Goals of Treatment for Rheumatoid Arthritis

The primary goals of treatment for rheumatoid arthritis (RA) include:

• Alleviating joint-related symptoms (e.g., pain, swelling, stiffness)
• Preserving function of the affected joints
• Preventing deformity and disability
• Preserving the patient's quality of life to the greatest extent possible
• Educating patients about their disease including the importance of patient compliance with the treatment plan and helping patients set realistic expectations with respect to the long-term prognosis (outlook)

Although rheumatoid arthritis (RA) is usually treated by a rheumatologist , a physician who specializes in the diagnosis and management of rheumatic diseases, often patients require the expertise of other health care providers that may include:

• Physical therapists
• Occupational therapists
• Orthopaedic surgeons
• Podiatrists
• Mental health professionals
• Nurses
• Social workers

Drug Therapy for Rheumatoid Arthritis

Because damage to the joints occurs early in the course of rheumatoid arthritis (RA), early diagnosis and treatment is crucial for halting progression of the disease and preserving functional ability. Although RA is a life-long illness for which currently there is no known cure, early and aggressive treatment can help to slow down the disease progression and prevent disability.

In general, there are four major categories of drugs that are used for the management of patients with RA:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids
• Disease-modifying antirheumatic drugs (DMARDs)
• Selective costimulation modulators

Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually used for the management of pain, inflammation, and stiffness in patients with early-stage rheumatoid arthritis (RA). Because NSAIDs do not alter the course of the disease, they are usually used together with another class of drugs known as disease-modifying antirheumatic drugs (DMARDs) which are the only medications that are known to slow down the progression of RA. Patients with early-stage RA may be started on NSAIDs for a short period of time to control pain, inflammation, and stiffness. As soon as the diagnosis of RA is established, a DMARD is usually added for long-term therapy. Long-term use of NSAIDs (with or without DMARDs) poses a risk of gastrointestinal perforation and bleeding so patients must be carefully monitored to prevent this potentially serious side-effect of NSAID therapy.

Examples of medications that belong to the NSAID category of drugs include:

• Aspirin (e.g., Bayer)
• Acetaminophen (e.g., Tylenol)
• Ibuprofen (e.g., Motrin)
• Naproxen (e.g., Aleve)
• Cox-2 inhibitors (e.g., Celebrex)
• Diclofenac (e.g., Voltaren)
• Indomethacin (e.g., Indocin)
• Ketoprofen (e.g., Orudis)

Corticosteroids, such as prednisone , are highly potent anti-inflammatory agents that are useful for controlling the chronic inflammation that is responsible for causing joint damage in patients with rheumatoid arthritis (RA). In general, corticosteroids are used together with disease-modifying antirheumatic drugs (DMARDs)in a type of treatment known as "bridging therapy". Because corticosteroids work much more quickly than DMARDs, they are often used to "bridge" the time interval from when DMARDs are started until their maximum efficacy can be realized (usually several weeks or months). Corticosteroids (e.g., prednisone) may be given orally or injected directly into an arthritic joint. Due to their potentially serious side-effects, corticosteroids are used at the lowest effective doses and treatment is usually of short duration.