Rheumatoid Arthritis (cont.)
How is rheumatoid arthritis treated?
There is no known cure for rheumatoid arthritis. To date, the goal of treatment in rheumatoid arthritis is
to reduce joint inflammation and pain, maximize joint function, and prevent
joint destruction and deformity. Early medical intervention has been shown to be
important in improving outcomes. Aggressive management can improve function, stop damage to joints as
monitored on X-rays, and prevent work disability. Optimal treatment for the disease involves a combination of
medications, rest, joint-strengthening exercises, joint protection, and patient (and family)
education. Treatment is customized according to many factors such as disease
activity, types of joints involved, general health, age, and patient occupation.
Treatment is most successful when there is close cooperation between the doctor,
patient, and family members.
Two classes of medications are used in treating rheumatoid arthritis:
fast-acting "first-line drugs" and slow-acting "second-line
drugs" (also referred to as disease-modifying antirheumatic drugs or DMARDs). The first-line drugs, such as aspirin and cortisone
(corticosteroids), are used to reduce pain and inflammation. The
slow-acting second-line drugs, such as gold, methotrexate, and hydroxychloroquine (Plaquenil),
promote disease remission and prevent progressive joint destruction, but
they are not anti-inflammatory agents.
The degree of destructiveness of rheumatoid arthritis varies among affected individuals. Those with uncommon, less destructive forms of the disease or disease that has quieted after years of activity ("burned out" rheumatoid arthritis) can be managed with rest
and pain and anti-inflammatory medications alone. In general, however, function is improved and disability and joint destruction are minimized when the condition is treated earlier with second-line drugs (disease-modifying antirheumatic drugs), even within months of the diagnosis. Most people require more aggressive second-line drugs, such as methotrexate, in addition to anti-inflammatory agents. Sometimes these second-line drugs are used in combination. In some cases with severe joint deformity, surgery may be necessary.
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