| Rheumatoid arthritis is the most common | | | | treated as such. This means disease modifying |
| inflammatory form of arthritis. It affects | | | | anti-rheumatic drugs (DMARDS). These drugs slow |
| approximately 2.1 million Americans. Here is the | | | | the progression of disease. The one we use most |
| approach to management that we use at the | | | | often is methotrexate. We also add low dose |
| Arthritis and Osteoporosis Center of Maryland.o | | | | prednisone or perhaps a |
| Make the diagnosis: | | | | non-steroidal-anti-inflammatory drug (NSAID) to |
| This means listening: We ask questions such as: | | | | help with symptoms. |
| How much stiffness do you have in the morning? | | | | If a patient doesn't improve within a month to six |
| How long does it last? How long have you had | | | | weeks, we add a biologic drug. The purpose of |
| your symptoms? How fatigued are you? Do you | | | | these medicines is to get the disease into |
| have any painful joints? Any swollen joints? Any | | | | remission. The drug of choice is an anti-TNF drug |
| family history of rheumatoid arthritis? | | | | like adalimumab (Humira), etanercept (Enbrel), or |
| This means looking: is there joint swelling? Which | | | | infliximab (Remicade). |
| joints? Is the pattern symmetric (one side looking | | | | If a patient doesn't respond to one of these |
| like the other)? Any joint redness? Any other | | | | within 2-3 months, we will switch to a different |
| associated symptoms such as dry eyes and | | | | anti-TNF drug. |
| mouth (which may signify Sjogren's syndrome, a | | | | Within 2-3 months if a patient doesn't have |
| condition that often accompanies rheumatoid | | | | optimal response to two different anti-TNF drugs, |
| arthritis)? | | | | we will go to a second-line biologic treatment. |
| This means getting the appropriate tests: | | | | There are two available. We try one first and if a |
| Blood tests: Rheumatoid factor, Anti-nuclear | | | | patient doesn't respond we go to another. |
| antibody, Anti CCP, Erythrocyte sedimentation | | | | One option is rituximab (Rituxan) which is a drug |
| rate (sed rate), C-reactive protein, complete blood | | | | that targets B-cells. Another option is abatacept |
| count, blood chemistries, thyroid function, | | | | (Orencia) which is a drug that targets T-cells. |
| urinalysis. | | | | Periodic joint injection with corticosteroids |
| Imaging: Magnetic resonance imaging (MRI) or | | | | occasionally is needed. |
| ultrasound to detect early inflammation and | | | | While all these medicines are being used we also |
| erosions (damage). Damage to the joints occurs | | | | recommend sufficient rest and once a patient |
| within six months of onset!o Start aggressive | | | | starts to feel better, regular exercise. Joint |
| treatment: | | | | protection is important as is proper nutrition. |
| Rheumatoid arthritis is the result of a | | | | Proper nutrition and weight control are advised. |
| self-perpetuating dysfunction of the immune | | | | Nutritional supplementation with anti oxidants is |
| system leading to overproduction of harmful | | | | valuable. |
| chemical messengers called cytokines and | | | | Pain control with modalities such as acupuncture, |
| chemokines. These harmful messengers lead to | | | | physical therapy, massage, and low level (cold) |
| the excessive generation of destructive enzymes. | | | | laser can also be helpful. |
| The damage caused by these different enzymes | | | | Anti-inflammatory herbs and homeopathic agents |
| involves many organ systems such as the joints, | | | | also work well in conjunction with the above in |
| the lungs, the eyes, and the heart. In addition, the | | | | many instances. |
| chronic inflammation causes further complications | | | | Adjunctive therapies such as hypnosis, guided |
| such as accelerated atherosclerosis (hardening of | | | | visualization, meditation, and prayer are also |
| the arteries) leading to early heart attack and | | | | frequently recommended. |
| stroke. Another potential complication is the | | | | Rheumatologists want to do more than control |
| development of lymphoma (cancer of the lymph | | | | rheumatoid arthritis. We want to get it into |
| system). | | | | complete remission. Fortunately, today, it is |
| So, the diagnosis of rheumatoid arthritis is | | | | possible to do it. |
| considered a medical emergency and needs to be | | | | |