Rheumatoid arthritis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Overview

There is no known cure for rheumatoid arthritis. However, many different types of treatment can be used to alleviate symptoms and/or to modify the disease process.

Medical Therapy

Early diagnosis of rheumatoid arthritis is helpful in treatment. Choice of treatment depends on the following factors:

• Stage of disease (eg, mild/moderate/severe).
• Associated with other comorbid conditions.
• Stage of therapy (eg, initial versus subsequent therapy in patients resistant to treatment).
• Presence of severe prognostic signs.

Non-pharmacological treatment

• Heat or cold compresses are used to reduce the swelling, pain, and stiffness.
• Orthotics and splints
• Active and passive exercise helps in restoring range of motion.
• Patient education about taking healthy diet and taking proper rest.

Pharmacological treatment

• The mainstay of treatment of rheumatoid arthritis is pharmacotherapy.
• Principles used for the treatment of rheumatoid arthritis are:
  • Making an early diagnosis and taking early treatment is helpful.
  • Use of disease-modifying antirheumatic drugs early in the treatment.
  • Consult a specialist like a rheumatologist.
  • Use of anti-inflammatory drugs and glucocorticoids as an adjuvant.

Test to be done before starting the therapy

• CBC with differentials.
• ESR and CRP
• Serum creatinine
• Screen for Hepatitis B and Hepatitis C
• Test for latent tuberculosis
• Ophthalmological testing

Various therapy used depending upon the stage of disease:

• Active disease:
  • Combined therapy include disease-modifying antirheumatic drugs (DMARDs) are used along with the anti-inflammatory drugs.
  • The first line of the drug is Methotrexate along with anti-inflammatory drugs like NSAIDs and glucocorticoids.
  • Preferred regimen : Methotrexate 7.5 mg PO weekly for 4 weeks.
  • Followed by an increase in dose by 2.5mg PO or 5mg PO depending on the severity of disease and renal function.
  • Monitoring of renal function is done after 4 weeks.
  • Folic acid 1mg PO q24h or leucovorin weekly is usually added to MTX to avoid side effects.

Other disease-modifying antirheumatic drugs (DMARDs) used are:

• Leflunomide:
  • It is used in active disease, helps in improving physical activity.
  • Mechanism of action - it is a pyrimidine synthesis inhibitor that blocks autoimmune antibodies and reduces inflammation.
  • Leflunomide inhibits dihydroorotate dehydrogenase and has antiproliferative activity.
  • Contraindicated in pregnancy.