- person's general condition
- current and predicted severity of the illness
- length of time he or she will take the drug
- drug's effectiveness and potential side effects
Early Aggressive Treatment
For many years, doctors initially prescribed aspirin or other pain-relieving drugs for rheumatoid arthritis, as well as rest and physical therapy. They usually prescribed more powerful drugs later only if the disease worsened.
Today, however, many doctors have changed their approach, especially for patients with severe, rapidly progressing rheumatoid arthritis. Studies show that early treatment with more powerful drugs, and the use of drug combinations instead of one medication alone, may be more effective in reducing or preventing joint damage. Once the disease improves or is in remission, the doctor may gradually reduce the dosage or prescribe a milder medication.
Drug Options
Medications currently used to treat rheumatoid arthritis include:
- analgesics including acetaminophen
- nonsteroidal anti-inflammatory drugs (NSAIDs) including:
- salicylates (both acetylated such as aspirin and nonacetlyted)
- traditional NSAIDs (i.e ibuprofen, ketoprofen, and naproxen)
- COX-2 inhibitors
- corticosteroids (i.e. methylprednisolone and prednisone)
- disease-modifying antirheumatic drugs (DMARDs) including:
- azathioprine
- cyclosporine
- hydroxychloroquine
- gold sodium thiomalate
- leflunomide
- methotrexate
- sulfasalazine
- Biologic response modifiers (BRMs) including:
Biologic response modifiers are newer drugs used in the treatment of rheumatoid arthritis. They can help reduce inflammation and structural damage to the joints by blocking the action of cytokines, proteins of the body's immune system that trigger inflammation during normal immune responses.
Osteoporosis Prevention
People with rheumatoid arthritis may want to discuss preventing osteoporosis with their doctors as part of their long-term, ongoing care. Osteoporosis is a condition in which bones become weakened and fragile. Having rheumatoid arthritis increases the risk of developing osteoporosis for both men and women, particularly if a person takes corticosteroids. Such patients may want to discuss with their doctors the potential benefits of calcium and vitamin D supplements, hormone therapy, or other treatments for osteoporosis.
Surgery
Several types of surgery are available to patients with severe joint damage. The primary purpose of these procedures is to reduce pain, improve the affected joint's function, and improve the patient's ability to perform daily activities. Surgery is not for everyone, however, and the decision should be made only after careful consideration by patient and doctor. Together they should discuss the patient's overall health, the condition of the joint or tendon that will be operated on, and the reason for, as well as the risks and benefits of, the surgical procedure. Cost may be another factor. Common surgical procedures include:
- joint replacement
- tendon reconstruction
- synovectomy
Joint replacement
This is the most frequently performed surgery for rheumatoid arthritis, and it is done primarily to relieve pain and improve or preserve joint function. Artificial joints are not always permanent and may eventually have to be replaced. This may be an important consideration for young people.
Tendon reconstruction
Rheumatoid arthritis can damage and even rupture tendons, the tissues that attach muscle to bone. This surgery, which is used most frequently on the hands, reconstructs the damaged tendon by attaching an intact tendon to it. This procedure can help to restore hand function, especially if the tendon is completely ruptured.
Synovectomy
In this surgery, the doctor actually removes the inflamed synovial tissue. Synovectomy by itself is seldom performed now because not all of the tissue can be removed, and it eventually grows back. Synovectomy is done as part of reconstructive surgery, especially tendon reconstruction.
Related Resources
Source: NIH Publication No. 04-4179
