Rheumatoid Arthritis - Management

Management

There is no known cure for rheumatoid arthritis, but many different types of treatment can alleviate symptoms and/or modify the disease process. Recommendations of the American College of Rheumatology (ACR), published in 2008, followed a trend in supporting earlier, more aggressive treatment of RA, and reflected heightened expectations of treatment effectiveness, including remission or substantial alleviation of symptoms for a rising percentage of patients.

The goals of treatment include minimizing clinical symptoms such as pain and swelling, as well as preventing bone deformity and radiographic damage (for example, bone erosions visible in X-rays), and maintaining the quality of life in terms of day-to-day activities. These goals can be achieved using the following two main categories of pharmacological drugs: analgesics and NSAIDS, and DMARDS (see below;). ACR recommends that RA should generally be treated with at least one specific anti-rheumatic medication. ACR also recommends different combinations or DMARDs depending on the duration of disease from onset, prognosis (based on radiographic images and laboratory results), and activity of the disease.

Cortisone therapy has offered relief in the past, but its long-term effects have been deemed undesirable. However, cortisone injections can be valuable adjuncts to a long-term treatment plan, and using low dosages of daily cortisone (e.g., prednisone or prednisolone, 5–7.5 mg daily) can also have an important benefit if added to a proper specific anti-rheumatic treatment.

Pharmacological treatment of RA can be divided into disease-modifying antirheumatic drugs (DMARDs), anti-inflammatory agents and analgesics. Treatment also includes rest and physical activity.