Understanding Rheumatoid Arthritis

Overview of Rheumatoid Arthritis

Affecting approximately 1% of the global population, rheumatoid arthritis (RA) is a chronic inflammatory condition primarily impacting the joints, particularly in the hands and feet. Common symptoms include painful swelling, fever, fatigue, bone erosion, and potential joint deformity. The onset of RA typically occurs between the ages of 20 to 40, with a higher incidence observed in individuals over 55.

Recent Research and Treatment Awareness

Recent comprehensive reviews of RA medications have been published by the European League Against Rheumatism (EULAR). It is essential for individuals to be informed about available treatment options and to engage in discussions with their healthcare providers to ensure optimal care.

Treatment Options for Rheumatoid Arthritis

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

Disease-modifying anti-rheumatic drugs (DMARDs) are the most commonly recommended initial treatment for RA and should be prescribed promptly upon diagnosis. DMARDs are categorized into two groups: synthetic and biological.

Synthetic DMARDs

Synthetic DMARDs are often the preferred choice among physicians due to their well-documented risks and side effects, which minimize the likelihood of overtreatment. Notable synthetic DMARDs available in Canada and the U.S. include:

– **Methotrexate**: This drug can be used alone or in combination with other synthetic DMARDs and is considered the most effective, cost-effective, and safe option for long-term use. Possible side effects include rashes, upset stomach, liver and bone marrow toxicity, birth defects, and shortness of breath. Regular monitoring by a healthcare provider is vital, and taking folic acid may alleviate some side effects.

– **Plaquenil and Sulfasalazine**: These medications are best suited for mild RA and generally have fewer side effects. However, they carry a risk of eye damage, necessitating annual visits to an ophthalmologist.

– **Minocycline**: An antibiotic that may help reduce inflammation, although it can take several months to a year to become effective. Long-term use may lead to skin discoloration.

– **Arava and Leflunomide**: These drugs work effectively in conjunction with Methotrexate. Side effects may include diarrhea and potential harm to a fetus.

Biological DMARDs

For patients who do not respond adequately to synthetic DMARDs, biological DMARDs are available. These include Enbrel, Actemra, Humira, Kineret, Orencia, Remicade, Rituxan, Cimzia, and Simponi. Administered via injection, biological DMARDs begin to take effect within 2-6 weeks and are most effective when used alongside Methotrexate. Although they have fewer side effects than synthetic DMARDs, there is a risk of severe infections and low blood and liver counts. The long-term effects of these newer treatments are still under evaluation.

Glucocorticoids and Short-Term Relief

For individuals with severe RA, glucocorticoids or steroids may be considered for short-term relief. These can be administered through injection or orally, along with other DMARDs, and are particularly useful during flare-ups when rapid reduction of swelling is needed. Side effects may include weight gain, increased diabetic symptoms, cataracts, osteoporosis, and a heightened risk of infections.

Monitoring and Follow-Up Care

Patients with RA are advised to consult a rheumatologist every 1 to 3 months and to reassess their treatment regimen every 3 to 6 months if there is no improvement with current medications.

References

Smolen, J.S. et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Annals of Rheumatic Diseases: The EULAR Journal. Available from: http://ard.bmj.com/content/early/2010/05/04/ard.2009.126532.abstract. Last accessed: July 2013.

Chronic diseases and health promotion: chronic rheumatic conditions. World Health Organisation. Available from: http://www.who.int/chp/topics/rheumatic/en/. Last accessed: July 2013.

Treating rheumatoid arthritis with disease-modifying drugs (DMARDs). WebMD. Available from: http://www.webmd.com/rheumatoid-arthritis/guide/dmard-rheumatoid-arthritis-treatment. Last accessed: July 2013.

Patient information: rheumatoid arthritis treatment (beyond the basics). UpToDate. Available from http://www.uptodate.com/contents/rheumatoid-arthritis-treatment-beyond-the-basics#H10. Last accessed: July 2013.

Written by Julia Yusupova