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.
Treatment discussion from Johns Hopkins University:
About.com arthritis site information about diagnosis and treatment of RA:
Therapy options from MedicineNet:
Mayo Clinic guide to RA therapies:
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