Health encyclopaedia - Alphabetical Topic List

| A | | B | | C | | D | | E | | F | | G | | H | | I | | J | | K | | L | | M |
| N | | O | | P | | Q | | R | | S | | T | | U | | V | | W | | X | | Y |

Treatment of Rheumatoid arthritis

Your doctors may use a variety of approaches to treat your rheumatoid arthritis. The goals will always be to relieve pain, reduce inflammation, slow down or stop joint damage, and to enable you to have a positive outlook on life.

Disease modifying antirheumatic drugs (DMARDs) A specialist rheumatologist will prescribe one or more of a number of disease modifying antirheumatic drugs (DMARDs) as soon as possible to slow down the effects of the disease much as possible. The choice of drug depends on other illnesses, symptoms, side- effects etc.

The two most common drugs prescribed are methotrexate and sulfasalazine . These can reduce pain and swelling in your joints and help to stop your joints from wearing down. These drugs may take three to six months to work and may be prescribed with other DMARDs. It is important to keep taking your DMARD as prescribed, even if it does not seem to be working initially. You may need to take a combination of drugs for some months, but once your symptoms start to get better, you may be able to stop taking some of them.

Other DMARD’s include

  • an antimalarial (hydroxychloroquine);
  • leflunomide;
  • an antibiotic (minocycline); 
  •  injectable gold (side effects are quite common and can be serious); 
  •  oral gold (rarely used now);
  • penicillamine (side effects are quite common and can be serious); 
  •  azathioprine (side effects are common and can be serious- usually only prescribed after trying other drug treatments);
  • Ciclosporin (very common side- effects - only prescribed after trying other drug treatments);
  • and tumour necrosis factor antagonists (possibly increases your chance of getting a form of blood cancer (lymphoma), although this is anyway more common in people with RA.

Each DMARD has different possible side-effects. If you experience problem side-effects with one DMARD, a different one may suit you better. Serious side-effects are rare but your doctor will give you regular blood tests to test for side- effects before they become serious. Your doctor may give you a leaflet detailing possible side-effects; if not, make sure you ask what these may be.

Many DMARDs will require you to have regular blood tests. The frequency of these will vary with the particular drug.

Once a DMARD is found that helps with your symptoms, it is usual for it to be prescribed for the long- term.

Steroids (Corticosteroids)- Low doses of steroid can also help to reduce swelling and prevent your joints from wearing down. These may be taken by mouth or as an injection.

Other drugs- These are commonly used in addition to DMARD’s to control every day pain and stiffness, especially in the first months after starting to take DMARD’s, and include: 

  •  Painkillers (paracetamol, co-codamol, tramadol etc.)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)/ COX-2 inhibitors are commonly used to help with the pain and swelling in your joints (Drugs include: - Diclofenac, ibuprofen, indometacin, ketoprofen, naproxen (may increase risk of a heart attack or stroke), meloxicam, etoricoxib, celecoxib (may increase risk of a heart attack or stroke), valdecoxib (may increase risk of a heart attack or stroke; possibly causes dangerous skin reactions).
  • TNF-alpha blockers – These are new drugs, which have recently been developed, and include etanercept, infliximab, and adalimumab. They appear to be effective in the treatment of RA, but they are however costly and they need to be given by injection or drip . Either yourself or a helper can inject etanercept and adalimumab under the skin, at home. Infliximab is given via a drip in hospital at regular intervals.

They may be prescribed when

  • At least 2 DMARDs (one of which must be methotrexate) have failed to work, or have produced intolerable side-effects 
  •  You must have active rheumatoid arthritis, as measured by your DAS score.

People with some pre-existing conditions may not be suitable for this treatment. Your specialist will be able to advise you.

Lifestyle

It’s important for you to have a positive outlook on life. Rest and exercise are both important. You should take plenty of rest periods when your joints are inflamed and you are in pain. Relaxation techniques may also help. However exercise is important at other times for maintaining healthy and strong muscles, preserving joint mobility, and maintaining flexibility. Advice and support from self-help groups can be invaluable.

 To reduce stress on your joints, always wear comfortable shoes. You may find a splint useful to relieve pain at times. An occupational therapist will be able to assist you with self- help devices to enable you to carry out all your daily activities, such as opening a jar or getting in and out of the bath. A physiotherapist can advise about suitable hobbies and exercise.

You should aim to eat a healthy diet although there is no evidence that a particular food helps or harms most people with rheumatoid arthritis. You should be careful about drinking too much alcohol, especially when taking certain medicines.

 Complementary therapies

Many people with RA try or use complementary therapies. In most cases there have been no scientific studies and no evidence that they are effective. However there are some therapies, especially those aimed at reducing the stress of living with RA, which may help to make you feel better in yourself.