Rheumatoid arthritis treatment

 I) Medications
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.

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.
Rheumatoid arthritis treatment

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.



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