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Treatment of RA
Drug treatment:
DMARD = Disease Modifying Anti-Rheumatic Drugs. They attack the immune system over-activity of auto immune diseases. They are now used for other auto immune diseases such as Crohn's disease and Lupus. They include drugs used for cancer such as methotrexate (MTX).
DMARDS are known to have significant toxic side effects. This presents difficulties for the treating physician. The early use of DMARDS significantly affects the outcome of the disease, but they should be used and supervised by someone who is familiar with these drugs, preferably a specialist. However access to a specialist may be difficult because of waiting lists or impossible in the absence of coverage. This is complicated by the high cost of some of the DMARDs especially some of the new ones. Sometimes a GP will start the patient on DMARDs at the suggestion of the specialist while awaiting an appointment, if that GP and specialist have a working relationship and mutual respect. Methotrexate, MTX, is usually the first DMARD used.
Pain and swelling:
NSAIDS and aspirin can be used to control pain and swelling. The gastric upset including haemorrhage that affects regular patients on NSAIDs is worse in RA patients. Gastric protective medication is often used as soon as the NSAID is prescribed. NSAIDs are used with caution in patients at high risk for heart and artery disease.
STEROIDS (cortisone) can be injected into the affected joints to reduce the swelling of the lining of the joint, the synovium.
Steroids may also be used orally to control the disease. They are used at the lowest effective dose because the patient is liable to be on the drug long term, or repeatedly over years, and these drugs have known and serious side effects. Similarly NSAIDs are used at minimum effective dose because of their long term dangers.
DMARD list:
methotrexate,MTX,
intramuscular gold injections,
sulfasalazine,
adalumimab,
entanercept,
infliximab,
hydroxychloroquine,
leflunamide,
minocycline
Non-drug treatment
Physiotherapy helps:
Drug treatment:
- Stop the joint destruction
- Help pain
- Reduce swelling
DMARD = Disease Modifying Anti-Rheumatic Drugs. They attack the immune system over-activity of auto immune diseases. They are now used for other auto immune diseases such as Crohn's disease and Lupus. They include drugs used for cancer such as methotrexate (MTX).
DMARDS are known to have significant toxic side effects. This presents difficulties for the treating physician. The early use of DMARDS significantly affects the outcome of the disease, but they should be used and supervised by someone who is familiar with these drugs, preferably a specialist. However access to a specialist may be difficult because of waiting lists or impossible in the absence of coverage. This is complicated by the high cost of some of the DMARDs especially some of the new ones. Sometimes a GP will start the patient on DMARDs at the suggestion of the specialist while awaiting an appointment, if that GP and specialist have a working relationship and mutual respect. Methotrexate, MTX, is usually the first DMARD used.
Pain and swelling:
NSAIDS and aspirin can be used to control pain and swelling. The gastric upset including haemorrhage that affects regular patients on NSAIDs is worse in RA patients. Gastric protective medication is often used as soon as the NSAID is prescribed. NSAIDs are used with caution in patients at high risk for heart and artery disease.
STEROIDS (cortisone) can be injected into the affected joints to reduce the swelling of the lining of the joint, the synovium.
Steroids may also be used orally to control the disease. They are used at the lowest effective dose because the patient is liable to be on the drug long term, or repeatedly over years, and these drugs have known and serious side effects. Similarly NSAIDs are used at minimum effective dose because of their long term dangers.
DMARD list:
methotrexate,MTX,
intramuscular gold injections,
sulfasalazine,
adalumimab,
entanercept,
infliximab,
hydroxychloroquine,
leflunamide,
minocycline
Non-drug treatment
Physiotherapy helps:
- modalities e.g., TNS, ice, US, splinting to reduce pain and swelling:
- general exercise such as pool aerobics, exercycling are useful but must be kept to a level that does not stress inflamed loints:
- specific exercise is directed at increasing limb strength and joint flexibility.
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