Rheumatoid Arthritis

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Treatment

There is no cure for rheumatoid arthritis and the goals of treatment are to relieve symptoms, improve function, slow progression of the disease, and prevent disability. It is important to diagnose RA early and begin aggressive treatment as soon as possible. Patients who have the condition often are treated by a team of physicians and other health care providers, including rheumatologists, nurses, counselors, and physical therapists.

Medications called disease-modifying anti-rheumatic drugs (DMARDs) are often prescribed to treat rheumatoid arthritis. Until these medications take affect, other medications can be used to reduce symptoms.

Analgesics are medications that relieve pain only—they have no impact on inflammation. The most common non-prescription analgesic is acetaminophen (e.g., Tylenol®). For pain that does not respond to acetaminophen, doctors may prescribe opioid analgesics such as Percoset®, Darvocet®, or codeine.

Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce inflammation in addition to relieving pain. There are three types of NSAIDs:

• Traditional NSAIDs include non-prescription ibuprofen (e.g., Advil®) and about 20 different prescription forms. These medications relieve pain and reduce inflammation, but may cause gastrointestinal bleeding and stomach upset.
• COX-2 inhibitors (e.g., Celebrex®) are relatively new to the market and studies continue on their safety and side effects. In general, these drugs are considered to produce fewer gastrointestinal side effects.
• Salicylates include aspirin and non-acetylated salicylates. These medications relieve pain and reduce inflammation. Possible side effects include kidney problems and intestinal bleeding.

In cases where inflammation seriously threatens joints and other tissues, corticosteroids (e.g., prednisone) may be prescribed. In low doses, these drugs can work quickly and effectively to prevent inflammation from harming the eyes and internal organs in advanced cases of rheumatoid arthritis.

Taken in high doses for long periods of time, corticosteroids have caused brittle bones, high blood sugar, and cataracts. However, these drugs currently are prescribed in lower doses and for shorter periods of time to reduce the risks of these side effects.

Disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate (Rheumatrex®), sulfasalazine (Azulfidine®), leflunomide (Arava®), and gold (oral and injectable), may be used alone or in combination to reduce RA symptoms and prevent joint damage.

Biologic response modifiers (BRMs), such as etanercept (Enbrel®) and infliximab (Remicade®), which inhibit a protein that contributes to inflammation, may be used when other treatments have been ineffective. BRMs can slow the progression of RA and can even bring about long periods of remission.

Side effects of these medications may be severe and include nausea, liver damage (hepatotoxicity), bone marrow suppression, lung inflammation (pneumonitis), and oral ulcers. DMARDs and BRMs suppress the immune system and can make the patient more vulnerable to infection. Patients receiving these medications should receive regular physical examinations, as well as regular blood tests and organ function tests.

Rituximab (Rituxan®) may be used in combination with methotrexate to treat adults who have moderate-to-severe RA that does not respond to other treatment.

Rituximab is a biologic therapy that targets certain white blood cells (B-cells) thought to be involved in the abnormal immune system response that causes rheumatoid arthritis. This medication is administered in two infusions and may improve RA symptoms for up to 6 months. Serious side effects (e.g., fatal infusion reactions, irregular heartbeat) may occur following treatment.

Prognosis

Studies have shown that early diagnosis and aggressive treatment for rheumatoid arthritis can help prevent joint damage and maintain function in many patients who have the disease. Recent advancements in treatment have helped more patients with RA to live healthy and productive lives.

Rheumatoid Arthritis, Treatment, Prognosis reprinted with permission from podiatrychannel.com
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