RA; Arthritis - rheumatoid

RA usually requires lifelong treatment, including medications, physical therapy, exercise, education, and possibly surgery. Early, aggressive treatment for RA can delay joint destruction.

MEDICATIONS

Disease modifying antirheumatic drugs (DMARDs): These drugs are the first drugs usually tried in patients with RA. They are prescribed in addition to rest, strengthening exercises, and anti-inflammatory drugs.

• Methotrexate (Rheumatrex) is the most commonly used DMARD for rheumatoid arthritis. Leflunomide (Arava) and sulfasalazine may also be used.
• These drugs may have serious side effects, so you will need frequent blood tests when taking them.

Anti-inflammatory medications: These include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naprosen.

• Although NSAIDs work well, long-term use can cause stomach problems, such as ulcers and bleeding, and possible heart problems.
• Celecoxib (Celebrex) is another anti-inflammatory drug, but it is labeled with strong warnings about heart disease and stroke. Talk to your doctor about whether COX-2 inhibitors are right for you.

Antimalarial medications: This group of medicines includes hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine), and is usually used along with methotrexate. It may be weeks or months before you see any benefit from these medications.

Corticosteroids: These medications work very well to reduce joint swelling and inflammation. Because of long-term side effects, corticosteroids should be taken only for a short time and in low doses when possible.

BIOLOGIC AGENTS:

Biologic drugs are designed to affect parts of the immune system that play a role in the disease process of rheumatoid arthritis.

They may be given when other medicines for rheumatoid arthritis have not worked. At times, your doctor will start biologic drugs sooner, along with other rheumatoid arthritis drugs.

Most of them are given either under the skin (subcutaneously) or into a vein (intravenously). There are different types of biologic agents:

• White blood cell modulators include: abatacept (Orencia) and rituximab (Rituxan)
• Tumor necrosis factor (TNF) inhibitors include: adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), golimumab (Simponi), and certolizumab (Cimzia)
• Interleukin-6 (IL-6) inhibitors: tocilizumab (Actemra)

Biologic agents can be very helpful in treating rheumatoid arthritis. However, people taking these drugs must be watched very closely because of serious risk factors:

• Infections from bacteria, viruses, and fungi
• Leukemia or lymphoma
• Psoriasis

SURGERY

Occasionally, surgery is needed to correct severely damaged joints. Surgery may include:

• Removal of the joint lining (synovectomy)
• Total joint replacement in extreme cases; may include total knee, hip replacement, ankle replacement, shoulder replacement, and others

PHYSICAL THERAPY

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Rheumatoid arthritis

Rheumatoid arthritis

Synovial fluid

Rheumatoid arthritis

Rheumatoid arthritis

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Review Date: 02/14/2011
Reviewed By: Michael E. Makover, MD is a professor and attending in rheumatology at the New York University Medical Center, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)