Rheumatoid arthritis causes painful swelling of the lining of the joints. Arthritis has no cure. It is a progressive disease that eventually damages the joints and limits movement. The goal of treating arthritis is to reduce pain and inflammation while slowing disease progression. Many treatments simply relieve pain and inflammation without affecting the course of the disease, whereas other medications slow or even stop the damaging effects.
Nonsteroidal anti-inflammatory agents, or NSAIDS, such as ibuprofen, aspirin, acetaminophen, and naproxen sodium, reduce inflammation and pain. These agents act quickly, but they have no effect on joint damage or disease progression. These drugs are available over-the-counter or in stronger prescription formulations and are associated with gastrointestinal discomfort. Corticosteroids, for example, prednisone or methylprednisolone, reduce inflammation. Available in oral, intravenous, or intramuscular formulations, corticosteroids may be injected directly into the arthritic joint for rapid effect. These agents are associated with a number of side effects, including weight gain, bone thinning, bruising, and an increased risk of cataracts, osteoporosis, and diabetes. Corticosteroids are often used early in the course of treatment to relieve symptoms until other agents begin to have an effect. The risk of side effects associated with corticosteroids increases with long-term use, so the dosage of these agents is slowly reduced after the first few weeks of therapy to minimize side effects.
Disease Modifying Agents
Disease-modifying anti-rheumatic agents, or DMARDS, actually change the course of arthritis and slow or halt arthritic joint damage. The onset of action is slower than with NSAIDS or corticosteroids, generally taking several weeks or months before an effect is seen. The agents, which fall into several different classes, inhibit or interfere with particular aspects of the inflammatory process. For example, some agents target the inflammatory substance called tumor necrosis factor-alpha, or TNF-alpha, whereas others target other substances that mediate the inflammatory response. To be most effective, treatment with DMARDS should begin when rheumatoid arthritis is diagnosed. The most commonly used DMARDS are methotrexate, sulfasalazine, minocycline, hydroxychloroquine, and leflunomide. Other DMARDS include rituximab, abatacept, and anakinra.
The class of DMARDS called TNF-alpha inhibitors include etanercept, adalimumab, and infliximab. These drugs, which are injected, block TNF-alpha, an inflammatory substance found in large amounts in arthritic joints. TNF-alpha is an important factor in arthritic joint damage. Although TNF-alpha inhibitors prevent further joint damage, they are associated with potentially serious side effects, for example, injection site reactions, severe respiratory tract infections, including tuberculosis, and decreased white blood cell counts.
Reduction of Joint Stress
When deciding how to treat arthritis, attention must be paid to relieving joint stress to help control pain. Patients should maintain a healthy body weight and exercise regularly. Physical or occupational therapy can help patients learn to live with their arthritis. Canes, walkers, or splints may help support joints and relieve stress.
In severe cases where medication fails to slow disease progression, surgery may be necessary to repair damaged joints. Surgery may range from total joint replacement to repair of damaged tendons or removal of the synovia, or lining of the joint. In the most severe cases where joint replacement is impossible, the joints may have to be fused for stabilization or realignment.
Arthritis treatments cannot cure the condition, but they can relieve symptoms. Over-the-counter and prescription medications help reduce inflammation and relieve pain. Disease-modifying agents change the course of arthritis and prevent further joint damage. All medications are associated with side effects, ranging from stomach discomfort to serious respiratory infections and bone thinning. Combining medications with moderate exercise and lifestlye changes can help people with arthritis live active lives.
Johns Hopkins Arthritis Center: Rheumatoid Arthritis Treatment https://www.hopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/rheum_treat.html
MayoClinic.com: Rheumatoid Arthritis https://www.mayoclinic.com/health/rheumatoid-arthritis/DS00020/DSECTION=treatments-and-drugs