What is the first-line treatment for rheumatoid arthritis?

Rheumatoid Arthritis (RA) is a chronic and progressive auto-immune disease that causes joint pain, swelling, and gradual deformity in the structure of feet and hands. With increase in severity, a person may suffer from permanent deterioration and loss of bone health. While there is no cure to reverse the effect of rheumatoid arthritis, if diagnosed early, it can be treated to slow down the process through clinical methods. 

Treatment for includes medications called Disease-modifying anti-rheumatic drugs (DMARDs) that can slow down the progression of damage caused by rheumatoid arthritis 

Orthopaedic specialists from AMRI Hospitals explain that modern medications have improved treatment options if the condition is diagnosed at the right time. So, it is important to observe the early signs and get examined thoroughly. To get more insights on the line of treatment for rheumatoid arthritis, here’s an approach that can help: 

  1. Medication

Rheumatoid arthritis tends to affect smaller joints first and then progresses to wrists, elbows, knees, ankles, shoulders, and hips. Depending upon the spread, symptoms, and severity of the condition, your concerned orthopaedic specialist will recommend appropriate medications. 

  • NSAIDs

Non-steroidal anti-inflammatory drugs or NSAIDs are prescribed to reduce gradual inflammation and pain. However, these medications should not be taken without a doctor’s prescription. Some common NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Before taking NSAIDs, it is advisable to learn about the potential side effects to prevent the risk of further complications.

  • Disease-modifying anti-rheumatic drugs (DMARDs)

DMARDs work on the immune system to curb the acceleration of rheumatoid arthritis and prevent it from aggravating the condition. DMARDs that are typically recommended include  methotrexate (Trexall, Otrexup, others), leflunomide (Arava), hydroxychloroquine (Plaquenil), and sulfasalazine (Azulfidine). Among these, methotrexate is known for showing significant improvement in severe cases of rheumatoid arthritis. However, the use of DMARDs has potential side effects, if administered without a doctor’s advice.

  • Steroids

 In a majority of cases, steroids (corticosteroids) are given to ease the pain and stiffness of the joints temporarily. Commonly used steroids include hydrocortisone (Cortef), methylprednisolone (Medrol), and prednisone (Deltasone). However, some steroids can lead to weight gain and bone loss, due to which they are used sparingly in RA treatment. Steroids are often used in treating a flare-up to control the symptoms quickly. 

  • Biologic Agents

Biologic agents are recommended when DMARDs fail to relieve the pain of RA from rising symptoms and inflammation. Basically, biologics are genetically engineered proteins that bring instant ease in swelling and joint pain. The agent’s role is to block the particular part of the immune system that causes rapid inflammation of rheumatoid arthritis. Like other medications, biological agents shouldn’t be consumed without a prescription. 

  1. Therapy

In the case of stiffness and pain, your doctor may suggest consulting physical or occupational therapists to learn required exercises that will help you keep your joints flexible. According to your bone strength and condition, the therapist may recommend a few changes in daily tasks to protect joints from excessive pressure. You might also be asked to use assistive devices that make everyday chores easier to handle with painful joints. 

  1. Surgery

Surgery is generally the final step to consider while repairing damaged or painful joints. Sometimes a minor injury could lead to breakage of a joint bone, demanding surgery for repair or replacement. As a result, the patient might experience less pain and improved functionality. Surgery procedures for rheumatoid arthritis vary according to requirement. The following are some of the common procedures: 

  • Tendon Repair- It is performed to repair inflamed, loosened, or damaged tendons around the joints
  • Synovectomy- The surgery is practiced on knees, wrists, elbow, hips, or fingers to remove the inflamed lining of the synovium joint
  • Joint Fusion- In some crucial cases, a surgeon will opt for stabilising or realigning the affected joint to provide relief from immense pain; it is performed on those patients whose condition does not support joint replacement
  • Total Joint Replacement- In this surgery, the joint’s ruptured part is removed and replaced with metal or plastic prosthesis; total joint replacement gives best results in knee and hip surgeries