Rhumatoid Arthritis

Treating Rheumatoid Arthritis

Written by John Sinatra

Rheumatoid arthritis impacts about 1.2 million people yearly, with the vast majority of them being women. There is no cure for the disease, but there are a variety of treatments that can reduce symptoms and mitigate the disease's potential to cause bone and joint damage and impact other parts of the body. Rheumatoid arthritis is caused by the immune system attacking the lining of the joints, or the synovium, causing them to become inflamed. Over time the inflammation can become so severe that it causes the joints and bones to become malformed and misaligned, causing severe pain and reducing mobility. An early diagnosis of the disease and appropriate treatment can greatly reduce the damage this disease can do to the bones and joints and mitigate symptoms. The progression of rheumatoid arthritis varies greatly from patient to patient. Some patients can have the disease for years with little progression of symptoms or damage, and some can even undergo prolonged periods of remission. Other patients can have a quicker progression and steadily worsening symptoms and damage to the bones and joints. Regardless of the rate of progression, patients should work closely with their health care providers to monitor and treat their illness. While no cure for rheumatoid arthritis is available, treatments for the illness have been improving in recent years, particularly in disease modifying anti-rheumatic drug treatments. Drug options There are a variety of pharmacological options to treat the inflammatory and autoimmune aspects of rheumatoid arthritis, and to reduce pain and mitigate other symptoms of this disease. There are three types of drugs used in treating rheumatoid arthritis, corticosteroids, non-steroidal anti-inflammatory agents and disease modifying anti-rheumatic drugs. The NSAIDS help reduce the swelling that can lead to pain and joint and bone damage. The DMARDs work to slow the immune system's assault on the lining of the joints. The corticosteroids work to influence the immune system and the inflammatory aspects of the disease. DMARDs and corticosteroids are now commonly used early and aggressively in the treatment of rheumatoid arthritis to slow down the disease and limit the damage it can do to the joints and bones. NSAIDS work to reduce inflammation, thus improving the mobility of joints and reducing pain. These drugs won't change the course of the disease, nor will they prevent damage to the joints and bones, but they will make the illness more bearable for patients. Common NSAIDS used in the treatment of rheumatoid arthritis include aspirin, ibuprofen, meloxicam, etodolac, and COX-2 inhibitors such as celebrex. The most common side effects of these drugs include gastrointestinal problems and impaired renal function. Other drugs may help mitigate these side effects. DMARDs influence the immune system and can help slow the progression of the illness and mitigate its impact on joints and bones. Healthcare providers usually want to start DMARD treatment as early as possible to maximize their long term contribution to treating rheumatoid arthritis. Commonly used DMARDs include: methotrexate, sulfasalazine, T-cell costimulatory blocking agents and  hydroxychloroquine among others. There are a variety of side effects, most of which are specific to one certain drug, for these treatments. Some of these side effects can be quite severe, so close consultation with your healthcare provider is imperative if you're taking DMARDs. Corticosteroids can influence the immune system and regulate inflammation caused by rheumatoid arthritis. They can be taken orally or injected. The most  common corticosteroid used in the treatment of rheumatoid arthritis is predinisone. This drug may contribute to osteoporosis, but countermeasures can help offset this. Other side effects include weight gain and increased blood sugar and blood pressure. Surgical options There are some surgical options that can help reduce or prevent the damage to joints and bones caused by the inflammation of the synovium (joint lining) that results from rheumatoid arthritis. The surgical option is not to be taken lightly, and the patient and his doctors should carefully and realistically consider the risks and benefits of surgery and the patients ability and commitment to undergo rehabilitation before deciding on this course of action. One surgical option is a synovectomy, in which the surgeon removes the synovium around the wrist. This option is usually only used if the patient suffers from severe synovitis over six months to a year. Another surgical option is total joint arhtoplasties of the knee, wrist, elbow or hip. In this procedure the surgeon replaces malformed or malfunctioning joints with other tissue or prosthetics. Surgeons can also treat rheumatoid arthritis symptoms with some arthroscopic procedures and by removing some rheumatoid nodules.

 

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