Rheumatoid Arthritis Treatment

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

Once a diagnosis is confirmed, the current standard of care (in addition to rest, strengthening exercises, and anti-inflammatory drugs) is aggressive therapy with disease-modifying anti-rheumatic drugs (DMARDs).

Methotrexate (Rheumatrex) is the most commonly used DMARD for rheumatoid arthritis. Others include leflunomide (Arava), gold thiomalate (Myochrysine), aurothioglucose (Solganal), or auranofin (Ridaura).

Anti-inflammatory agents used to treat RA include aspirin and non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (Motrin, Advil), fenoprofen, indomethacin, and naproxen (Naprosyn). NSAIDS are commonly used to relieve joint pain and inflammation. Although NSAIDs work well, long-term use can cause stomach problems, such as ulcers and bleeding, and possible heart problems. In April 2005, the FDA asked drug manufacturers of NSAIDs to include a warning label on their product that alerts users of an increased risk for cardiovascular events and gastrointestinal bleeding.

COX-2 inhibitors block an inflammation-promoting enzyme called COX-2. This class of drugs was initially believed to work as well as traditional NSAIDs, but with fewer stomach problems. However, numerous reports of heart attacks and stroke have prompted the FDA to re-evaluate the risks and benefits of the COX-2s. Rofecoxib (Vioxx) and valdecoxib (Bextra) have been withdrawn from the U.S. market following reports of heart attacks in patients taking the drugs. Celecoxib (Celebrex) is still available, but labeled with strong warnings and a recommendation that it be prescribed at the lowest possible dose for the shortest duration possible. Patients should ask their doctor whether the drug is appropriate and safe for them.

Antimalarial medications such as hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine) are also beneficial, usually in conjunction with methotrexate. It may be weeks or months before a patient sees any benefit from these medications. Because they are associated with toxic side effects, the patient must have frequent blood tests.