Clinical Practice Guidelines for Treatment of Rheumatoid Arthritis

Rheumatoid arthritis is an incurable autoimmune disease which causes the sufferer painful, sometimes crippling, attacks of arthritis. According to the American College of Rheumatology, a disease so complex cannot have a simple outline for management. Understanding the clinical practice guidelines for the treatment of rheumatoid arthritis involves getting a better grasp of the complicated set of decisions, treatment options and skills necessary to manage the disease.

Decisions

• Once a doctor has established a diagnosis of rheumatoid arthritis, there are a number of decision steps that begin to unfold. The primary step is evaluating the extent of the disease and the damage or pain to the patient's joints. The extent of the disease and how it affects the patient will help the doctor determine what treatment options may work best, as well as how intense the treatment needs to be to prevent severe damage to the joints. The doctor will also decide how the patient is managing the disease psychologically and socially--a diagnosis of a chronic, incurable disease like rheumatoid arthritis can affect a patient's outlook, which can also affect his prognosis. Supporting the patient throughout the process is critical, and constant assessment throughout treatment is important to make sure that support happens.

Treatment Options

• Doctors have a number of treatment options for rheumatoid arthritis; based on the initial evaluation of the patient, most doctors start treatment with physical and occupational therapy, intense patient education about the disease, non-steroidal anti-inflammatory drugs, and, if needed, local or oral steroids such as prednisone. Patients with rheumatoid arthritis who do not respond to these initial therapies, or whose disease continues to progress, usually are good candidates for disease-modifying anti-rheumatic drugs (DMARDs). These drugs reduce or prevent damage to the joints and preserve joint integrity and function. Methotrexate is a popular example of a DMARD.

Important Skills

• Constant evaluation and follow up with the patient is critical for doctors treating rheumatoid arthritis. Based on the patient's response to anti-inflammatory drugs, physical therapy, DMARDs, or oral steroids, the doctor will need to continually adjust treatment options. The overall goal is to get the disease to go into remission and thereby prevent further damage to the joints. Following the patient regularly, frequent evaluation and testing of the progress of the disease and the effectiveness of the treatments, and keeping a good sense of timing on when to adjust therapies to stay ahead of the disease are key skills. In rare cases, doctors will have to determine whether to manage a difficult case of rheumatoid arthritis with surgery, based on joint symptoms, with the realization that surgery could either help the patient or worsen the symptoms.