In short, rheumatoid arthritis or RA is an autoimmune disease involving the body's immune system that normally protects the body by attacking foreign substances such as viruses and bacteria. Most commonly, rheumatoid arthritis affects the joints of the wrists, hands, elbows, ankles, feet and knees. Most often, the effect on the joints is symmetrical, which means that when one hand or knee is touched, the other also feels similar symptoms. In addition, since RA can also affect body systems such as respiratory or cardiovascular systems, it is a systemic disease that can affect the entire body.
Common treatment options for rheumatoid arthritis
The goals of rheumatoid arthritis treatments are:
- Put the disease in remission or stop the inflammation.
- Prevent damage to organs and joints
- Relieve symptoms
- Improve overall well-being and physical function
- Reduce long-term complications
Physicians generally adopt a combination of rheumatoid arthritis treatment strategies, including the following:
- Early aggressive treatment – The first strategy of treating RA is to stop or reduce inflammation as soon as possible, as they say, the sooner the better.
- Targeting remission – Doctors generally refer to inflammation during RA as an activity of the disease. Therefore, the ultimate goal of this line of treatment is to stop progression and achieve remission. This ultimately means that no sign or symptom of active inflammation should be present. A strategy designed to achieve this goal is known as "treat to target".
- Tight control – Reduce and maintain the activity of the disease of RA is known as the "strict control of RA". Studies reveal that strict control can slow the pace, or even prevent damage to the joints. The drugs for RA include several drugs used to treat rheumatoid arthritis. Some of them are mainly used to relieve the symptoms of RA, while others are used to slow down or stop the course of the disease and to inhibit structural damage.
- Medications to relieve symptoms – These are nonsteroidal anti-inflammatory drugs known as NSAIDs and are available over-the-counter or prescription. These medications are normally used to relieve the inflammation and pain caused by arthritis. NSAIDs usually include naproxen sodium, ketoprofen, and ibuprofen. Doctors may prescribe celecoxib, a type of NSAID known as the COX-2 inhibitor, to people who have had or are at risk of stomach ulcers. These are considered safer for the stomach. In addition, these drugs can be taken orally or applied to the skin as a patch or cream, directly on the swollen joint.
Drugs to slow down the activities of the disease include the following
- Corticosteroids – These drugs include prednisolone, prednisone, and methyprednisolone, fast-acting, potent anti-inflammatory drugs. These are used in RA to control potentially damaging inflammation while waiting for DMARDs and NSAIDs to take effect. Because of the risk of side effects of these medications, doctors generally prefer to use them only for as short a time as possible and at a low dose.
- DMARDs – This is an acronym for disease modifying antirheumatic drugs. DMARDs are drugs that alter the course of RA. Conventional DMARDs include azathioprine, cyclophosphamide, leflunomide, sulfasalazine, hchroxycholorquin and methotrexate. These medications can be taken orally, self-injected, or given as an infusion at a clinic.
- Organic Products – These are drugs that make up a subset of DMARDs. Biologics, however, act faster than DMARDs and are injected or administered by clinical perfusion. Since these drugs target specific stages of the inflammatory process, they do not destroy the body's entire immune response, unlike other treatments for rheumatic arthritis. Biologics can alter, slow down, or stop the progression of RA in many people, even when other treatments have not been of much help.
- Inhibitors of JAK – This is a new sub-category of DMARD known as JAK inhibitors, which blocks the JAK pathways, Janus Kinase, involved in the body's immune response. Tofacitinib is one of those drugs that belongs to this category. In addition, unlike biologics, JAK inhibitors can be administered orally.
- Surgery – Surgery for RA, however, may never be necessary, but it may be an excellent option for patients who have sustained permanent damage, which limits their mobility, daily activity, and independence. arthroplasty can effectively restore function and relieve pain in joints severely damaged by RA. The surgical procedure involves replacing the damaged parts of a joint with plastic and metal components. Knee and hip arthroplasty are the most common and sometimes even the elbows, wrists, shoulders, ankles and other joints can also be considered for replacement surgery.
New treatments for rheumatoid arthritis
There is a new drug called Remicade, which is proving to be a major breakthrough in the treatment of rheumatoid arthritis. This medication not only relieves pain, but can also prevent progression of RA. Remicade can stop the inflammatory changes that characterize potentially disabling RA and that can permanently damage the joints and cause chronic pain and disability. RA is a progressively debilitating disease that usually develops in people aged 25 to 50 years. The researchers developed Remicade when they discovered that the triggering factor of inflammation was the tumor necrosis factor, TNF, a chemical produced by the immune system. People who develop rheumatoid arthritis produce excessive levels of TNF, which in turn stimulate cells to cause inflammation of the joints. Remicade is specially designed to chemically deactivate TNF and neutralize its action. However, Remicade does not cure rheumatoid arthritis, but it is found that the joints recover from post-traumatic arthritis since the inflammation is turned off. Generally available as a subcutaneous injection similar to insulin injection for diabetic patients, Remicade can be self-injected at home twice a week or can also be administered by intravenous infusion once every two months within a hospital.