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Rheumatoid arthritis is a chronic inflammatory disease in which the immune system attacks our joints and causes inflammation, pain, stiffness and swelling and slowly damages the joints. Like many other autoimmune diseases, rheumatoid arthritis has no cure but it can be treated with certain medications and therapies that focus on limiting joint inflammation and pain, and slow down damage. The aim of these treatments is to reduce disability and enable you to live a healthy and active life.

DMARDs

DMARDs or “Disease-modifying anti-rheumatic agents” are the first line drugs for rheumatoid arthritis. Examples include methotrexate, hydroxychloroquine, sulfasalazine and leflunomide. If you have been diagnosed with rheumatoid arthritis, your doctor will probably prescribe you a combination of DMARD tablets as an initial treatment. These drugs are usually very effective in controlling the pain and swelling of rheumatoid arthritis. These are usually given in combination with corticosteroids or biological agents.

Methotrexate is normally the first drug prescribed along with another DMARD and a corticosteroid to reduce the pain. It is usually very effective in the reduction of swelling but it has a lot of side effects. Common side effects of methotrexate are headache, diarrhea, sore mouth hair loss and loss of appetite. Methotrexate can also lead to lung infections, liver damage and bone marrow suppression.

You will start noticing the effects of DMARDs in a few months; therefore compliance is very important here. You have to keep taking the medicine even if you don’t see any improvement at first.

Biological Agents

Biological Agents are a newer form of treatment modality for rheumatoid arthritis. These include abatacept, etanercept, anakinra, adalimumab, rituximab, infliximab and tofacitinib.

These drugs target the part of your immune system that triggers the inflammation in your joints. Hence, they prevent joint swelling and tissue destruction. Biological agents are usually added in the regime when DMARDs are not working. They are given by injection and have mild side effects.

NSAIDs

NSAIDs or “non-steroidal anti-inflammatory drugs” are used to reduce inflammation and relieve the chronic pain of rheumatoid arthritis. Examples of NSAIDs used for rheumatoid arthritis are naproxen sodium, diclofenac, Indomethacin, celecoxib, ketorolac, piroxicam and ibuprofen. NSAIDs usually don’t show side effects in most people but some may experience stomach problems.

Steroids

Steroids reduce the activity of immune system and decrease inflammation in joints. Examples include Prednisone, methylprednisolone, cortisone and triamcinolone.

Steroids serve to slow your hyperactive immune system down by affecting the function of white blood cells. Steroids also decrease the production of inflammatory mediators and minimize joint tissue damage.

Steroids are mostly prescribed for controlling acute joint pains and stiffness. The dose is then tapered off gradually. Steroids are usually prescribed in combination with DMARDs or biological agents.

Physical Therapy

Physical therapy is also very helpful for managing the symptoms of rheumatoid arthritis. Your physiotherapist will design a long term exercise plan after assessing your strength, fitness and function. He will teach you certain exercises for each affected joint that will keep your joints flexible. Application of Ice packs and therapeutic massages are also used for relieving the chronic pain of rheumatoid arthritis.

Surgery

Surgery is the last option if your joints are severely damaged and do not respond to medications. The purpose of the surgery is to repair the damaged joints, correct the deformities and restore the joint function. The surgical procedures may include joint fusion, tendon repair and total joint replacement.

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