Rheumatoid arthritis is a chronic, progressive and disabling autoimmune inflammatory disease that causes pain, swelling, stiffness and loss of function in the joints of hands, fingers, wrists, feet and knees equally on both sides of the body, according to the National Institute of Arthritis and Musculoskeletal Disease and Skin Diseases. Early aggressive treatment can slow down progression of the disease. The best medicines include biological-response modifiers, disease-modifying anti-rheumatic drugs, non-steroidal anti-inflammatory drugs and analgesics.
Prevalence
Scientists at the Centers for Disease Control and Prevention estimate that rheumatoid arthritis affects 1.3 million adults in the United States. According to the National Institute of Arthritis and Musculoskeletal Disease and Skin Diseases, rheumatoid arthritis affects two to three times as many females as males, affects people in all races and ethnic groups, and usually begins in middle age, although it can start at any age.
Identification
Rheumatoid arthritis progresses in three stages, according to the Arthritis Foundation. The first stage begins with the onset of swelling, pain and stiffness in the lining of the joint. This stage is followed by rapid division and growth of cells in the lining of the joint, causing the joint to thicken. The final stage is characterized by deterioration of the bone and cartilage, which causes the joint to lose its shape, alignment and ability to move and induces intense pain.
Classes/Types of Medicine
According to the National Institute of Arthritis and Musculoskeletal Disease and Skin Diseases, any one or more of four classes of medicines are used to treat rheumatoid arthritis. Analgesics such as acetaminophen and aspirin relieve pain. Corticosteroids such as prednisone and non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen, also known as NSAIDS, reduce inflammation. Disease-modifying anti-rheumatic drugs, also known as DMARDS, such as cyclosporine and methotrexate, slow down the progression of disease.
Biological-response modifiers, such as etanercept, infliximab, adalimumab, golimumab, anakinra, rituximab and abatacept, are genetically engineered and represent the newest class of medicines with the best potential benefits to reduce inflammation and slow down or stop structural damage to the joints.
Frequent monitoring by a physician of a patient's response to any of these medications is vital for safety and to gauge outcomes.
Prevention/Solution
A combination of drugs can be more effective in reducing or preventing damage to the joints and progression of the disease than just one medication. Waiting to see if the disease worsens before taking powerful drugs is too great a risk, considering the potential irreversible effects and disability. It's vital for people with symptoms of rheumatoid arthritis to see a doctor for early diagnosis and aggressive treatment.
Considerations
Scientists reported in "Expert Opinion on Drug Safety" that biological-response modifiers are more effective than DMARDS, yet they also increase the risk for infections, tumors, congestive heart failure and lupus. Before deciding on prescribing a biological-response modifier, it is prudent to evaluate the medical history of the patient, severity of disease, and the FDA-approved label of the drug being considered.
References
- National Institute of Arthritis and Musculoskeletal and Skin Diseases: Rheumatoid Arthritis
- "Arthritis and Rheumatism: Estimates of the Prevalence of Arthritis," Part I"; C. G. Helmick; January 2008
- Arthritis Foundation: Rheumatoid Arthritis
- "Expert Opinion on Drug Safety"; Consider Rheumatoid Arthritis; R. M. Fleischmann; September 2004
- Arthritis Foundation: Arthritis Foundation
