Dr. P. D. Rath

Rheumatoid arthritis is a progressive disease mainly involving small joints of hands and feet’s. The inflammation associated with the disease damages the joints. Over time, this can lead to deformities. Any joints damages done by the disease is permanent. Therefore, early drugs treatment is essential to minimize and even prevent any permanent joint damage.

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Year ago, Doctors started rheumatoid arthritis treatment with drugs that primarily addressed symptoms, gradually working their way up to DMARDs (disease –modifying anti-rheumatic drugs), a class of medications that address the root causes of immune system malfunction, often at the cellular level.

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But today, doctors believe there’s early window of opportunity to treat rheumatoid arthritis before the onset of irreparable joint damage. Studies show that taking action quickly may even put disease into remission.

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Getting an accurate diagnosis is the first step in taking control of RA. Usually a rheumatologist is most suited to make this diagnosis. It is good to see a doctor if you have stiffness, pain and swelling in one or more joints on both sides of the body for an extended period of time.

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RA can be difficult to diagnose because it may begin with only subtle symptoms, such as stiffness in the morning. There is no single test which diagnoses early RA with 100 percent certainly. However, it can usually be confidently diagnosed by an experienced doctor based on the following combination of factors like early morning stiffness lasting for more than an hour improving with activity and worsening with rest, affecting small joints of both hands and feet usually in a symmetrical fashion and so on.

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A ‘window of opportunity’ exists to initiate early treatment that will change the course of the disease. This window may be as little as three to four months.

 

Treatment

At present, there seems to be no permanent cure for RA. Drug treatment can make a big difference but lifelong therapy is required. Still the outlook for patients these days is likely to be much better than it was a few years ago. This is because of the availability of newer and better drugs, in particular the newer disease- modifying drugs.

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Drugs for treating RA can be categorized as follow:

DMARDs (disease –modifying anti –rheumatic drugs)

Corticosteroids, often called “steroids” (never used as standalone drugs), always used in combination with supervision of a rheumatologist

The newer biologics like anti TNF (etanercept, infliximab), abatacept, tocilizzumab and rituximab.

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The newer category of drugs ‘biologics’ are the agents which block the key mediators of inflammatory response. They rapidly reduce pain and swelling in the joints. These days have dramatically improved the outcomes of the disease and will contribute to the future improvements in the management of rheumatoid arthritis. Biologics like tocilizumab, for example, when initiated early, in the right indication, can profoundly inhibit joint damage. This prevents long term disabilities associated with the disease.

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Nowadays, early diagnosis and novel treatment have improved the outlook of the disease considerably and patients can enjoy a close to normal life.