Rheumatoid Arthritis - Treatments

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What is the treatment for rheumatoid arthritis? What types of medications treat RA?

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 RA treatment 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. RA 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 [Rayos, Celestone, Depo-Medrol, Kenalog]), are used to reduce pain and inflammation. The slow-acting second-line drugs, such as methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo) and hydroxychloroquine (Plaquenil), promote disease remission and prevent progressive joint destruction.

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 many years of activity ("burned out" rheumatoid arthritis) can be managed with rest plus pain control 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.

The areas of the body other than the joints that are affected by rheumatoid inflammation are treated individually. Sjögren's syndrome can be helped by artificial tears and humidifying rooms in the home or office. Medicated eyedrops, cyclosporine ophthalmic drops (Restasis), are also available to help the dry eyes in those affected. Regular eye checkups and early antibiotic treatment for infection of the eyes are important. Inflammation of the tendons (tendinitis), bursae (bursitis), and rheumatoid nodules can be injected with cortisone. Inflammation of the lining of the heart and/or lungs may require high doses of oral cortisone.

In some cases with severe joint deformity, surgery may be recommended to restore joint mobility or repair damaged joints. Doctors who specialize in joint surgery are orthopedic surgeons. The types of joint surgery range from arthroscopy to partial and complete replacement of the joint. Arthroscopy is a surgical technique whereby a doctor inserts a tube-like instrument into the joint to see and repair abnormal tissues.

Total joint replacement is a surgical procedure whereby a destroyed joint is replaced with artificial materials. For example, the small joints of the hand can be replaced with plastic material. Large joints, such as the hips or knees, are replaced with metals.

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Comment from: Shankar, 35-44 Female (Caregiver) Published: January 25

My wife had rheumatoid arthritis. She was getting back pain once in a year during winter and after taking tablets for 1 or 2 months it used to go away. But last year it was worse. She had constant body pain though she was under medication. When doctor changes tablet she used to feel better for 1 or 2 days and then the pain was back. The doctor then tried steroid tablets. My wife started accumulation of fat. But it didn't help at all. We tried Ayurveda. It increased her gastric problems and she started getting nausea. We were terrified without knowing what to do. Then I found a book on naturopathy. I thought I would give it a try. It really helped her. Since a year she doesn't have any symptoms of rheumatoid arthritis. This is what we did that helped us. I hope it might help someone having trouble with rheumatoid arthritis. Daily drink fruit juice without adding sugar or anything extra. Drink it twice morning and evening. Take 2 thick cotton towels (Turkish towel). Dip one in hot water 40 to 50 degree Celsius. Squeeze it dry. Put the hot towel on your back. Let it stay for 2 minutes. Now take the cold towel. Dip another in cold water. Squeeze it dry and put that on your back. Leave it for 30 seconds. Repeat it 4 times before your bed. End this by applying another hot towel for 1 minute. Then take some massage oil and massage the back for 3 to 4 minutes. Try it for 3 weeks. I bet you will see improvements. English medicines will have side effects. This is all natural and you will feel better naturally. Good luck.

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Comment from: NOMOREGOUT, 65-74 Male (Patient) Published: January 27

I have had problems with tendonitis, bursitis and yes, gout since I was a teenager. High uric acid runs in the family. My father passed from a disease called polymyositis a severe form of rheumatoid arthritis. I have even had some gout attacks that landed me in the emergency room. This time though was different. I had knee replacement surgery, and the surgeon reported to me that I had tophi coated on all the ligaments and joints in my knee. That was after the surgery and it created such a gout flare up that I was put in the ICU for three days after surgery, with intravenous Dilaudid and the weaker morphine. Well, I used to like to drink gin. I haven't had a drink since that episode. I am three-quarters vegetarian now. I lost 30 pounds, I dropped from 220 to 190. I get regular exercise and flare ups still happen like waves rippling out from the initial attack, each one is weaker than the last. There is one practical piece of advice, or I should say my opinion as to deal with this, stay ahead of it. Get yourself a bottle of prednisone and stick it in the back of a door somewhere. Then, when on Friday night a flare up occurs you don't have to suffer until Monday to get to the doctor (if you can get in). Take 40 mg for 4 days, 30 mg for three days, and 20 for two days. Naprosyn, colchicine, meloxicam, Indocin, they all work, but not like prednisone.

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