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Rheumatoid arthritis is a disabling joint disease that causes pain and deformities in the joints of the body. The hands and feet are most commonly affected, although larger joints can be involved as well. Rheumatoid arthritis is different from the osteoarthritis that many people develop with age or after injury because it is an autoimmune disease where antibodies attack the joints causing inflammation. This can lead to pain, swelling and permanently deformed joints.
The American College of Rheumatology estimates that 1.3 million Americans are affected by rheumatoid arthritis. These patients are usually women between 30 and 50 years of age, but anyone can develop rheumatoid arthritis at any age. Different types of medications, including methotrexate and low dose prednisone, are used to treat rheumatoid arthritis.
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Symptoms and Diagnosis of Rheumatoid Arthritis
Patients with rheumatoid arthritis usually experience joint stiffness in the morning that may last several hours. Other symptoms include fatigue, low-grade fever, dry mouth and eyes, and nodules under the skin. Diagnosis usually includes blood tests that measure anemia, autoimmune antibodies and markers of inflammation. Sometimes X-rays are helpful, but may not show damage to the joints in the early months of the disease. MRI and ultrasound can also be used to help diagnose rheumatoid arthritis.
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Treatment of Rheumatoid Arthritis with Methotrexate
While currently rheumatoid arthritis cannot be cured, the symptoms can be managed with various medications. One of the mainstays of treatment is methotrexate, a drug originally used for cancer patients. Methotrexate is used alone or with other medications. It helps to decrease swelling and pain from rheumatoid arthritis and stops the damage to the bones in the joints. Methotrexate blocks the overactive immune system that leads to the damage from rheumatoid arthritis and also blocks an enzyme that helps the body use folic acid.
Most patients do well with methotrexate. Some side effects include hair loss, mouth sores and upset stomach, which may be helped by taking additional folic acid supplements while using methotrexate. Serious side effects can include liver and lung damage and suppression of the immune system which makes patients more likely to get infections. These last effects are more often associated with the high methotrexate doses used in cancer treatment.
Patients taking methotrexate should expect relief after a few weeks of methotrexate treatment. Blood tests are needed while on the medication to ensure that liver function remains normal.
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Low Dose Prednisone for Rheumatoid Arthritis
Steroids like prednisone are occasionally used for rheumatoid arthritis. They help decrease inflammation and suppress the immune system, but have been thought to have few effects on the bony deformities that occur with rheumatoid arthritis. However, recent studies may have shown that there is some effect of low dose prednisone on the disease process itself. Low dose prednisone may be used orally at the beginning of treatment until other medications like methotrexate take effect. Steroid injections directly into the joints are also occasionally used to decrease inflammation. Some prescribers will combine methotrexate and low dose prednisone to treat rheumatoid arthritis.
The many side effects limit the use of steroids for rheumatoid arthritis. Patients must watch for weight gain, increased blood sugar and bone loss when taking prednisone and other steroids. Long term use of steroids may make it difficult to stop them as the body becomes used to steroids over time.
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Matsumoto, AK. Rheumatoid Arthritis Clinical Presentation. The Johns Hopkins Arthritis Center. Accessed January 11, 2011, http://www.hopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/rheum_clin_pres.html
Rheumatoid Arthritis. American College of Rheumatology. Accessed January 11, 2011.
Methotrexate. American Cancer Society Guide to Cancer Drugs. Accessed January 1, 2011, http://www.cancer.org/Treatment/TreatmentsandSideEffects/GuidetoCancerDrugs/methotrexate
Methotrexate. MedlinePlus. Accessed January 11, 2011.