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 the development of joint erosion’s. The exact reason for their effectiveness is at this stage not well understood. Their effectiveness in their ability to slow the progression of erosion’s is judged through the use of X-rays.
With DMARDs early diagnosis and treatment of RA is important in the aim of preventing joint deformity and disability. DMARDs take 6-8 weeks to achieve beneficial effects. Treatment with these drugs should be closely monitored. Regular blood and urine tests are often done to identify side effects and potential problems as soon as possible.
DMARDs that are used in the treatment of RA.
Methotrexate (e.g. Ledertrexate, Methoblastin) may be used in moderate to severe rheumatoid arthritis. This medication can be taken orally or by intramuscular injection. Supplements of folic acid are recommended to alleviate side effects such as nausea and mouth ulcers. Methotrexate It is potentially toxic to the liver. Methotrexate is the leading DMARD in the fight against inflammation in RA.
Sulfasalazine such as Pyralin EN and Salazopyrin EN. These drugs while less potent, have fewer adverse side effects and are used in the treatment of mild RA. These however can still cause nausea, dyspepsia, diarrhea, rash and headaches. These side effects however are reduced once the maintenance dose is reached. It can also lead to severe anemia on occasion.
Leflunomide (e.g. Arava). Used for severe active RA that does to methotrexate. Leflunomide is as effective as methotrexate in the treatment of RA.
Antimalarials such as hydroxychloroquine sulfate such as Plaquenil are also used in the treatment of mild rheumatoid arthritis. They are less toxic than some of the other treatments. Plaquenil is often used in combination with other DMARDs.
Azathioprine (e.g. Imuran) is used to treat only severe active RA that is unresponsive to other DMARDs. Because of high toxicity it is rarely used.
Non-steroidal anti-inflammatory drugs
These drugs are prescribed as pain killers. They may also reduce inflammation inflammatory forms of arthritis, such as RA. They have no effect on the progress of the disease but may relieve symptoms. Ibuprofen such as Nurofen or Tri-Profen and naproxens such as Naprogesic are available without prescription. Drugs such as such as diclofenac, piroxicam, sulindac and indomethacin have to be prescribed by a doctor.
The use of NSAIDs is often limited because they increase the risk of upper gastrointestinal problems, such as gastric ulcer. They are not suitable for use by people who have had a peptic ulcer or gastrointestinal bleeding.
COX-2 specific inhibitors
The coxibs (e.g. celecoxib – brand name Celebrex) These are non-steroidal anti-inflammatory agents. They are effective in reducing inflammation and relieving pain and are far gentler on the stomach than the conventional, older NSAIDs. Coxibs may be associated with an increased risk of cardiovascular events, such as heart attack and stroke, when taken in high doses. People with an increased risk of heart attack or stroke are advised not to use these medications.
Corticosteroids, also known as glucocorticoids, such as prednisone and prednisolone, are medications that reduce inflammation and suppress the immune system. These agents are used in the treatment of RA, both as tablets and as injections into the joint. Prednisolone is sometimes used in moderate to severe RA where NSAIDs and DMARDs are not controlling the disease. Oral corticosteroids (those taken by mouth) are usually used at the lowest effective dose to minimize adverse effects such as weight gain, hypertension (high blood pressure) and osteoporosis.
Corticosteroids may also be injected into joints if the arthritis is not being controlled through oral therapy, however this has to be limited to 3 to 4 injections a year. Joints commonly injected are fingers, toes, knees and shoulders. Corticosteroids are also sometimes injected into the muscles.
A new category of arthritis treatments called tumour necrosis factor (TNF) inhibitors has been developed. TNF inhibitors occur naturally in the body and are key players in the process of inflammation in rheumatoid arthritis. It is found in high concentration in the joint fluid of people with RA. By attaching to the TNF, these new agents can block its effect.
Infliximab (e.g. Remicade) is a TNF inhibitor available for the treatment of RA in selected patients. It slows the progression of RA and reduces joint damage. Inflixmab is given by infusion via a drip into a vein. Each treatment takes approximately 2 hours. It is given along with methotrexate. There are very tight Government restrictions In Australia on which patients with RA can obtain access to Remicade because of the expense involved.
Etanercept (e.g. Enbrel)
You use plenty of heat, epsom salts are wonderful in a nice warm to hot bath (As tolerated) Also please use Advil, aleeve. As in all medication’s please keep out of reach of children. new alert on any kind of ibuprofen.. Allergy alert… Ibuprofen may cause a severe allergic reaction especially in people allergic to aspirin
symptoms may include hives, facial swelling, asthma (wheezing) shock, skin reddening, rash, blisters . If an allergic reaction occurs, stop use and seek medical attention right away!
stomach bleeding warning: Advil contains a non steroidal anti inflammatory drug (NSAID) which may cause stomach bleeding. The chance is higher if you are 60 or older
All that being said they may help in certain cases in relieving pain or discomfort, However it is important to keep in mind that in the case of Rheumatoid arthritis you are dealing with an autoimmune disease and all the Epsom salts or hot water in the world is not going to cure the problem. this needs to be treated by a professionally trained person that is able to stop ongoing damage caused by the disease. The use of drugs for most illnesses may carry certain risks, however Gramass special Rheumatoid medcine never stopped her hands from becoming a horible gnarled mess before she died a miserable death. regardless of the goodold natural non invasive treatments that are available, usually at a price).
Each case is different depending on how severe and the patients tollerance to medicines used for treatments. I take Enbrel injections twice a week, 4 Methotrexate pills a week and 2 Folic Acid pills daily.
All of your Rheumatic diseases basically turn your immune system on your body. Methotrexate inhibits the activity of the immune system, in turn reducing inflammation. Since Methrotrexate is a folate antagonist that blocks folic acid activity, Folic Acid is prescribed in conjunction with Methrotrexate. Enbrel is a TNF blocker. TNF is a protein the body produces, it promotes the inflammation and its associated fever and signs such as pain, tenderness, and swelling.
At the moment the symptoms of rheumatoid arthritis is treated with anti inflammatory’s such as prednezone and cellebrex As it iis a disease that involves the attack of the immune system on the body immunity inhibitors such as methablastin are also used with some success. If a person has R A it is important that they seek proper medical assistance as early as possible as damage is being done constantly if it is left untreated. we may not be able to cure it yet but we can reduce the devastating effects a lot compared to only a few years ago.
The pain in RA is the result of inflammation and eventually other damage that is done by the disease, so initially your best bet would be to try to bring the inflammation under control. this is done with a variety of drugs. if you have not yet done so you would do well to See a Rhumatologist to work out what treatment would best suit your particular situation. Only taking pain killers for a disease like RA may have disastrous consequences in the longrun. Stem cell research
There is some very promising research happening in GB, Australia and in the USA where stem cells are being used to create damaged tissue and bone to replace those that are damaged. In Australia that has reached a human testing stage after success in sheep.