How do we Treat Rheumatoid Arthritis?

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If you have been given the diagnosis of rheumatoid arthritis, do not panic! We have gained a huge understanding of this disease and developed very effective medications over the last decade.

The goal of treatment is to suppress the disease to prevent joint damage. It is extremely important that it is diagnosed early before the joints are damaged permanently. Clinical evidence suggests early aggressive treatment results in a higher chance of achieving remission. Your rheumatologist may use the term ‘window of opportunity’ which is usually defined as the first 6 months after the diagnosis.

There are two groups of medications commonly used to treat rheumatoid arthritis.

  • Anti-inflammatory medication and corticosteroids are effective in controlling the symptoms but they do not prevent joint destruction. They work rapidly and most patients experience improvement within a few days. They are gradually tapered once the symptoms improve.
  • Diseases modifying anti-rheumatic drugs (DMARD) are medications, which work on the deranged immune pathway. These medications include methotrexate, sulphasalazine, hydroxychloroquine, leflunomide, azathioprine and cyclosporin. They have different side effect profiles and all must be monitored very closely. Only 30-50% of patients have adequate disease control with one agent and the majority of patients require combination treatment, and some patients require a biological DMARD (bDMARD).

Biological DMARDs (Humira, Enbrel, Remicade, Simponi, Cimzia, Orencia, Actemra and Mabthera) are more powerful immunosuppressants and are given as either subcutaneous injections or regular infusions into the vein. These medications have revolutionised the treatment of rheumatoid arthritis over the last decade. Patients who previously had aggressive disease, who did not have adequate control even with triple or quadruple combination therapy can often achieve significant improvement with this family of medication. Medicare Australia subsidises treatment if your disease is not well controlled after six months’ of combination therapy.

Most patients with rheumatoid arthritis require long-term treatment and it is essential to have regular blood tests to monitor treatment response and treatment toxicity. Your rheumatologist will advise you the appropriate monitoring protocol.

Patients with rheumatoid arthritis have a higher risk of osteoporosis and cardiovascular disease. It is extremely important to address these issues at the same time. Your rheumatologist will work with your general practitioner to facilitate investigations including bone mineral density, blood tests for cholesterol, triglycerides and blood sugar. If you have hypertension and/or diabetes, it is crucial that these are optimally controlled.

Lastly, there is solid evidence that smoking increases the severity of rheumatoid arthritis, accelerates bone loss resulting in osteoporosis and exponentially increases the risk of heart attacks and strokes. Smoking cessation is as important as DMARDs and should be an integral part of rheumatoid arthritis treatment.

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