There is no cure for the disease, and all treatment must be seen as relieving symptoms and preventing progression where possible. The goals of rheumatoid arthritis therapy are:
Pain relief
Reduction of inflammation
Preservation of function
Advertisement
>
Exercise and Physiotherapy
There are a variety of types of exercise and physiotherapy which can help. Affected joints can be splinted to reduce inflammation. Exercises are aimed at maintaining muscle strength and joint mobility without exacerbating the joint inflammation.
Medication
Simple painkillers and anti-inflammatories are used to decrease pain and stiffness. New cox 2 inhibiting non-steroidal anti-inflammatories are available with less gastro-intestinal side-effects.
Early aggressive treatment with a "disease-modifying" drug is essential. These drugs seem to be able to reduce the amount of joint destruction, and include Methotrexate gold injections, the anti-malarials, sulfasalazine , D-penicillamine and the new tumour necrosis factor alpha blocking agents (TNF-Alpha agents). THE TNF-Alpha agents have shown excellent results in controlling the disease but unfortunately they are very costly (approximately R8 000-R10 000 per month).
Immunosuppressive therapy with azothioprine and cyclophosphamide is useful under certain conditions where vasculitis (inflammation of blood vessels) occurs with the disease.
Surgery
Surgery is used in patients with severely damaged joints. The most successful procedures are carried out on hips and knees. Realistic goals of such surgery are to relieve pain, correct deformity and provide modest functional improvement.
What is the outcome of rheumatoid arthritis?
The course of rheumatoid arthritis is variable and difficult to predict. Most people experience persistent but fluctuating disease activity, along with variable degrees of joint deformity. After ten to twelve years, fewer than 20 percent of patients will have no evidence of disability or deformity.
New treatment with disease modifying drugs has improved the outcome of the disease over the last ten years.
Those who are likely to have severe disease are older people, women, and people who have evidence of more severe disease on x-ray, rheumatoid nodules or raised levels of rheumatoid factor. Neither the disease pattern nor currently available treatments seem to determine whether disabilities will develop.
About 15 percent of people with rheumatoid arthritis will have a short-lived inflammatory process that leaves no major deformity.
Remission of disease activity can occur in the first year, but usually only occurs after 10-15 years, if it is to occur at all. The greatest progression of the disease takes place in the first six years and is much slower after that.
The average life expectancy of people with rheumatoid arthritis is three to seven years shorter than normal. In 15 to 20 percent of people, rheumatoid arthritis itself is responsible for the increased mortality. This occurs more in patients with more severe disease and is mainly due to infection and gastrointestinal bleeding. Drug treatment may also play a role in these patients due to side effects such as gastro-intestinal bleeding and bone marrow suppression with severe secondary infections.
When to see your doctor
Consult your doctor if:
You are feeling tired, and have a poor appetite, generalised weakness and non-specific joint pains - particularly if you have a family history of rheumatoid arthritis.
You already know you have rheumatoid arthritis and experience more pain, swelling and limitation of movement.
You are on drugs for rheumatoid arthritis and experience pain and discomfort in your stomach, bleeding from your anus, black stools or vomiting blood. Other signs of problems with drugs are fever and infection.
You are on medication for rheumatoid arthritis but persist to have severe joint swelling, pain or stiffness.
Bookmark with:
What are social bookmarks?