| Treatment for RA has changed dramatically and newer medications can help prevent joint damage. The goal of RA treatment is to control synovitis and thus prevent joint damage and disability. Optimal management involves a combination of nonpharmacological therapy (i.e., rest, exercise, stress reduction, diet modification, psychotherapy or counseling, massage, and physical therapy) and drug therapy. Although regular rest is recommended and complete bed rest may be indicated during flare-ups (disease exacerbations), individuals with RA respond favorably to gentle exercise such as walking, yoga and stretching exercises.
Drugs are prescribed for pain management (analgesia), to control inflammation, and to suppress the immune response. Nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen), which include cyclooxygenase-2 (COX-2) inhibitors (celecoxib), provide important symptomatic relief of pain and inflammation, but do not alter the long-term course of the disease.
There has been a growing emphasis on early diagnosis and intensive treatment since joint damage occurs early in the course of the disease. Disease-modifying antirheumatic drugs (DMARDs) are a diverse group of therapeutic agents that can slow disease progression. Some examples of DMARDs are methotrexate, sulfasalazine, and hydroxychloroquine. Biological agents are man-made analogs of naturally occurring molecules that interfere with joint inflammation and destruction. Leflunomide inhibits pyrimidine synthesis. Tumor necrosis factor (TNF) antagonists (etanercept, infliximab, adalimumab) inhibit TNF, a mediator of joint inflammation. Another class of biological agents (abatacept, rituximab) act by inhibiting the interleukin-1 receptor. Combinations of DMARDs and biological agents are used to delay radiologic progression of disease and achieve remission. Medications used to treat RA may have serious side effects so regular monitoring is necessary.
Injections of corticosteroids into affected joints or short-term use of oral corticosteroids may provide relief for acute flare-ups, but are seldom used on a continuing basis because of significant long-term toxicity
Splinting of inflamed joints is sometimes employed to decrease synovitis, prevent deformity, and improve limb function. Surgical treatment, such as to remove synovial tissue (synovectomy), repair joints (arthroplasty), or replace joints, is reserved for the most severe cases in which joints have been completely destroyed and mobility is severely compromised. |
Source: Medical Disability Advisor