Rheumatoid Arthritis Treatment
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Rheumatoid Arthritis Treatment
There are different treatments that the doctors recommend for relieving the symptoms and slowing down the process of RA.
There are three general classes of drugs commonly used in the treatment of rheumatoid arthritis:
- non-steroidal anti-inflammatory agents (NSAIDs)
- remittive agents or disease modifying anti-rheumatic drugs (DMARDs).
NSAIDs and corticosteroids have a short onset of action while DMARDs can take several weeks or months to demonstrate a clinical effect.
Non-steroidal Anti-inflammatory Agents
The major effect of these agents is to reduce acute inflammation thereby decreasing pain and improving function.
Typically, these will be your aspirins, Tylenol, Ibuprofen, and Aleve. No one NSAID has been demonstrated to be better than another for the treatment of rheumatoid arthritis.
You will usually start feeling some relief within an hour but it takes a while before they start helping the swelling not to occur.
Corticosteroids have both anti-inflammatory and immunoregulatory activity. They can be given systemically or can be injected.
Corticosteroids are useful in early disease as it can take a while waiting for DMARDs to exert their anti-inflammatory effects.
Corticosteroids are also useful for people with severe disease that is not well controlled on NSAIDs and DMARDs. Prednisone is usually used in these cases. Once started, corticosteroid therapy is very difficult to discontinue and even at low doses. Tapering of prednisone should be done slowly over a few weeks and symptoms may reoccur with small changes in the prednisone dose.
Weight gain is a frequent problem and source of patient complaints. Higher doses of prednisone are rarely necessary unless there is a life-threatening complication of RA and, if used for prolonged periods, may lead to serious steroid toxicity. Although a few patients can tolerate every other day dosing of corticosteroids which may reduce side effects, most require corticosteroids daily to avoid symptoms.
(e.g., 40mg of triamcinolone in a knee, 20mg in a shoulder, or 2mg in a finger) are effective for controlling a local flare in a joint without changing the overall drug regimen.
DMARDs include methotrexate, leflunomide (Arava, etanercept) (Enbrel) infliximab (Remicade), adalimumab (Humira), anakinra (Kineret), antimalarials, gold salts, sulfasalazine, d-penicillamine, cyclosporin A, cyclophosphamide and azathioprine.
Because cartilage damage and bony erosions frequently occur within the first two years of disease, rheumatologists now move more aggressively to a DMARD agent. In some cases, analgesic drugs may also be helpful.
See Methotrexate Information