Note:- Actually there is no cure for RA , but treatments can uplifts symptoms & slow the progression of the disease.
A) NSAIDs : first line drugs( eg; indomethacin , naproxen,diclofenac etc.) for RA used to reduced inflammation.
B) Disease modifying antirheumatic drugs (DMARDs) - Secon
d line of drugs for RA.
d line of drugs for RA.
1. Immunosuppressants
Methotrexate (MTX) , Azathioprine, Cyclosporin.- Methotrexate(MTX):- single oral low-dose (7.5-15 mg) weekly. Maximun weekly dose -20 mg. Duration of treatment unknown.
Side effects:- nodulosis, oral ulceration, GI upsest . with prolonged therapy liver get damaged leading to cirrhosis, incidence of chest infarct also may cause.
Contraindication:- pregnancy, breast feeding ,liver disease, active infection, leucopenia & peptic ulcer.
- Azathioprin:- 50-150 mg per day. It is not combined with MTX. It's given along with corticosteroids ,it has steroid sparing effect.
2. Sulphasalazine
Doses 1-3 g / day in 2-3 divided doses. It's used as a seond line drug for milder cases.Side effects:- neutropenia , thrombocytopenia & hepatitis.
3. Chloroquine and hydroxychloroquine
Doses - Chloroquine 150 mg per day . hydroxychloroquine 400 mg/day for 4-6 weeks, followed by 200 mg/ day for maintenance.Side effects:-Retinal dmage ,corneal opacity , rashes,graying of hairs, irritable bowel syndrome , myopathy, and neuropathy.
Note :- Chloroquine / hydroxychloroquine are used in milder non erosive diseases , especially when only one or a few joints are involved ,or they are combined with MTX/ Sulfasalazine.
4. Leflunomide
Dose of 100 mg daily for 3 days followed by 20 mg OD.Adverse effects:diarrhea, headache, nausea,rashes, loss of hair, thrombocytopenia, leucopenia, increased chance of chest infection and raised hepatic transaminase .
Contraindication:- children and pregnant /lactating mother.
Note:- it's alternative to MTX or can be added to it,but their combination is more hepato toxic. Leflunomide combination with sulfasalazine improves quality.
5. Gold sod. thiomalate, Auranofin
6. d- Penicillamine
Start with 125-250 mg OD, then 250 mg BD.Side effects:- loss of taste, systemic lupus, myasthenia gravis etc.
Note:- It' can be used in stage II and III scleroderma .
C) Biologic response modifiers ( BRMs)
1.TNFalpha inhibitors
- Etanercept:-SC injection 50 mg weekly.
Side effect:- pain, redness, itching & swelling occurs at injection site, chest infection chances may develop.
- Adalimumab:- SC injection every 2 weeks
- Infliximab:- 3-5 mg/kg IV every 4-8 weeks.
2. IL-1 antagonist
- Anakinra:- It's less effective than TNF inhibitars.somehow used in patient who have failed on 1 or more DMARDs. Dose- 100 mg SC daily. Local reaction & chest infection are main side effects.
3. Adjuvant drugs
- Corticosteroids :- Prednisolone long term used of it caries serious disadvantages .Thus, either low doses ( 5-10 mg prednisolone or equivalent) are used to supplement NSAIDs or high doses are givenover short periods in cases with severe systemic manifestations.
II) Life style modifications
- Regular exercise useful to maintain muscles strength and over all physical functions .
- Occupational therapy has (+) role for RA.
- Physical activity
- In past it was thought that "night -shade" foods,eg : tomatoes would aggravate RA so better to avoid it.
- There is no any special food to avoid in RA patients.
- Folic acid supplements used to prevent side effect of MTX while treating RA.
- fish oil, such as in salmon, and omega- 3 fatty acid supplements have been shown to be beneficial in RA.
- Curcumin in dietary turmeric ,an ingredient in curry may be beneficial in reducing symptoms of RA.
- Vitamin D and calcium used to prevent osteoporosis in RA .
- Avoid alcohol or minimize taking it when someone on MTX.
- yoga , swimming and others exercises should be suggested because they are important in maintaining joint mobility and strengthening the muscles around the joints.
