The major goal of Rheumatoid arthritis treatment is to decrease the joint pain and swelling in the joints, to enhance the functioning of the joint and prevent the deformity and destruction of the joints. The medical intervention in the early stages of the rheumatoid arthritis is considered to be giving improved results.
The treatment is said to be optimum if it is offered with the combination of drugs, proper rest, exercises for strengthening of joint, protection of the joint and patient education. The treatment strategy varies depending on the number of joints that are affected, disease activity, age of the patient, general health and occupation of the patient.
There are two classes of drugs that are used for the treatment of Rheumatoid Arthritis. They are fast acting or first-line medications and slow acting or second-line medications. The first-line drugs are meant for treating the pain and inflammation in the joints. The second-line drugs are mostly involved in promoting the remission of the disease and prevent the gradual destruction of the joint.
The extent of the damage occurred in Rheumatoid arthritis depends on the individual affected. The individuals who had little damage done to the disease or if the disease has reduced its intensity after a few years of activity then the management of arthritis can be done by taking rest and by using anti-inflammatory drugs.
The improvement in the joint functioning and the limited damage to the joints is observed when the disease is treated with second-line drugs for few months after its diagnosis. Some cases require usage of aggressive second-line drugs like methotrexate in combination with anti-inflammatory agents. If the joints are damaged heavily then surgery might be suggested.
First-Line Rheumatoid Arthritis Medications
Non-steroidal Anti-Inflammatory Drugs Or NSAIDs
Aspirin, Naproxen, etodolac and Ibuprofen are some of the non-steroidal anti-inflammatory medications that can help in decreasing the swelling and pain in the tissue. Aspirin taken in higher dosages than that used for fever and headache is effectively used as anti-inflammatory drug for Rheumatoid arthritis. Aspirin is the popular NSAID that is known to be used since the ancient period. The novel NSAIDs are as effective as Aspirin in decreasing the pain and swelling and they are required in low dosages in a day.
The most effective NSAID with fewer side effects has to be identified by the physician and prescribed by him/her. The response of the people towards the various NSAIDs differs widely. The common side effects of the aspirin and any other NSAID are stomach upset, ulcers, abdominal pain, and gastrointestinal bleeding. To decrease any problems related to gastrointestinal tract, the administration of NSAIDs is done. The ulcers that might result from the use of NSAIDs can be reduced by taking certain other medications like sucralfate, antacids, misoprostol and proton-pump blockers. The drugs like celecoxib, which is a Cox-2 inhibitor is a new NSAID that shows anti-inflammatory effect as well as causes less irritation in the stomach.
These medications are administered either orally or given as injections into the joints or tissues. Corticosteroids are believed to be more effective compared to NSAIDs in normalizing the joint movement and its function as well as in reducing the inflammation. Corticosteroids are very beneficial for short durations when there is serious burst of disease or when the disease does not respond to the NSAIDs.
Corticosteroids will have severe side effects if they are administered for long duration and in larger dosages. The side effects of corticosteroids include body prone to easy bruise formation, gain in weight, infection risks, damaging of large joints, facial puffiness, cataracts and muscle wasting.
If the symptoms are improved then it is better to gradually taper the dosages of corticosteroids to avoid the side effects. It is not suggested to discontinue corticosteroids suddenly as it might cause withdrawal symptoms of these medications or lead to disease flares. The thinning of the bones due to corticosteroids can be compensated by the intake of sufficient quantities of calcium and vitamin D supplements.
Second-Line Rheumatoid Arthritis Medications
The first-line drugs will not be able to stop joint deformity even though they can reduce the pain and inflammation. The progressive damage to the bone, soft tissues and cartilage can be prevented by the medications other than NSAIDs and corticosteroids.
The effective management of Rheumatoid arthritis can be done using certain medications classified as disease-modifying anti-rheumatic drugs or also called as DMARDs. These are slow acting drugs that take around months to become active and treat the problem. These drugs are used in combination therapy and the second-line medications have to be chosen by the physician carefully before he/she treats the patient with those drugs.
Some of the slow acting drugs include hydroxychloroquinone, sulfalazine, methotrexate, Gold salts, and D-penicillamine. Several immunosuppressive medications are also utilized for the treatment of Rheumatoid arthritis. They include chlorambucil, azathioprine, cyclosporine and cyclophosphamide.
Novel Treatment For Rheumatoid Arthritis
New second-line medications have been released which are emerged as a result of modern biotechnology. Compared to the traditional second-line drugs, these new drugs are known to show their action very quickly and are found to be more powerful in blocking the joint destruction. It can be said that new drugs are targeted exactly towards effective therapy. These drugs include leflunomide, infliximab, etanercept, adalimumab, anakinra, abatacept, rituximab, tocilizumab and certolizumab pegol.
This drug will bring relief to the rheumatoid arthritis symptoms and stops the progression of this disease. Leflunomide functions by inhibiting the activity of a vital enzyme which is known to be involved in immune activation. Leflunomide is otherwise called as Arava and should not be taken during pregnancy as it might cause birth defects in babies.
Infliximab, Etanercept, Adalimumab And Certolizumab Pegol
These drugs are biologic medications which have the ability to interfere with the function of a messenger protein called tumor necrosis factor. This protein usually is involved in enhancing the joint inflammation in rheumatoid arthritis. Before TNF initiates the process of inflammation, these TNF blockers will act on the factor and prevent it from acting.
Moderate to severe rheumatoid arthritis is treated by Anakinra. This drug works by binding to a messenger protein IL-1 in the cell and prevents it from causing inflammation.
It is an antibiotic that was earlier being used for treating lymphoma. This drug is used in effectively treating rheumatoid arthritis and other autoimmune diseases. It works by reducing the number of B-cells which are vital for the inflammation and synthesis of abnormal antibodies.
This drugs works by inhibiting the activation of T-cell. This drug is used in patients who did not respond to traditional DMARDs.
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