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Rheumatoid arthritis is a chronic disorder for which
there is no known cure. Because rheumatoid arthritis presents itself in many
different forms and ways, treatment must be designed for the individual,
taking into account the severity of the arthritis, other medical conditions
and lifestyle. It therefore requires a comprehensive program that combines
medical, social and emotional support for the patient. The main goal of
rheumatoid arthritis treatment is to reduce pain, discomfort, prevent
deformities and loss of joint function, and maintain a productive and active
life. Rheumatoid arthritis treatments are most often medications, reduction
in joint stress, surgical intervention, exercise, and life style change.
Medications
Proper medication treatment is important in controlling your rheumatoid
arthritis. Commonly used drugs for rheumatoid arthritis treatment are:
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
These drugs are used in the reduction of inflammation and relieving pain.
Medications such as aspirin, ibuprofen, indomethacin and COX-2 inhibitors
such as valdecoxib and celecoxib are some of the common drugs.
Analgesic Drugs
These drugs relieve pain, but do not necessarily have an effect on
inflammation. Some of these medications include: acetaminophen, propoxyphene,
mepeidine, and morphine.
Glucocorticoids or Prednisone
These drugs are prescribed in low maintenance doses to slow joint damage
cause by inflammation.
Disease Modifying Antirheumatic Drugs (DMARDs)
These rheumatoid arthritis treatment drugs are used with NSAIDs and/or
prednisone to slow joint destruction caused by rheumatoid arthritis over
time. Some of these medications are: methotrexate, injectable gold,
penicillamine, azathioprine, chloroquine, hydroxychloroquine, sulfasalazine
and oral gold.
Biological Response Modifiers
These drugs inhibit proteins called cytokines which contribute to
inflammation. Some of these drugs include: etanercept, infliximab,
adaliumumab and anakinra.
Protein-A Immuoadsorption Therapy
Although this is not a drug, this is a therapy that filters the blood to
remove antibodies and immune complexes that promote inflammation.
Reduction in Joint Stress
Ideal body weight should be achieved and maintained. The less you weigh the
less stress on the musculoskeletal system. Generally, rest is an important
feature of management. Vigorous activity should be avoided when the joints
are actively inflamed, because they can intensify joint inflammation or
cause a traumatic injury to structures weakened by the inflammation.
Conversely, patients should be encouraged to maintain a modest level of
activity to prevent laxity and muscular atrophy. Immobilizing acutely
inflamed joints particularly at night and using walking aids like canes or
walkers are all effective means of reducing stress on specific joints.
Consulting with therapist is always recommended early in the course.
Surgical Approaches
The decision to have surgery is a complex one because lots of things must be
taken into consideration, such as the motivation and goals of the patient
and their ability to undergo rehabilitation and their general medical
status.
Synovectomy is one form of surgical approach but is not ordinarily
recommended for patients with rheumatoid arthritis, mainly because the
relief is only momentary. However, an exception is synovectomy of the wrist,
which is recommended for intense synovitis that has been continual for over
six to twelve months despite medical treatments.
Joint arthroplasties of the knee, hip, wrist and elbow are highly
successful. Arthroplasty of the MCP joints can also reduce pain and improve
function. Other operations include removal of symptomatic rheumatoid nodule,
release of nerve entrapments like carpal and tunnel syndrome, and
arthroscopic procedures.
Rheumatoid arthritis treatment should start with education about the
disease, the possibility of joint damage and disability, and the risks and
benefits of potential treatments. Along term-treatment plan should be
developed by patients and their health professionals.
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