Understanding rheumatoid arthritis (RA) - treatment
The main treatment goals with rheumatoid arthritis are to control inflammation and slow or stop the progression of rheumatoid arthritis.
Treatment is usually a multifaceted programme of medication, occupational therapy, physiotherapy and regular exercise. Sometimes surgery is used to correct joint damage. Early aggressive treatment is key to good results. With today’s treatments joint damage can be slowed or stopped in many cases.
Which medications are used to treat rheumatoid arthritis?
As part of your rheumatoid arthritis treatment your doctor will probably prescribe a nonsteroidal anti-inflammatory drug (NSAID), for example ibuprofen. These medications reduce pain and inflammation.
Most people with rheumatoid arthritis require a prescription NSAID as they offer longer lasting results and require fewer doses throughout the day. There are many prescription NSAIDs to choose from.
All prescription NSAIDs carry a warning regarding the increased risk of heart attack and stroke. NSAIDs can also raise blood pressure, and they can cause stomach irritation, ulcers and bleeding.
You and your doctor can weigh the benefits of NSAIDs against the potential risks. You may have to try a few different ones to find the one that’s right for you.
NSAIDs decrease the symptoms of rheumatoid arthritis but do not slow the progression of rheumatoid arthritis. People with moderate to severe rheumatoid arthritis often require additional medications to prevent further joint damage.
Disease-modifying antirheumatic drugs (DMARDs) help to slow or stop the progression of rheumatoid arthritis. The most common DMARD used to treat rheumatoid arthritis is methotrexate.
In rheumatoid arthritis an overactive immune system targets joints and other areas of the body. DMARDs work to suppress the immune system. However they aren’t selective in their targets, so they decrease the immune system overall and increase the likelihood of catching infections.
DMARDs, particularly methotrexate, have produced dramatic improvements in severe rheumatoid arthritis and can help preserve joint function.
The newest and most effective treatments for rheumatoid arthritis are biologics. Biologics are genetically engineered proteins derived from human genes. They are designed to inhibit specific components of the immune system that play a pivotal role in inflammation, a key component in rheumatoid arthritis.
Biologics are usually used when other medications have failed to calm the inflammation of rheumatoid arthritis. They can often slow or stop rheumatoid arthritis progression when other medicines have failed to do so.
TNF blockers help to reduce pain by blocking an inflammatory protein called tumour necrosis factor (TNF). There is some evidence that TNF blockers may stop the progression of rheumatoid arthritis. Recent studies have shown benefits when they are combined with methotrexate. TNF blockers include etanercept, adalimumab and infliximab.
Other biologics suppress different areas of the immune system.
Since biologics suppress the immune system, they also increase the risk of infection. Severe infections have been reported with biologics.
For severe rheumatoid arthritis or when rheumatoid arthritis symptoms flare up, your doctor may recommend steroids to ease the pain and stiffness of affected joints. In most cases they can be used temporarily to calm a symptom flare-up. However, in certain people, steroids are needed long term to control the pain and inflammation.
Steroids can be given as injections directly into an inflamed joint or taken as a pill. Potential side effects of long-term steroid use include high blood pressure, osteoporosis and diabetes. However when used appropriately, steroids are often effective and quickly improve pain and inflammation.