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Treatment Options for Rheumatoid Arthritis

Rheumatoid arthritis is considered to be one of the more disabling forms of arthritis. It is two to three times more common in women than men. Symptoms usually begin relatively early, between the ages of 30 and 50. Although its exact cause is not known, rheumatoid arthritis is thought to be an autoimmune disease, causing chronic inflammation of joints as well as other parts of the body. Some individuals may have a hereditary tendency to this disease.

Unlike osteoarthritis, rheumatoid arthritis produces more pronounced symptoms in the morning. These typically include stiffness in joints and muscles, swelling of the hands and wrists, swelling in three or more joints or swelling of the same joints on both sides of the body. Additional symptoms, such as fatigue, fever or loss of appetite, may accompany the inflammation. Just like osteoarthritis, there is no cure for rheumatoid arthritis either.

Medications for Rheumatoid Arthritis

Drug treatment for rheumatoid arthritis begins with the same types of medications used for osteoarthritis, such as paracetamol (acetaminophen), over-the-counter NSAIDs such as acetylsalicylate (Aspirin) and prescription NSAIDs and COX-2 selective inhibitors as well as corticosteroid injections as the disease progresses and pain becomes more intense. Yet another treatment from the first line of defence is capsaicin.

Capsaicin – this naturally occurring substance in hot peppers appears to be effective in temporarily relieving minor pain associated with rheumatoid arthritis. Capsaicin can be found in many over-the-counter topical products (ointment, lotion, cream, jelly, patch, etc.) that are applied to the skin over the affected joints in order to suppress a chemical in the body that promotes inflammation.

Second-Line Drugs against Rheumatoid Arthritis

Doctors are increasingly turning to more potent treatments, called “second-line” medications or disease modifying anti-rheumatic drugs (DMARDs), if NSAIDs fail to control joint inflammation and pain after four to six months of regular use. Though proven to be more effective in relieving the symptoms of rheumatoid arthritis than NSAIDs, the second-line drugs are also likely to cause more severe side effects.

Hydroxychloroquine (Plaquenil, Quineprox) – is an oral antimalarial drug that relieves inflammation in mild to moderate forms of rheumatoid arthritis. Hydroxychloroquine must be used over longer periods as it needs several weeks to become effective. Possible side effects include headaches, diarrhea, loss of appetite, stomach pain, skin rash and possible damage to the light-sensitive tissue at the back of the eye called retina.

Sulfasalazine – (Azulfidine) is an anti-inflammatory medication used to treat a chronic, progressive bowel disease called ulcerative colitis and Crohn’s colitis. When used for treating rheumatoid arthritis, sulfasalazine is typically prescribed in combination with anti-inflammatory medications NSAIDs. Its side effects are relatively infrequent but they may include upset stomach and rash.

Gold compounds (gold salts) can help patients with mild to moderate rheumatoid arthritis that is progressing slowly to decrease the inflammation of the lining of the joint. Auranofin (Ridaura) is a capsule taken by mouth while gold sodium thiomalate (Myochrysine) is an injection. However, these medications may cause serious side effects, including bruising, blood in the urine, diarrhea, skin rash, mouth sores and numbness in the hands and feet. Gold salts are being gradually phased out and replaced by more effective treatments.

Penicillamine (marketed as Cuprimine and Depen) appears to slow the progression of rheumatoid arthritis, specifically deformities of the joints, and improve functionality. Penicillamine is taken orally much like gold salts and it also requires two to six months to become effective. However, it causes fewer side effects than gold. Due to its ability to prevent joint deformity, penicillamine also belongs among the so-called slow-acting or disease modifying anti-rheumatic drugs (DMARDs).

Tumor necrosis factor (TNF) antagonists – such as etanercept (Enbrel) represent the latest hope in fight against rheumatoid arthritis and other autoimmune diseases such as juvenile rheumatoid arthritis and psoriatic arthritis, plaque psoriasis and ankylosing spondylitis. These drugs play a role in the inflammatory process by supressing the inflammatory response. The TNF antagonists seem to successfully reduce the pain and morning stiffness in patients with rheumatoid arthritis. Patients with a weak immune system or those suffering from conditions that make them prone to infections may not use the TNF antagonists such as etanercept.

Immunosuppressive drugs – the drugs that suppress the immune system, called immunosuppressants, are considered to be the last line of defence against rheumatoid arthritis. Rheumatoid arthritis, as recent evidence shows, is an autoimmune disease in which the immune system attacks the body’s own tissues. Immunosuppressive drugs such as azathioprine (Azasan, Imuran), methotrexate (Rheumatrex), cyclophosphamide (Cytoxan), cyclosporine (Sandimmune) and chlorambucil (Leukeran) have been approved by the FDA for use in treating rheumatoid arthritis. Because of their potentially serious side effects immunosuppressants are reserved only for patients with very aggressive form of the disease. The only exception is methotrexate (Rheumatrex) which is not associated with causing serious side effects.

Methotrexate – (Rheumatrex) is the most commonly used second-line drug against rheumatoid arthritis. In comparison with other immunosuppressive drugs, low-dose methotrexate is known to act faster, more effectively and cause fewer side effects. Although this immunosuppressive drug may adversely affect the bone marrow and the liver, its side effects are relatively infrequent and can be reduced by supplementation with folic acid. For patients who do not respond well to methotrexate alone, a combination of methotrexate and the TNF antagonist infliximab (Remicade) can be prescribed.

Leflunomide – (Arabloc, Arava, Lunava) is yet another disease modifying anti-rheumatic drug (DMARD). The advantage of leflunomide is that it restrains the immune system’s inflammatory actions without significantly suppressing its disease-fighting capability. The drug can be taken in combination with NSAIDs to help retard the damaging effects of rheumatoid arthritis. Immunosuppression and potential liver damage belong among the most serious side effects of this medication.

The Role of Exercise in Treating Rheumatoid Arthritis

Treatment of rheumatoid arthritis involves exercise, which role is to protect arthritic joints from further damage and to maintain or restore joint function. The key is to maintain a regular exercise pattern over time. Therapeutic exercises should include stretching exercises aimed at increasing strength and flexibility and aerobic exercises, such as walking and swimming. Swimming is the most effective activity for building upper- and lower-body endurance whereas walking, dancing, stationary bicycles and treadmills also provide significant benefits.

Diet and Rheumatoid Arthritis

Although some scientists believe that food may be a culprit in certain patients with rheumatoid arthritis, the value of dietary treatments remains controversial. The theory has it that when patients consume certain foods they are allergic to, they may be increasing inflammation throughout their body and thus their symptoms may actually reflect the food allergy rather than the disease. Scientific evidence to support this theory is lacking, though. In order to help to fight inflammation in the body you may want to try traditional Mediterranean diet and exclude red meat and processed foods from your menu. So, in the end, most doctors simply recommend a healthy, balanced diet.

Surgery for Rheumatoid Arthritis

As with other forms of arthritis like osteoarthritis, surgical procedures such as hip and knee replacements can also help patients with rheumatoid arthritis to eliminate pain and resume normal daily activities and maintain an independent lifestyle. Artificial joints can be used to replace those incapacitated by the disease and can be expected to last for up to 20 years while arthroscopic surgery can be applied to remove damaged tissue without replacing the whole joint.

Where to Get More Information:
American College of Rheumatology
Arthritis Foundation
Arthritis Research UK