Wednesday, April 26, 2017

Treatment Options For Rheumatoid Arthritis

Patients with rheumatoid arthritis need proper management and control of their symptoms to improve the quality of life. Although taking analgesic medicines for a long duration of time leads to gastric problems but it is important to give patient some relief from disturbing pain and inflammation.

Non Pharmacological Management
  • Encourage regular exercise, physio and occupational therapy.
  • Provide household aids and personal aids e.g wrist splints.
  • Good mental and social support to improve life style and cope up with the disease.
Pharmacological Management
If there is no contraindication e.g an active peptic ulcer start with an NSAID, such as ibuprofen. There is no single NSAID that is superior to other agents, and newer agents have not been shown to have a decreased incidence in toxicity. If patient cannot tolerate NSAIDs then consider COX2 inhibitors that prevents gastrointestinal side effects.

Steroids may decrease joint damage and control difficult symptoms but using them for prolonged period of time leads to decreased bone density and predisposition to osteoporosis as well as other side effects related to prolonged steroid use.

Disease Modifying DrugsStart DMARDs if there is persisting synovitis for more than 6 weeks. Sulfasalazine and methotrexate are typical 1st choices and are often used together. The drugs included in this group include:
  • Salfasalazine
  • Methotrexate
  • Ciclosporin
  • Gold
  • Azathioprine
  • Penicillamine
  • Hydroxychloroquine
Anti cytokine therapyTumor necrosis factor alpha is the key cytokine over produced in rheumatoid arthritis synovium. The pro inflammatory effects of TNF-alpha suggest that its inhibition will be clinically useful in RA. There are three TNF inhibitors approved for the treatment of RA and these include;
  • Infliximab
  • Etanercept
  • Adalimumab

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