What is rheumatoid arthritis?
Arthritis is a general term that describes inflammation in joints. Rheumatoid
arthritis is a type of chronic (ongoing) arthritis that occurs in joints on both
sides of the body (such as both hands, wrists, and knees). This symmetry helps
distinguish rheumatoid arthritis from other types of arthritis.
In addition to affecting the joints, rheumatoid arthritis may occasionally
affect the skin, eyes, lungs, heart, blood, nerves, or kidneys.
What are the goals of treating rheumatoid arthritis?
The most important short-term goal of treatment is to reduce joint inflammation.
Joint pain and swelling improve once joint inflammation is reduced.
The long-term goal of treatment is to slow or stop joint damage, which can be
seen on X-rays. Once joint inflammation is controlled, pain will be reduced.
Normal joint 
| Joint afftected by rheumatoid arthritis 
|
Changing philosophy about drugs
In the past, many doctors did not believe that drugs for rheumatoid arthritis
changed the likelihood of eventual disability from the disease. Therefore, drugs
with the least side effects were prescribed to decrease pain. Stronger drugs
were avoided because of doctors’ concerns about dangerous side effects.
Now, however, doctors know that early treatment can improve the long-term
outcome for most patients. Newer drugs that have proven to be effective are
being used soon after the patient is diagnosed. Combinations of drugs are
proving to be more effective and, in recent studies, just as safe as single drug
treatment.
What drugs are used to treat rheumatoid arthritis?
The drugs used to treat rheumatoid arthritis can be divided into two groups:
Drugs that decrease pain and local inflammation, including aspirin and
non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen or naproxenDrugs that decrease pain and inflammation while decreasing the growth of
abnormal synovial tissue (the tissue that lines the inside of the joint).
These drugs include methotrexate and low doses of corticosteroids (such as
prednisone or cortisone). In some people, these drugs also decrease joint
destruction.Other medications used to treat rheumatoid arthritis include: anti-malarial
medications (such as hydroxychloroquine), gold, sulfasalazine, penicillamine,
cyclophosphamide, cyclosporin, and minocycline. Sometimes, more than one drug
may be prescribed.
Newer biologic agents that block the effects of specific inflammatory factors
(cytokines) are now available. Infliximab, etanercept and adalimumab block the
cytokine anti-tumor necrosis alpha, and anakinra blocks the cytokine
interleukin-1. These agents are somewhat more effective than previous medicines
and can be combined with them, especially with methotrexate.