Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Rheumatoid arthritis is a progressive inflammatory disease. This means that unless the inflammation is stopped or slowed, the condition will continue to get worse in most people. Although rheumatoid arthritis does occasionally go into remission without treatment, this is rare. Starting treatment soon after diagnosis of rheumatoid arthritis is strongly recommended. The best medical care combines medication and nondrug approaches.
Nondrug approaches include the following:
Physical therapy helps preserve and improve range of motion, increase muscle strength, and reduce pain.
Hydrotherapy involves exercising or relaxing in warm water. Being in water reduces the weight on your joints. The warmth relaxes your muscles and helps relieve pain.
Relaxation therapy teaches techniques for releasing muscle tension, which helps relieve pain.
Both heat and cold treatments can relieve pain and reduce inflammation. Some people's pain responds better to heat and others' to cold. Heat can be applied by ultrasound, microwaves, warm wax, or moist compresses. Most of these are done in the medical office, although moist compresses can be applied at home. Cold can be applied with ice packs at home.
Occupational therapy teaches you ways to use your body efficiently to reduce stress on your joints. It also can help you learn to decrease tension on the joints through the use of specially designed splints. Your occupational therapist can help you develop strategies for coping with daily life by adapting to your environment and using different assistive devices.
Prosorba column: This is not a drug but a medical device. It filters antibodies linked to rheumatoid arthritis out of the blood. This procedure is available only in some medical centers and generally is used only for very severe rheumatoid arthritis.
In some cases, reconstructive surgery and/or joint replacement operations provide the best outcome.
Drug approaches include a variety of medications used alone or in combinations.
Rheumatoid arthritis was traditionally treated in the past with a stepwise approach starting with nonsteroidal
anti-inflammatory drugs (NSAIDs) and progressing through more potent drugs such as glucocorticoids, disease-modifying antirheumatic drugs (DMARDs), and biologic response modifiers.
In the past, DMARDs were avoided early in the disease because of their potentially serious side effects and because they did not often bring on remission. DMARDs were usually reserved for people who showed signs of joint damage.
Over time, however, this strategy was recognized as being faulty, because people treated early with DMARDs have better long-term outcomes, with greater preservation of function, less work disability, and a smaller risk of premature death.
The goal of drug treatment is to induce remission or at least eliminate evidence of disease activity.
Early use of DMARDs not only controls inflammation better than less potent drugs but also helps prevent joint damage. Newer DMARDs work better than the older ones in long-term prevention of joint damage. Bottom line: the earlier aggressive treatment begins, the better the outcome.
The current approach, therefore, is to treat rheumatoid arthritis aggressively with DMARDs soon after diagnosis. Treating rheumatoid arthritis early, within
three to 12 months after symptoms begin, is the best way to stop or slow progression of the disease and bring about remission.
Ongoing (long-term) treatment with combinations of medications may offer the best control of rheumatoid arthritis for the majority of people.
Combinations of these agents do not usually have more severe adverse effects than one agent alone.