Treatment for Rheumatoid Arthritis
For patients now diagnosed with rheumatoid arthritis (RA) there is
great hope for a normal life with modern drug therapy. Nearly all
patients will be placed on multiple medications since aggressive
treatment is now believed to be in the best interests of patients.
Some of these medications have been used for many years while others
are very recent and treat the disease in whole new ways.
Inflammation is the hallmark of RA and is what causes damage to
joints and other parts of the body, so therapy is designed to
control or prevent inflammation from occurring. Pain may be treated
with opiates when it is severe but it is preferable to control it by
controlling the underlying illness since this is a chronic
condition.
One class of medication used in the treatment of RA is that of the
NSAIDs. These are non-steroidal anti-inflammatory drugs and range
from common aspirin to COX-2 inhibiting Celebrex. Corticosteroids
are another class of anti-inflammatory medication and prednisone is
commonly prescribed for an inflammatory arthritis such as RA. These
have been used for decades and are usually well tolerated. Cytotec
is also prescribed along with many of the NSAIDs to protect the
stomach.
Another class of RA medication is the DMARD or the disease-modifying
antirheumatic drug. DMARDs include medications such as gold salts,
methotrexate, azathioprine, cyclophosphamide, and cyclosporine A.
These drugs are also used in treating cancer and in preventing
rejection of organ transplants but have a valuable role in RA
treatment. Other agents include Plaquenil or hydroxychloroquine,
Azulfidine or sulfasalazine, and Arava or leflunomide.
A newer class of medications is the biologic response modifier.
Since in autoimmune illnesses the immune system is mistakenly
attacking body tissue, these drugs are used to turn the immune
response down or even turn it off and reduce inflammation by
preventing its cause. Some of these drugs work to suppress TNF, or
tumor necrosis factor, and these include Humira, Enbrel, and
Remicade.
Others suppress the action of white blood cells involved in immune
response. Orencia blocks the activity of T-cells while Rituxan
suppresses the B-cells. Kinaret acts on interleukins and prevents
inflammation by blocking receptors. These biologic response
modifiers are producing remissions and disease control even in most
patients who were resistant to earlier therapies.
Surgical repair of damaged joints is also possible. This may be
reconstructive or involve joint replacement surgeries. Of course, it
is much better to try to prevent the disease from causing such
extensive damage whenever possible.
Resources:
Treatment discussion from Johns Hopkins University:
www.hopkins-arthritis.org/rheumatoid/rheum_treat.html
About.com arthritis site information about diagnosis and treatment
of RA:
arthritis.about.com/od/rheumatoidarthritis/
Therapy options from MedicineNet:
www.medicinenet.com/rheumatoid_arthritis/article.htm
Mayo Clinic guide to RA therapies:
www.mayoclinic.com/health/rheumatoid-arthritis/
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