Rheumatoid Arthritis
Treatment options
Because rheumatoid arthritis presents itself on many different fronts and in many different ways, treatment must be tailored to the individual, taking into account the severity of your arthritis, other medical conditions you may have and your individual lifestyle. Current treatment methods focus on relieving pain, reducing inflammation, stopping or slowing joint damage and improving your functioning and sense of well-being.
Rheumatoid arthritis is a serious disease. It is crucial that you get an early diagnosis and work with your doctor to find the best treatment for you so that you can live well with it. Just a few years ago, your doctor might have only prescribed an over-the-counter pain reliever, like an analgesic or non-steroidal, anti-inflammatory drug (NSAID), until you experienced increased disease progression. Now, with the improvement of available medications, doctors know that they have to be more aggressive early on in order to prevent severe deformity and joint erosion.
Health-Care Professionals
In order to get the proper treatment for RA, you need to make sure you have the proper health-care team. Your primary doctor for treating RA should be a rheumatologist (ROO-ma-tall-o-jist), a physician with special training in arthritis and other disease involving diseases of the bone, muscles and joints. Your rheumatologist will coordinate with your primary care physician. Other team members may include a physical therapist, an occupational therapist, a nurse, a psychologist, an orthopaedic surgeon, a physiatrist, and a social worker. Learn more about these specialists in the Glossary of Health Professionals.
Medications
The proper medication regimen is important in controlling your RA. You must help your doctor determine the best combination for you. The main categories of drugs used to treat RA are:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) – These drugs are used to reduce inflammation and relieve pain. These are medications such as aspirin, ibuprofen, indomethacin and COX-2 inhibitors such as valdecoxib and celecoxib.
- Analgesic Drugs – These drugs relieve pain, but don’t necessarily have an effect on inflammation. Examples of these medications are acetaminophen, propoxyphene, mepeidine and morphine.
- Glucocorticoids or Prednisone – These are prescribed in low maintenance doses to slow joint damage caused by inflammation.
- Disease Modifying Antirheumatic Drugs (DMARDs) – These are used with NSAIDs and/or prednisone to slow joint destruction caused by RA over time. Examples of these drugs are methotrexate, injectable gold, penicillamine, azathioprine, chloroquine, hydroxychloroquine, sulfasalazine and oral gold.
- Biologic Response Modifiers – These drugs directly modify the immune system by inhibiting proteins called cytokines, which contribute to inflammation. Examples of these are abatacept, etanercept, infliximab, adaliumumab and anakinra.
- Protein-A Immuoadsorption Therapy – This is not a drug, but a therapy that filters your blood to remove antibodies and immune complexes that promote inflammation.
DMARDs, particularly methotrexate, have been the standard for aggressively treating RA. Recently, studies have shown that the most aggressive treatment for controlling RA may be the combination of methotrexate and another drug, particularly biologic response modifiers. The dual drug treatment seems to create a more effective treatment, especially for people who may not have success with or who have built up a resistance to, methotrexate or another drug alone. Doctors now are prescribing combination drug therapy more often and studies continue. It appears that these combination drug therapies might become the new road to follow in treating RA. Here are some medications your doctor may suggest you combine with methotrexate: lefluonomide (Arava), etanercept (Enbrel), adalimumab (Humira) and infliximab (Remicade).
For more information on these drugs, visit the Drug Guide.
Surgery
Many people with rheumatoid arthritis might consider surgery as part of their treatment plan. The surgical options available today can contribute greatly to improving your quality of life with RA. The following are different surgical options available to people with RA. For more in-depth information, visit the Surgery Center.
Synovectomy – When one or two joints are affected more severely than others, this procedure is used to reduce the amount of inflammatory tissue by removing the diseased synovium or lining of the joint. It may result in less swelling and pain and the slowing or prevention of further joint damage.
Arthroscopic Surgery – In this procedure, the surgeon inserts a very thin tube with a light at the end into the joint through a small incision. It is connected to a closed-circuit television and allows the surgeon to see the extent of the damage in the joint. Once there, the doctor can take tissue samples, remove loose cartilage, repair tears, smooth a rough surface or remove diseased synovial tissue. It is most commonly performed on the knee and shoulder.
Osteotomy – Literally meaning, “to cut bone,” this procedure is used to increase stability by redistributing the weight on the joint. Osteotomy isn’t often used with RA because there are other options available besides cutting the bones.
Joint Replacement Surgery or Arthroplasty - This is the surgical reconstruction or replacement of a joint. Successfully used to help people who otherwise might be in a wheelchair, joint replacement surgery involves the removal of the joint, resurfacing and relining of the ends of bones and replacing the joint with a man-made component. This procedure is usually recommended for people over 50 or who have severe disease progression. Typically a new joint will last between 20 and 30 years.
Arthrodesis or fusion – This procedure fuses two bones together. While it limits movement, it does decrease pain and increase stability of the joints in the ankles, wrists, fingers, toes and spine.
