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.
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 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 arthritis and associated conditions.
You may also be referred to an orthopedic surgeon who specializes in the diagnosis and treatment of bones and joints 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 age of the patient.
It consists of 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 the last resort.
(A) Therapy for Rheumatoid Arthritis
- Physiotherapy guides you to exercise the muscles of the affected joints to maintain the 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.
(B) Rheumatoid arthritis medications and their side effects
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.
1. 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 such as Prednisolone are given to reduce inflammation. Side effects of steroids are to be watched for, and these drugs are given 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.
3. Diseases modifying antirheumatic drugs (DMARDs)
These RA medications act to stop 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 taken over 2 to 3 months and due to their serious side effects were formerly reserved for patients who have joint damage.
However, in choosing 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.
As rheumatoid arthritis is due to our own autoimmune system, immunosuppressants are used to modify our autoimmunity.
They block the action of certain proteins of 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: gives a better effect and reduces the side effects of these two drugs.
Side effects: Immunosuppressants medications depress bone marrow function and cause anemia, a low white cell count, and low platelet counts.
5. Prosorba column is a device that filters out the antibodies, which cause inflammation of the joints, from the blood. This therapy is now not used due to its ineffectiveness.
- Joint replacement is done by replacing the joint with a metal one.
- Synovial sac is removed surgically when it is damaged due to chronic inflammation.
- Tendon repair is carried out when the tendon is badly damaged.
- 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 | Living with Rheumatoid Arthritis
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 of the patients, RA stays on to be chronic and progressive. These patients have to take prolonged treatments.
Alternative Treatment for Rheumatoid Arthritis
Natural or alternative treatment does not play a significant role in RA and cannot be relied upon solely. This is because after the onset of RA, prompt treatment to stop bone damage immediately is essential. Herbal remedies for rheumatoid arthritis do not offer such prompt results.