The inflammation caused by RA results in damage to the joints. Themain way to stop or at least reduce joint damage is by givingmedications that suppress inflammation. Disease-ModifyingAnti-Rheumatic
Disease Modifying Anti Rheumatic Drugs
These can also be described as slow acting anti rheumatic drugs(SAARDs). These drugs suppress inflammation and may also retard thedevelopment of joint erosion’s. The exact reason for theireffectiveness is at this stage not well understood. Theireffectiveness in their ability to slow the progression of erosion’sis judged through the use of X-rays. With DMARDs early diagnosisand treatment of RA is important in the aim of preventing jointdeformity and disability. DMARDs take 6-8 weeks to achievebeneficial effects. Treatment with these drugs should be closelymonitored. Regular blood and urine tests are often done to identifyside effects and potential problems as soon as possible. DMARDsthat are used in the treatment of RA.
Methotrexate (e.g. Ledertrexate, Methoblastin) may be used inmoderate to severe rheumatoid arthritis. This medication can betaken orally or by intramuscular injection. Supplements of folicacid are recommended to alleviate side effects such as nausea andmouth ulcers. Methotrexate It is potentially toxic to the liver.Methotrexate is the leading DMARD in the fight against inflammationin RA.
Sulfasalazine such as Pyralin EN and Salazopyrin EN. These drugswhile less potent, have fewer adverse side effects and are used inthe treatment of mild RA. These however can still cause nausea,dyspepsia, diarrhea, rash and headaches. These side effects howeverare reduced once the maintenance dose is reached. It can also leadto severe anemia on occasion.
Leflunomide (e.g. Arava). Used for severe active RA that does tomethotrexate. Leflunomide is as effective as methotrexate in thetreatment of RA.
Antimalarials such as hydroxychloroquine sulfate such as Plaquenilare also used in the treatment of mild rheumatoid arthritis. Theyare less toxic than some of the other treatments. Plaquenil isoften used in combination with other DMARDs.
Azathioprine (e.g. Imuran) is used to treat only severe active RAthat is unresponsive to other DMARDs. Because of high toxicity itis rarely used.
Non-steroidal anti-inflammatory drugs
These drugs are prescribed as pain killers. They may also reduceinflammation inflammatory forms of arthritis, such as RA. They haveno effect on the progress of the disease but may relieve symptoms.Ibuprofen such as Nurofen or Tri-Profen and naproxens such asNaprogesic are available without prescription. Drugs such as suchas diclofenac, piroxicam, sulindac and indomethacin have to beprescribed by a doctor.
The use of NSAIDs is often limited because they increase the riskof upper gastrointestinal problems, such as gastric ulcer. They arenot suitable for use by people who have had a peptic ulcer orgastrointestinal bleeding.
COX-2 specific inhibitors
The coxibs (e.g. celecoxib – brand name Celebrex) These arenon-steroidal anti-inflammatory agents. They are effective inreducing inflammation and relieving pain and are far gentler on thestomach than the conventional, older NSAIDs. Coxibs may beassociated with an increased risk of cardiovascular events, such asheart attack and stroke, when taken in high doses. People with anincreased risk of heart attack or stroke are advised not to usethese medications.
Corticosteroids, also known as glucocorticoids, such as prednisoneand prednisolone, are medications that reduce inflammation andsuppress the immune system. These agents are used in the treatmentof RA, both as tablets and as injections into the joint.Prednisolone is sometimes used in moderate to severe RA whereNSAIDs and DMARDs are not controlling the disease. Oralcorticosteroids (those taken by mouth) are usually used at thelowest effective dose to minimize adverse effects such as weightgain, hypertension (high blood pressure) and osteoporosis.
Corticosteroids may also be injected into joints if the arthritisis not being controlled through oral therapy, however this has tobe limited to 3 to 4 injections a year. Joints commonly injectedare fingers, toes, knees and shoulders. Corticosteroids are alsosometimes injected into the muscles.
A new category of arthritis treatments called tumour necrosisfactor (TNF) inhibitors has been developed. TNF inhibitors occurnaturally in the body and are key players in the process ofinflammation in rheumatoid arthritis. It is found in highconcentration in the joint fluid of people with RA. By attaching tothe TNF, these new agents can block its effect.
Infliximab (e.g. Remicade) is a TNF inhibitor available for thetreatment of RA in selected patients. It slows the progression ofRA and reduces joint damage. Inflixmab is given by infusion via adrip into a vein. Each treatment takes approximately 2 hours. It isgiven along with methotrexate. There are very tight Governmentrestrictions In Australia on which patients with RA can obtainaccess to Remicade because of the expense involved.
Etanercept (e.g. Enbrel)
You use plenty of heat, epsom salts are wonderful in a nice warm tohot bath (As tolerated) Also please use Advil, Aleeve. As in allmedication’s please keep out of reach of children. new alert on anykind of ibuprofen.. Allergy alert… Ibuprofen may cause a severeallergic reaction especially in people allergic to aspirin.Symptoms may include hives, facial swelling, asthma (wheezing)shock, skin reddening, rash, blisters. If an allergic reactionoccurs, stop use and seek medical attention right away!
Stomach bleeding warning: Advil contains a non steroidal antiinflammatory drug (NSAID) which may cause stomach bleeding. Thechance is higher if you are 60 or older
All of your Rheumatic diseases basically turn your immune system onyour body. Methotrexate inhibits the activity of the immunesystem, in turn reducing inflammation. Since Methrotrexate is afolate antagonist that blocks folic acid activity, FolicAcid is prescribed in conjunction with Methrotrexate. Enbrelis a TNF blocker. TNF is a protein the body produces, it promotesthe inflammation and its associated fever and signs such as pain,tenderness, and swelling.
At the moment the symptoms of rheumatoid arthritis is treated withanti inflammatory’s such as prednezone and cellebrex As it iis adisease that involves the attack of the immune system on the bodyimmunity inhibitors such as methablastin are also used with somesuccess. If a person has R A it is important that they seek propermedical assistance as early as possible as damage is being doneconstantly if it is left untreated. we may not be able to cure ityet but we can reduce the devastating effects a lot compared toonly a few years ago.