TRC: Therapy of RA

Therapy

Therapy of RA

To treat rheumatoid arthritis, an early and effective intervention is required. The aim of the treatment is to diminish disease activity as much as possible and to prevent joint destruction. Once present, joint destruction is not reversible.

Non-pharmacological treatment is important in the treatment of RA. For example, exercises can slow-down the development of a disability and handicap. It has proven effective in counteracting the development of decreased physical condition and muscle strength, and of osteoporosis. Surgery and/or artificial joint replacement must be considered when, despite the treatment, the joint is destroyed.

Pharmacological treatment involves mostly a combination of analgesics, anti-inflammatory drugs and disease modifying agents.

Non-disease modifying drugs are applied to treat the pain, whether due to inflammation or destruction. Painkillers such as paracetamol and NSAIDs (non-steroidal anti-inflammatory drugs) or COX-2 inhibitors are used. These drugs do not modify the course of the disease (non-modifying drugs), but provide ‘symptomatic’ treatment only.

DMARDs (disease modifying anti-rheumatic drugs) are effective in suppression of disease activity (inflammation) and decrease thereby the symptoms of inflammation such as pain, swelling and stiffness. Moreover, most of them have been tested in RCTs and proven to be able to slow down the rate of joint damage. Most frequently used DMARDs are methotrexate, sulfasalazine (salazopyrine), leflunomide, and gold. Corticosteroids (prednisone) and recently emerged TNFα-blocking DMARDs are very effective in lowering disease activity and slowing down the joint damage. Corticosteroids are mostly used as ‘bridging’ or for local (intra-articular) treatment of arthritis.

More information check: therapy of RA.

A woman with RA presents with an acute painful swollen knee and high fever. Management would be:

Extra info: This acute presentation of a painful swollen knee and high fever in a well-controlled rheumatoid arthritis could be caused by bacterial infection. A bacterial infection needs to be treated with antibiotics.

Option explanation:

injecting the knee with intraarticular glucocorticoids

changing medication to a more effective NSAID

aspirating fluid from the knee to look for crystals and for culture and starting oral colchicine

aspirating fluid from the knee to look for crystals and for culture and starting intravenous antibiotics

Therapy

Therapy of RA

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