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Rheumatology Treatment Guidelines

The National Institutes of Health says rheumatoid arthritis (RA) is a permanent disease that causes inflammation of the joints and surrounding tissues. It can also affect other organs, including the heart and lungs. RA generally requires ongoing treatment that includes a combination of medications, physical therapy, exercise and, in some cases, surgery. The Arthritis Foundation says 1.3 million people in the U.S. are affected by RA. There is no cure for rheumatoid arthritis and although its cause is unknown, prompt treatment can postpone damage to joints.

  1. Symptoms

    • The symptoms of rheumatoid arthritis may begin slowly and worsen over time. Signs may include tender, swollen and painful joints. Hands may appear puffy and red; there may be solid bumps of tissue (rheumatoid nodules) under the skin of your arms. Morning stiffness that persists for at least 30 minutes upon wakening is possible along with weight loss, lack of appetite, fatigue and fever.

    Medications

    • Disease modifying anti-rheumatic drugs (DMARDs) are often prescribed in the early stages of RA to minimize joint damages. These medications can also prevent surrounding tissues from suffering irreversible damage. Methotrexate (Rheumatrex) is the most frequently prescribed DMARD. Since these medications can have toxic side effects, regular blood tests are required during use.

    Controlling Inflammation

    • There are a number of treatments that can help manage inflammation. Orencia (abatacept) is given under the skin or into a vein once a month. Rituxan (rituximab) is similar in nature but treatment is needed only two times per year.

      Corticosteroids may be prescribed to lessen joint swelling and inflammation. Cyclooxygenase-2 (COX-2) inhibitors, like celecoxib (Celebrex), work by blocking an inflammation-promoting enzyme called "COX-2." Since this drug has been associated with stroke and heart attacks, it comes with an U.S. Food and Drug Administration warning.

    Surgery

    • Rheumatoid arthritis surgery is needed from time to time to repair severely impacted joints. Surgical options include total joint replacement (arthroplasty), tendon repair or removal of the joint lining (synovectomy). In severe and advanced cases of RA, total knee or hip replacement surgery may be necessary.

    Physical Therapy

    • A physical therapist can teach patients range-of-motion exercises that can slow down the loss of joint function. Deep heat, electrical stimulation, splints and similar gear may be used to alleviate pain, provide support and offer protection to the joints and improve mobility.

    Outlook

    • RA sufferers should undergo frequent blood or urine tests to keep track of how well medications are working and if they are causing side effects. As treatment for rheumatoid arthritis has progressed, serious complications and severe disability occur far less often. Many people with RA are able to live reasonably normal lives.

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