Video: Treatment Options for Rheumatoid Arthritis

Doctor Ariel D. Teitel discusses several treatments that can help control the progression of the disease and help to alleviate the swelling and pain.

Video Transcript:

Treatment Options for Rheumatoid Arthritis
What is Rheumatoid Arthritis?

Ariel D. Teitel, MD

"Rheumatoid Arthritis is a disease that results in swelling and pain, usually in the joints of the hands and feet, but it may also affect other areas of the body. In addition to inflammation and pain, destruction of the joint, cartilage and bones may occur as well. An autoimmune disease is a disease where the body fights itself, the white blood cells normally used for the bodies defense, attack the joint tissue instead. Controlling the inflammation of Rheumatoid Arthritis is important, for disease treatment and pain control. Roughly one percent, or one out of a hundred adults has Rheumatoid Arthritis, and women are more likely to get Rheumatoid Arthritis than men. There's two age peaks for Rheumatoid Arthritis, the child bearing years for women and men as well, so twenties to thirties, and then there's another peak at around, say fifty or sixty. Typical symptoms of Rheumatoid Arthritis include tender, painful and stiff joints of the hands and feet. Early morning stiffness may be common, a low grade fever, weakness and fatigue may also occur. The effects of Rheumatoid Arthritis can interfere with a patients ability to work, exercise and enjoy the normal activities of daily life. While there is no treatment that will cure Rheumatoid Arthritis, several treatments are available that can control the progression of the disease and help to alleviate the swelling and pain.



Treatment Options for Rheumatoid Arthritis
The DMARDs

Ariel D. Teitel, MD

"There is no cure for Rheumatoid Arthritis, but medications that are available nowadays are so excellent that basically many people that have it feel like they don't have it anymore. I mean, this is really incredible this wasn't the case 20 years ago. It is important that Rheumatoid Arthritis treatment be an informed decision, made between the patient and their doctor. Medications used to help slow down the progression and inflammation of Rheumatoid Arthritis are called the Disease Modifying Antirheumatic Drugs, or DMARDs. Clinical studies show that early treatment with DMARDs, typically within the first twelve weeks of diagnosis, may improve a patients outcome. DMARDs are classified as non biologic and biologic response modifiers. Methotrexate is often the non biologic DMARD of first choice in Rheumatoid Arthritis. The Methotrexate is still used and still an important part of the treatment and still helps the newer drugs work better in fact. They do have immunomodulatory effect, or immune control effect. In Rheumatoid Arthritis, Methotrexate is thought to work by blocking proteins that can lead to inflammation, the results may be seen as early as three weeks. Methotrexate may be given orally or by injection. Many biologic DMARDs have been approved by the FDA for the treatment of Rheumatoid Arthritis. Examples of biologic DMARDs include: HUMIRA a TNF antagonist, Kineret a interleukin-1 receptor antagonist, and Rituxan a monoclonal antibody to B cell receptors. The biologic DMARDs have been shown to slow disease progression when non biologic agents fail, many of the DMARDs may also be used in combination for added effectiveness when a single agent fails. I think it's great for patients to be educated and to look up whatever they want about medications but I would recommend making sure you go to authoritative places and read careful information and again, look at the actual risk. What is that risk, is it one in five, is it one in a hundred, is it one in five thousand, that's a big difference."



Treatment Options for Rheumatoid Arthritis
NSAIDs and Corticosteroids

Ariel D. Teitel, MD

"DMARDs may take weeks to months to fully work in Rheumatoid Arthritis, because of this other medications are often used with the DMARDs to more quickly provide relief from pain swelling and stiffness. The Non-Steroidal Anti-Inflammatory Drugs or NSAIDs are one such group. Many of the drugs are available generically, helping to lower their cost. NSAIDs work by blocking the cyclooxygenase enzyme and reducing the production of prostaglandins which in turn results in decreased inflammation and pain. They block the formation of one of the chemical messengers that causes inflammation; of course they have their side effects as well, and a lot of that is related to the patient. If the patient already has kidney issues or high blood pressure then that's something to consider, but in most patients, as long as the doctor is aware of these things, takes precautions, follows blood tests usually you can decrease the chances of problems. I do prescribe steroids to patients routinely and it can be very helpful in rapidly getting somebody back to work or back to feeling reasonable while you are waiting for the other medicines to take effect. Generally speaking, in Rheumatoid Arthritis, the treatment we want to use the lease toxic therapy in the lowest dose possible for the least amount of time possible, generally. Long term use of corticosteroids may be associated with osteoporosis, cataracts, cushingoid symptoms, and alterations in blood glucose levels. Doses may need to be withdrawn slowly to help avoid these side effects. When a small number of joints are effected, corticosteroids such as Triamcinolone may be given directly into the joint space and tissue. This route is associated with fewer adverse effects, but there are limitations on the number of injections that can be given per year. When using corticosteroids long term, calcium and vitamin D supplements or osteoporosis treatments such as Fosamax may be needed to help prevent or treat bone loss."

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