Rheumatoid Arthritis Treatment

As there is no cure for this disease hence the aim of Rheumatoid arthritis treatment includes the following

• decrease the pain and inflammation
• protect the joints and maintain their function
• control the involvement of other organs

General rheumatoid arthritis treatment methods include the following

• Rest during inflammation and pain.
• Exercise to maintain the range of motion of joints, muscle strength and prevent development of deformities.
• Use of splints and other devices to prevent deformities.
• Education about the disease and the requirement of continous therapy and lifestyle modifications.
• Involvement of the patient and his or her family in community programs for arthritis patients.

Medical rheumatoid arthritis treatment includes the following drugs

• Non Steroidal Anti-inflammatory Drugs also called NSAID's
• Steroids
• Disease Modifying Anti-Rheumatic Drugs also called DMARDs
• Biological Agents
• Immunosuppressive Drugs
• Diet Supplements

The function of NSAIDs is to reduce the inflammation there by controlling the pain and swelling in the joints. They have no effect on the disease process that continues to go on relentlessly. These drugs are of two types

• those that block the enzyme cyclo-oxygenase 1 and 2 (aspirin, diclofenac, ibuprofen, piroxicam)
• those that block the enzyme cyclo-oxygenase 2 only (called coxibs as etoricoxib)

Those drugs that block the enzyme cyclo-oxygenase 1 and 2 have the main side effect of ulceration the stomach and duodenum along with gastro-intestinal bleeding.

Those that block the enzyme cyclo-oxygenase 2 only cause an increased chances of having a heart attack. So they are better for young people who have almost no risk of having a heart attack. Initially these drugs gained much popularity but when their adverse effects on the heart were discovered they fell into disrepute.

I only use NSAIDs in those patients that have very mild disease. In other patients I may use them for a week or two. After that I stop them and continue steroids.

Steroids have a strong anti-inflammatory action. They can be given in the form of tablets and injections. Their anti-inflammatory action is caused by a decrease in the production of cytokines and chemokines by the the white blood cells. They also limit the movement of inflammatory cells to the local site (synovium in rheumatoid arthritis).

They enhance the effect of NSAIDs and certain DMARDs. They have also been found to reduce the formation of bony erosions.

Disease Modifying Anti-Rheumatic Drugs or DMARDs are a class of drugs that have been found to effect the progression of the disease. They include the following drugs

• methotrexate
• hydroxychloroquine
• leflunomide
• gold salts
• D-penicillamine

The effect of DMARDs is not immediate. There full effect is usually seen after a few months. They are usually unable to induce a remission (complete halt of the disease process that can last for months to years with out any continuous treatment required). They cause a reduction in the rheumatoid factor, C reactive protein and erythrocyte sedimentation rate levels.

I use methotrexate along with hydroxychloroquine and if the response is inadequate then I add lefunomide. Steroids are given in as low a dose as possible.

Biologic agents used for rheumatoid arthritis treatment are a group of substances that

• block the activity of cytokine Tumor Necrosis Factor, this group includes
1. Infliximab
2. Adalimumab
3. Etanercept
• block the activity of Interleukin 1, this includes the drug called Anakinra
• block the activation of T cells, this includes the drug Abatacept
• cause a depletion of B cells, this includes the drug Rituximab

These agents reduce the signs and symptoms of the disease and also prevent the destruction of bone and cartilage. They are good for patients that do not respond to DMARDs.

Immunosuprressive drugs include the following agents

• Cyclosporine
• Cyclophosphamide
• Azathioprine

Their efficacy is similar to DMARDs. They have more serious side effects hence are only used in patients that have failed to respond to DMARDs and biological drugs. Extra-articular disease may at times require therapy with these agents.

Increasing dietary intake of omega 3 fats found in fish oil and reducing in take of omega 6 fats results in a improvement of symptoms.

I hope the information provided was helpful. If you have any query you can ask me at the contact me page.

This page was last updated on 31st March 2009.

See also...

Rheumatoid Arthritis Cause

Rheumatoid Arthritis Pathology

Rheumatoid Arthritis Symptoms

Rheumatoid Arthritis Diagnosis

Rheumatoid Arthritis Drugs

Rheumatoid Arthritis Prognosis

Hand Deformities

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