What Every Rheumatoid Arthritis Patient Ought to Know.

Rheumatoid arthritis causes hand deformity

Start DMARDS early for Rheumatoid Arthritis.

A diagnosis of rheumatoid arthritis (RA) is frightening and confusing for anyone. So, let’s get to the bottom of what every rheumatoid arthritis patient ought to know. Unfortunately, RA has no cure and is a chronic medical condition that patients live with for the rest of their lives. RA is an autoimmune disease (the body attacking itself) with an unknown cause. Genetic factors seem to represent a major risk. It affects about 2% of the population and can vary from a mild condition to a severely disabling disorder. It generally presents itself as pain and stiffness of the small joints of the hands and feet. The pain and swelling mainly affect the fingers of both hands. In about a quarter of cases, RA presents as arthritis of a single joint such as the knee. It can progress to severe pain, deformity and disability of multiple joints.

The goal of RA treatment is the lowest level of disease activity, minimising joint damage, and enhancing physical function and quality of life.

DMARDS stands for Disease Modifying Anti-Rheumatic Drugs. They prevent erosions in the joints and permanent damage. They are the only medications that are proven to change the course of the disease.

Rheumatoid arthritis causes damage and deformity of the joints.

Rheumatoid arthritis causes damage and deformity of the joints.


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What medications are used to treat RA?

There are three general classes of drugs that are used to treat RA. Non-steroidal anti-inflammatory agents (NSAIDS), corticosteroids and disease modifying anti-rheumatic dugs (DMARDS). NSAIDS and corticosteroids together with general pain relief medications, start to work quickly to improve symptoms of pain and swelling. Prolonged use of these medications do have significant adverse side effects. Ideally they are used sparingly. Current best practice is for the early commencement of DMARDS usually coordinated by a patient’s specialist rheumatologist.

Fish oil

Fish oil over several months has been shown to reduce symptoms and lower the need for NSAIDS.

Non-steroidal Anti-Inflammatory Agents (NSAIDS) and simple analgesics

NSAIDS temporarily relieve symptoms but they do not alter the course of the disease. Common agents include ibuprofen, naproxen and meloxicam. Many patients find options with once or twice a day dosage easier to manage.

Corticosteroids

Oral prednisolone can be considered for patients with severe symptoms as a temporary addition to DMARD treatment or when other treatments have failed. Prednisolone is most commonly used.

Rheumatoid arthritis patients take oral medication.

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Disease-modifying anti-rheumatic drugs (DMARDS).

What every rheumatoid arthritis patient ought to know – start DMARDS early!

DMARDS stands for Disease Modifying Anti-Rheumatic Drugs. They are a class of medications that are proven to change the course of the disease. They prevent erosions in the joints and permanent damage. Many studies show significant progression of the disease in the first two years of diagnosis. These are key medications to get started early on from the diagnosis of RA to minimise long term joint damage. There are two main subcategories.

Conventional oral DMARDS.

These medications work by modulating the immune system so it’s not as active in damaging the joints. Methotrexate is the first line DMARD agent for most patients with RA. It should be commenced as early as possible. Initially starting at 5-10mg once a week. Folic acid 5-10mg is added twice a week (not on the same day as methotrexate). Sulfasalazine, leflunomide are other conventional DMARDS. These medications have been used for many years in RA treatment and are generally well tolerated by most patients. Patients need blood tests regularly to monitor for any side effects such as liver dysfunction and changes in the blood cell count. The big advantage of these medications is that they are standard oral medications.

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Biologic DMARDS.

The other main class are biologic DMARDS. The range of options is increasing and is considered if remission is not being achieved with methotrexate treatment. These agents work by dampening down immune system activity in combination with the other RA treatments. The reduced immune system activity does put patients at increased risk of infections such as pneumonias. Patients should be aware of unusual symptoms such as fever or cough, urinary tract symptoms or skin infections. These agents are generally delivered by injection or infusion.

Combination treatment.

Medication classes are often combined. There are many different treatment options including the combination of multiple oral medications with conventional and biologic DMARDS. This is most commonly under the guidance of a rheumatologist.

Key takeaways – what every rheumatoid arthritis patient ought to know.

Its understandable that a diagnosis of rheumatoid arthritis can be upsetting. Fortunately, patients can be reassured that today, we have many different treatment options for RA. As we have seen, commencing the right treatment plan early on in the disease is vital. We can really manage the disease well, reduce permanent damage and help people achieve their treatment goals and maintain the best quality of life. It’s important that patients develop a strong relationship with a local general practitioner and a specialist rheumatologist to partner with them in the management of this chronic health problem.

Treatment is a team effort.

Dragonclaw is an RA patient support group.

Dragonclaw is a rheumatoid arthritis patient support group.

Looking after a chronic medical condition such as rheumatoid arthritis involves a team effort. A good treatment plan takes a holistic approach in coordinating care with physical therapy (physiotherapy, hydrotherapy, exercises), occupational therapy (splints, aids and appliances) and social supports (home medication delivery). Patients are not alone. Dragonclaw is a patient-led support and advocacy group leading with an integrated and holistic approach to managing RA by bringing together practical information, personal stories, dietary advice and hints and tips.

There is no cure for Rheumatoid Arthritis.

Learn how to achieve your best quality of life not defined by your disease.

Free medical and lifestyle advice for RA patients.

 

  • Get access to Australian doctors and pharmacists 24/7 to answer your questions about Rheumatoid Arthritis.
  • Free articles from health experts about evidence based management to prevent permanent joint damage, chronic pain and life threatening complications.
  • Your questions answered about natural therapies for rheumatoid arthritis. Are they effective? Are they safe?
  • Stop feeling isolated. Join other Australian RA patients in the Medmate Community below. We’re all in this together.

  • Dr Ganesh Naidoo
  • About the Author

    Dr Ganesh Naidoo BSc(biomed), MBBS, FRACGP is an Australian General Practitioner. He has significant clinical experience in multiple regions of Australia and has a passion for health transformation to improve clinical outcomes for all patients.

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Discussion

Comments

Anonymous

June 10 2021
I have been on methotrexate for 30 years now and has done wonders for me
REPLY

Fran

June 10 2021
I'm in my 70s an my hands give me hell.
REPLY
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