of lungs, kidneys or other affected organs, less pain or less fatigue.
  • It is usually necessary to treat over 3-6 months before relevant evaluation can be done.

It is a goal to treat effectively, but with the least amount of drugs and the lowest possible drug doses. The risk of side effects is then reduced to a minimum. In order to succeed, good and regular contact between patient, GP and specialist is required.

Drugs (a selection): Alphabetical drug selection with links:

Aclasta (zoledronic acid)

Advagraf (Tacrolimus) See Prograf below


Apremilast (if Otezla)

Arava (Leflunomide)

Benepali (Etantercept)

Benlysta (Belimumab)

Bio-equivalent drugs (biosimilars)

Bosentan (Tracleer)

Calcigran Forte

Calcort (Deflazocort)

  • A cortisone preparation that has many common features with prednisolone. Studies suggest that Calcort has the same side effects (and effects) as prednisolone when the dose is similar to prednisolone (reference: Badadjanova G, 1996). Deflazocort such as Calcort or other trade names is not available in Norway.
  • Information from Wikipedia (English) here (in Danish)

CellCept (Mycophenolate mofetil)

Cimzia (Certulizumab)

Colrefuz (kolkisin)

Cosentyx (sekukinumab)

Enbrel (Etanercept)

Evoax (cevilemine) tablets

  • Alternatives to the Salagen (see below). Stimulates residual saliva production and can be used for dry mouth where one expects a residual function in salivary glands
  • Evoax is not marketed in Norway. One must apply The Norwegian Medicines Agency on a special form + write prescription
  • Side effects include sweating, chills, runny nose, headache and other cholinergic side effects. Side effects increase with increasing dose.
  • In heart or lung disease, Evoax may be contraindicated (not to be used)
  • The most commonly used dose is 30mg 3 daily
  • More information here (in Danish) (

Folic acid

Humira (Adalimumab)

Azathioprine (Azathioprine)

Inflectra (Inflix Simab)

Kineret (Anakinra)


LDN (Low dose naltrexone)

  • Uncertain if the drug has an effect on pain and fatigue
  • LDN is an opioid antagonist.
    • thus, counteracts the effect of Pinex forte, Paralgin Forte and similar analgesic drugs containing opioid-like substances.
  • Apply for registration.
  • Delivery in Norway via Kragerø Apotek
  • Please read more about LDN here (in Danish) (

MabThera (Rituximab)

Methotrexate / methotrexate


  • Please see CellCept here (in Danish)
  • NB Myfortic has different pharmacogenetics from CellCept so that AUC cannot be calculated in the same way.

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

Nucala (mepolizumab)

Oluminant (baricitinib)

Summary (marcitentan)

Orencia (abatacept)

Otezla (apremilast)

Plaquenil (Hydroxychloroquine)


Prograf (Tacrolimus)

Remicade (Infliximab)

Remsima (Inflix Simab)

Revatio (sildenafil)

Rixathon (rituximab) is bioequivalent to MabThera

RoActemra (Tocilizumab)

Salagen (pilokarpin)

  • Information in English Wikipedia here (in Danish)
  • The most commonly used dose is 5mg 3 tablets daily
  • Stimulates residual saliva production and can be used for dry mouth if one expects a residual function in salivary glands
  • Salagen is not marketed in Norway and one must apply The Norwegian Medicines Agency on a special form + write prescription
  • Side effects include sweating, chills, headaches and other minor serious cholinergic side effects. The incidence of side effects increases with increasing dose
  • If one suffers from cardiovascular or eye disease, one may not use the Salagen

Sandimmun Neoral (Ciclosporin A)

Sendoxan (Cyclophosphamide)


Simponi (Golimumab)

Soliris (eculizumab)

SoluMedrol (Methyl prednisolone)

Stellara (Ustekinumab)


  • se Prograf og Advagraf above

Tracleer (bosentan)

Viatmin D 

Ambrisentan (ambrisentan)

Volon A oral saliva 0,1%, (DERMAPHARM)

Xeljanx (tofacitinib)

Current links

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