Rheumatoid Arthritis Treatment:

Nondrug Treatments:

Physical therapy helps improve the range of motion of the joints and it also increases muscle strength as well as reduce pain. Exercising in warm water makes your muscle relax and relieves joint pain. Heat and cold treatments can also relieve pain and inflammation. You can do hot and cold compress at home by using either ice packs or moistened towel.

Medications:

Treatment of rheumatoid arthritis include 2 components. First, reduction of inflammation and the prevention of joint damage and disability. Second, relief of symptoms such as pain. Treatment options for rheumatoid arthritis would include reduction of the stress on the joints, physical therapy, medications and in severe cases, surgical procedures.

The three general classes of drugs used in the treatment of rheumatoid arthritis:

Non-Steroidal Anti-inflammatory Agents (NSAIDs) - The main effect of this drug class is the reduction of inflammation which in turn decreases pain and improves the overall physical function of the joints. These drugs does not alter the course of the disease and does not even prevent joint destruction.

Over the counter NSAIDS are Ibuprofen, (Advil ®, Motrin®, Nuprin ®) and naproxen (Alleve®). Prescription only NSAIDs are Meloxicam (Mobic®), etodolac (Lodine®), nabumetone (Relafen®), sulindac (Clinoril®), tolementin (Tolectin®), choline magnesium salicylate (Trilasate®), diclofenac (Cataflam®, Voltaren®, Arthrotec®), Diflusinal (Dolobid®), indomethicin (Indocin®), Ketoprofen (Orudis®, Oruvail®), Oxaprozin (Daypro®), and piroxicam (Feldene®). COX II inhibitors like (celecoxib, Celebrex®, etoricoxib, Arcoxia®; lumiracoxib, Prexige®). COX II inhibitors are designed to minimize the risk of gastrointestinal irritation but it may also increase the risk of cardiovascular diseases. Some COX II inihibitors (rofecoxib, Vioxx®; valdecoxib, Bextra®) are already pulled out from the market because of this side effect.

Corticosteroids - they posses both anti-inflammatory and immune regulatory properties. Corticosteroids can be given orally, intramuscularly or intravenously. It is only given to patients with severe arthritis that is not controlled by NSAIDs and DMARDs.

(Prednisone; methylprenisolone, Medrol®)

Disease Modifying Anti-rheumatic Drugs (DMARDs) - DMARD agents are reported to stop or slow the course of rheumatoid arthritis, what they do is interfere in the immune processes which promote inflammation in arthritis. DMARDs can also suppress the infection fighting capability of the immune system. It would be advisable to watch out for signs of infection like fever, cough or sore throat.

Example of DMARDs are antimalarials, gold salts, d-penicillamine, cyclosporin A, cyclophosphamide and azathioprine (Imuran). leflunomide (Arava®), etanercept (Enbrel®), infliximab (Remicade®), adalimumab (Humira®), abatacept (Orencia®), rituximab (Rituxan®), anakinra (Kineret®), methotrexate, sulfasalazine. DMARDs can take several weeks or months before its full clinical effect can be demonstrated.
Methotrexate (Rheumatrex®, Trexall®) - It is very effective in reducing the symptoms and signs of rheumatoid arthritis as well as psoriatic arthritis.

Hydroxychloroquine (Plaquenil ®) - This is actually an antimalarial drug which is safe and well tolerated by most patients suffering from rheumatoid arthritis but this drug has limited ability in the prevention of joint damage when used alone. It is usually combined with methotrexate and sulfasalazine for a synergistic effect.

Sulfasalazine (Azulfidine®) - the effectiveness of this drug is less than that of methotrexate but it is also reported to reduce the signs and symptoms of rheumatoid arthritis and slows down joint damage.

 Leflunomide (Arava®) - it has similar efficacy to methotrexate and is a good alternative for patients who cannot tolerate methotrexate.

Tumor necrosis factor (TNF) inhibitors - TNF or tumor necrosis factor alpha promotes inflammation and is found in the rheumatoid joint.

Surgical Approaches:

Synovectomy - this procedure is usually not recommended for people with rheumatoid arthritis because the relief is transient. However, synovectomy of the wrist is recommended specially if synovitis persists even if medical treatment is applied for over 6 to 12 months.

Arthroplasty - arthroplasty of the knee, wrist, hip and elbow have high success rates. Arthroplasty of the joints of the knuckle can also reduce pain and improve its physical functions.

References:

Rheumatoid Arthritis Treatment
by Alan K. Matsumoto, M.D. , Joan Bathon, M.D. and Clifton O. Bingham III, M.D.

Harris ED Jr (2005). Clinical features of rheumatoid arthritis. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 2, pp. 1043–1078. Philadelphia: Elsevier Saunders.

O'Dell JR (2005). Rheumatoid arthritis: The clinical picture. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 1, pp. 1165-1194. Philadelphia: Lippincott Williams and Wilkins.

Kremer JM (2001). Rational use of new and existing disease-modifying agents in rheumatoid arthritis. Annals of Internal Medicine, 134(8): 695–706.

Firestein GS (2005). Rheumatoid arthritis. In DC Dale, DD Federman, eds., ACP Medicine, section 15, chap. 2. New York: WebMD.

Page last updated: May 02, 2008