There is no known cure for rheumatoid arthritis. It stays with you lifelong with periods of remissions and flare-ups. The rheumatoid arthritis treatment, therefore, provides options only to
- reduce the joint inflammation and pain,
- prevent further bone and cartilage damage and deformity
- improve the function of the affected joint.
Rheumatoid arthritis, or RA, is a chronic autoimmune inflammatory disease. This means that your body’s immune system attacks particular healthy tissue cells in your body by mistake, causing inflammation, pain, and swelling in the affected parts of the body.
In rheumatoid arthritis, the immune system mainly attacks the tissue lining the symmetrical joints on both sides of your body.
The number of joints involved in RA varies a lot, but almost always the involvement is eventually polyarticular, sometimes involving five or more joints. Occasionally, some patients may experience an eruptive polyarticular onset occurring over 24 to 48 hours.
Ideally, it is best to diagnose rheumatoid arthritis early so that prompt and aggressive treatment can be initiated and further damage to the bones and cartilage can be prevented or stopped.
Who treats rheumatoid arthritis?
Ideally, a rheumatologist treats rheumatoid arthritis. He is a super-specialist in internal medicine with additional training and experience in joint and connective tissue diseases as well as in the diagnosis and treatment of various forms of arthritis and associated conditions.
You may also be referred to an orthopedic surgeon who specializes in the diagnosis and treatment of bones and joint diseases.
You will also have to see a physiotherapist to exercise your affected joints to restore and increase their range of mobility.
An occupational therapist may be called in to teach you ways to perform your daily activities with the least effort and pain.
Rheumatoid Arthritis Treatment Guidelines
Treatment to control rheumatoid arthritis is customized to suit every case differently and depends on the severity of the condition, the joints involved, the general condition, and the age of the patient.
The most important purpose of treating rheumatoid arthritis is to reduce joint pain and swelling and to slow down or stop joint damage. This helps to maintain or improve joint function.
Rheumatoid arthritis treatment consists of:
- Educating the patient about his condition,
- Physiotherapy to strengthen the ligaments and muscles around the joint,
- Occupational therapy to help him deal with daily activities with the least discomfort and pain,
- A combination of drugs for relief from the symptoms and to arrest further damage to the joint,
- Surgery is indicated to restore the function of severely damaged joints and when your pain isn’t controlled with medication.
Physical therapy for rheumatoid arthritis
- Physiotherapy guides you to exercise the muscles of the affected joints to maintain mobility and reduce pain.
- Occupational therapy for rheumatoid arthritis advises the patient to carry on his everyday routine in ways that will not put the affected joints under strain. For example, a door can be opened by leaning on it instead of opening it with your hands whose joints are inflamed.
- Assistive devices can make help avoid stressing your painful joints.
Rheumatoid arthritis medications
Drugs for RA are used for relief from symptoms and to suppress the autoimmune system, which causes rheumatoid arthritis.
The first line of treatment consists of fast-acting anti-inflammatory painkillers and steroids to give relief from the symptoms such as pain and to reduce inflammation. These drugs do not halt the damage to the joints, cartilage, and the adjoining soft tissues
The second line of treatment consists of slow-acting drugs to prevent joint damage and promote remission of the disease.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as ibuprofen and naproxen sodium form the first line of treatment and help in reducing pain and inflammation. Aspirin in higher doses will also help. Mild NSAIDs are available over-the-counter and the stronger ones require a prescription. Side effects include pain in the abdomen, gastrointestinal bleeding, heart problems, liver, and kidney toxicity.
- Steroids. Steroids such as Prednisolone are given to reduce inflammation. Side effects of steroids are to be watched for, and these drugs are withdrawn in a tapering dosage. Long-term use of steroids can give rise to serious side effects such as weight gain, facial puffiness, thinning of the skin and bone, easy bruising, cataracts, risk of infection, muscle wasting, and destruction of large joints, such as the hips.
- Diseases modifying antirheumatic drugs (DMARDs). Biologic DMARDs help in RA by stopping the progressive damage that is taking place in the joints and tissues. Methotrexate (Trexall) is a commonly used DMARD drug. Other examples include leflunomide (Arava), hydroxychloroquine (Plaquenil), and sulfasalazine (Azulfidine).
Treatment with DMARDs is prolonged and takes over 2 to 3 months and due to their serious side effects were formerly reserved for patients who have joint damage.
However, in choosing the lesser of the two evils, nowadays, therapy with DMARDs is started soon after the diagnosis and is given in combination with another drug. This lessens the seriousness of the side effects. It is to be noted here that, DMARDs do not succeed in every patient but in most of them.
Side effects include liver toxicity, bone marrow suppression, and lung infections. However, methotrexate is a safer option as it is not usually associated with such serious side effects. It has, therefore, become the DMARD of choice.
- Immunosuppressants. As rheumatoid arthritis is due to our own autoimmune system, immunosuppressants are used to modify our autoimmunity. They block the action of certain proteins in our autoimmune system. This prevents further damage to the affected joints. These drugs are often given in combination with DMARDs. The combination helps in two ways. It gives a better effect and reduces the side effects of these two drugs.
Side effects: Immunosuppressant medications depress bone marrow function and cause anemia, a low white cell count, and low platelet counts.
Surgery for RA is the last resort in rheumatoid arthritis treatment. Your doctor will advise it when medications fail to prevent or slow joint damage. Surgery may help restore the function of your joint. It can also reduce joint pain and improve the function of the joints.
- Joint replacement. The surgeon removes the damaged joint and replaces it with a prosthesis made of metal and plastic. This functions like the original joint.
- Synovectomy. This surgery removes the inflamed lining of the joint (synovium), which helps to reduce pain and improves the joint’s function.
- Tendon repair. The surgeon repairs the damaged and loosened tendons around the joints.
- Joint fusion is carried out to stabilize the joint and give relief from pain. It is done when joint replacement is not an option.
Rheumatoid arthritis prognosis
Rheumatoid arthritis is characterized by periods of remissions and flares.
- In some patients, after an initial attack, there may be a period of remission for many years with no symptoms
- In some patients, there may be periods of remissions alternating with periods of flares.
- In most patients, RA stays on to be chronic and progressive. These patients have to take prolonged treatments or resort to surgery.
- Most patients with RA report that their quality of life improves a lot after such surgery. the time taken for recovery may take days, weeks, or months before you can go back to doing all the things you used to. Sometimes, you may recover faster and it may take no time at all.