RA usually requires lifelong treatment to:

• Reduce pain and stiffness in affected joints as much as possible
• Prevent joint damage
• Minimise any disability caused by pain, joint damage or deformity.

Medications are prescribed and a full list of drugs used to combat RA can be found here . Meanwhile below is a brief explanation of the most popular ones: -

"FIRST LINE" OR "FAST ACTING"

• Nonsteroidal anti-inflammatory drugs (NSAIDs) - may be used in addition to DMARDs to reduce inflammation (swelling), control every day pain and stiffness. Some of this are readily available over-the–counter at chemists. Most popular types of NSAIDs are: -
  
  

  • Aspirin, Diclofenac, Fenoprofen, Flurbiprofen, Ibuprofen, Indometacin, and piroxicam. These drugs can damage the lining of the stomach and cause bleeding, particularly if taken in higher doses or over a long period of time. They should therefore only be used with caution, particularly in older people and only continue to be used if they are controlling your symptoms.
    
    
• Steroids (corticosteroids) - are medicines that are similar to natural hormones produced in your body. They are very effective at reducing pain, stiffness and swelling. However, they do not slow the progress of RA or prevent joint damage. They may be prescribed in the short-term for bad flare-ups or while waiting for a DMARD to take effect. If you have a single inflamed or swollen joint, your doctor may inject a steroid into the joint. Relief is rapid and the effect can last a few weeks to several months depending on the severity of the RA.

Possible side effects include weight gain, a round face, osteoporosis (thinning of the bones), easy bruising, indigestion, muscle weakness, changes in mood (e.g. feeling depressed), psychosis, cataracts, susceptibility to infections, diabetes, high blood pressure and thinning of the skin.

"SECOND LINE" OR "SLOW ACTING"

• Disease modifying antirheumatic drugs (DMARDs) - these slow down the disease and prevent joint damage. These medicines can take several weeks to start working and a few months for the most benefit. Most popular types of DMARDs are: -

• Methotrexate – usually taken once a week as a tablet on the same day of the week. Sometimes it may be given once a week by injection.
  
  
• Sulfasalazine - usually started at a low dose and increased gradually over about four weeks as this helps to reduce any possible side effects.
  
  
• Leflunomide - a newer DMARD that works more quickly.
  
  
• Gold injections (sodium aurothiomalate) – as effective as methotrexate or sulphasalazine.
  
  
• Penicillamine - an older DMARD that is not often used except for people who have been taking it for many years.

Possible side effects are nausea, diarrhea, vomiting, skin rashes, mouth sores, loss of taste and gastrointestinal upset and loss of appetite. More serious side effects are urine problems, blood diseases, liver damage, severe allergic reactions, visual impairment and kidney damage (seen as increased levels of protein in urine). Tests are carried out regularly by your rheumatologist to monitor possible side effects.

COX-2 inhibitors - block an inflammation-promoting enzyme called COX-2. This class of drugs is initially believed to work as well as traditional NSAIDs, but with fewer stomach problems. They include: -

• Celecoxib (Celebrex) - labeled with strong warnings and a recommendation that it be prescribed at the lowest possible dose for the shortest duration possible.

Tumor necrosis factor inhibitors (anti-TNFs) - are a relatively new class of medications used to treat autoimmune disease. They include: -

• Etanercept (Enbrel)
• Infliximab (Remicade) – given intravenously

Sjogren's syndrome can be helped by artificial tears and humidifying rooms of the home or office. Medicated eye drops, cortisporine ophthalmic drops (Restasis), are also available to help the dry eyes in those affected. Regular eye check-ups and early antibiotic treatment for infection of the eyes are important.

Heart and/or lungs

May require high doses of oral cortisone to combat inflammation

Surgery

This will be an option if you develop a joint deformity through RA. It can be used to relieve severe pain and to improve the function of severely deformed joints that have not responded to medication. Types of surgery include: -

• Joint replacement of the knee or hips.
• Keyhole – removal of debris or inflamed joint tissue.
• Cervical spinal fusion - can be done to treat severe neck pain.

Knee replacement photo

Prosorba Column

Used for moderate to severe RA in adults with long-standing disease who have not responded to DMARDs. The therapy involves pumping blood drawn from a vein in the arm into an apheresis machine, or cell separator. This machine separates the liquid part of the blood (the plasma) from the blood cells. The Prosorba column is a plastic cylinder about the size of a coffee mug that contains a sand-like substance coated with a special material called Protein A. Protein A is unique in that it binds unwanted antibodies from the blood that promote the arthritis. The Prosorba column works to counter the effect of these harmful antibodies . The procedure takes 2-3 hours, and must be done once a week for 12 weeks.

Side effects include anemia, fatigue, fever, low blood pressure, and nausea. Some people have developed an infection from the tube used to remove the blood.

Physical Therapy

Range-of-motion exercises and individualized exercise programs prescribed by a physical therapist can delay the loss of joint function.

Swimming is particularly helpful because it allows exercise with minimal stress on the joints.

Joint protection techniques, heat and cold treatments, and splints to support and align joints may be very helpful.

Sometimes therapists will use special machines to apply deep heat or electrical stimulation to reduce pain and improve joint mobility.

Occupational therapists can construct splints for your hand and wrist, and teach you how to best protect and use your joints when they are affected by arthritis. They also show people how to better cope with day-to-day tasks at work and at home, despite limitations caused by RA.

Frequent rest periods between activities, as well as 8 to 10 hours of sleep per night, are recommended.

Complementary therapies

There has been no evidence to suggest that these are effective. However there are some therapies, especially those aimed at reducing the stress of living with RA, which may help to make you feel better in yourself.

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