Treatment for Rheumatoid Arthritis
RA usually requires lifelong treatment, including medications, physical therapy, exercise, education, and possibly surgery. Early, aggressive treatment for RA can delay joint destruction.
Disease modifying anti rheumatic drugs (DMARDs): These drugs are the current standard of care for RA, in addition to rest, strengthening exercises, and anti-inflammatory drugs. Methotrexate (Rheumatrex) is the most commonly used DMARD for rheumatoid arthritis. Leflunomide (Arava) may be substituted for methotrexate. These drugs are associated with toxic side effects, so you will need frequent blood tests when taking them.
Anti-inflammatory medications: These include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Although NSAIDs work well, long-term use can cause stomach problems, such as ulcers and bleeding, and possible heart problems. NSAID packaging now carries a warning label to alert users of an increased risk for cardiovascular events (such as heart attack or stroke) and gastrointestinal bleeding.
Anti malarial medications: This group of medicines includes hydroxy chloroquine (Plaquenil) and sulfasalazine (Azulfidine), and is usually used in combination with methotrexate. It may be weeks or months before you see any benefit from these medications.
Corticosteroids: These medications work very well to reduce joint swelling and inflammation. Because of potential long-term side effects, however, corticosteroids should be taken only for a short time and in low doses when possible.
Cyclooxygenase-2 (COX-2) inhibitors: These drugs block an inflammation-promoting enzyme called COX-2. This class of drugs was initially believed to work as well as traditional NSAIDs, but with fewer stomach problems. However, numerous reports of heart attacks and stroke have prompted the FDA to re-evaluate the risks and benefits of the COX-2s. Celecoxib (Celebrex) is still available, but labeled with strong warnings and a recommendation that it be prescribed at the lowest possible dose for the shortest possible duration. Talk to your doctor about whether COX-2s are right for you.
Specific white blood cell modulators: These treatments effectively control inflammation. They include:
- Orencia (abatacept) - Given under the skin (subcutaneously) or into a vein (intravenously) once a month. Reduces the number of T-cells (a type of white blood cell).
- Rituxan (rituximab) - Given under the skin or into a vein twice a year. Reduces the number of B-cells (a types of white blood cell).
Tumor necrosis factor (TNF) inhibitors: This class of medications block a protein in the body involved in creating inflammation. They are given under the skin or directly into a vein. They include:
- adalimumab (Humira)
- etanercept (Enbrel)
- infliximab (Remicade)
Occasionally, surgery is needed to correct severely affected joints. Surgeries can relieve joint pain, correct deformities, and modestly improve joint function.
The most successful surgeries are those performed on the knees and hips. The first surgical treatment is a synovectomy, which is the removal of the joint lining (synovium).
A later alternative is total joint replacement with a joint prosthesis. In extreme cases, total knee or hip replacement can mean the difference between being totally dependent on others and having an independent life at home.
Range-of-motion exercises and individualized exercise programs prescribed by a physical therapist can delay the loss of joint function.
Joint protection techniques, heat and cold treatments, and splints or orthotic devices to support and align joints may be very helpful.
Sometimes therapists will use special machines to apply deep heat or electrical stimulation to reduce pain and improve joint mobility.
Occupational therapists can construct splints for the hand and wrist, and teach how to best protect and use joints when they are affected by arthritis. They also show people how to better cope with day-to-day tasks at work and at home, despite limitations caused by RA.
Frequent rest periods between activities, as well as 8 to 10 hours of sleep per night, are recommended.