Rheumatoid arthritis or RA in short is an autoimmune disease involving the immune system of the body which normally protects the body by attacking foreign substances like viruses & bacteria. Most commonly rheumatoid arthritis is found to affect joints of wrists, hands, elbows, ankles, feet & knees. Most often the effect on joints is symmetrical, meaning that when one hand or knee is affected the other one is also feeling similar symptoms. Moreover, since RA can also affect body systems like respiratory or cardiovascular systems, it is a systemic disease which can affect the entire body.
Common Treatment Options for Rheumatoid Arthritis
Goals of rheumatoid arthritis treatments are as follows:
- Put disease in remission or stop inflammation.
- Prevent damage to organs & joints
- Relieve symptoms
- Improve overall well-being & physical function
- Reduce complications in the long-term
Doctors usually adopt a combination of strategies for treatment of rheumatoid arthritis including the following:
- Early Aggressive Treatment – First strategy of RA treatment is to stop or reduce inflammation as soon as possible, like they say, earlier the better.
- Targeting Remission – Doctors usually refer to inflammation during RA as disease activity. Therefore, ultimate goal of this line of treatment is to stop progression & achieve remission. This eventually means that no signs or symptoms of active inflammation should be present. One strategy which is designed to achieve this goal is known as ‘treat to target’.
- Tight Control – Putting RA disease activity at a lower level & keeping it there is known as ‘tight control of RA’. Studies reveal that tight control can slow the pace or even prevent damage to joints. Medications for RA include several drugs which are used for treating rheumatoid arthritis. Some of these are primarily used to ease symptoms of RA, while others are utilized to slow or stop course of the disease & for inhibiting structural damage.
- Drugs to Ease Symptoms – These are nonsteroidal anti-inflammatory drugs known as NSAIDs & which are available over the counter or by prescription. These drugs are normally used to ease arthritis inflammation & pain. NSAIDs commonly include naproxen sodium, ketoprofen & ibuprofen among others. Doctors may prescribe celecoxib, which is a type of NSAID known as COX-2 inhibitor, for people who have had or are at risk of stomach ulcers. These are considered safer for the stomach. Moreover, these medications can either be orally taken or applied to skin as a patch or cream, directly over the swollen joint.
- Drugs to Slow Disease Activities Include the Following
- Corticosteroids – These medications include prednisolone, prednisone & methyprednisolone, which are quick-acting & potent anti-inflammatory medications. These are used in RA to control potentially damaging inflammation while waiting for DMARDs & NSAIDs to take effect. Due to risk of side effects from these drugs, doctors generally prefer only to use them for as short period of time as possible & in low doses as well.
- DMARDs – This is an acronym for disease-modifying antirheumatic drugs. DMARDs are drugs which work in modifying the course of RA. Conventional DMARDs include azathioprine, cyclophosphamide, leflunomide, sulfasalazine, hudroxycholorquine & methotrexate. These medications can be taken orally, self injected or administered as an infusion in a clinic.
- Biologics – These are drugs which are a subset of DMARDs. Biologics are however found to work more quickly than DMARDs & are either injected or administered by infusion in a clinic. Since these drugs target specific steps within the inflammatory process, they do not wipe away the entire immune response of the body like some other rheumatic arthritis treatments do. Biologics can modify, slow down or stop progression of RA in several people, even when other treatments have not been able to help much.
- JAK Inhibitors – This is a new subcategory of DMARDs known as JAK inhibitors which block JAK, Janus Kinase pathways which are involved in immune response of the body. Tofacitinib is one such drug which belongs to this category. Moreover, unlike biologics, JAK inhibitors can be orally administered.
- Surgery – Surgery for RA may however never be required, but this can be an excellent option for patients who have undergone permanent damage which limits their mobility, daily activity & independence. Joint replacement surgery can effectively restore function & relieve pain in joints which are badly damaged by RA. Surgical intervention involves replacing damaged portions of a joint with plastic & metal components. Knee & hip joint replacements are most common & sometimes even elbows, wrists, shoulders, ankles & other joints may also be considered for replacement surgery.
Newer Treatments for Rheumatoid Arthritis
There is a new drug called Remicade which is proving to be a major breakthrough in treatment of rheumatoid arthritis. This drug not only eases pain, but can also prevent RA from progressing. Remicade can halt inflammatory changes which characterize the potentially crippling RA condition & which can permanently damage joints so as to cause chronic pain & disability. RA is a progressively debilitating condition which usually develops among people aged between 25 – 50 years. Remicade was developed by researchers when they discovered that a key trigger for inflammation was TNF, tumor necrosis factor, which is a chemical produced by the immune system. People who develop rheumatoid arthritis produce excessive levels of TNF which in turn stimulates cells to cause inflammation in the joints. Remicade is specifically designed to chemically switch off TNF & thereby neutralize its action. However, Remicade is not a cure for rheumatoid arthritis, but the joints are found to recover post traumatic arthritis since the inflammation is turned off. Generally available as a subcutaneous injection similar to insulin injection for diabetes patients, Remicade can be self-injected at home two times every week or can also be administered through intravenous drip just once every two months within a hospital.