Arthritis treatment Drug Guideline in Rheumatoid arthritis

Arthri­tis treat­ment Drug Guide­line  in Rheuma­toid arthritis

Rheuma­toid arthri­tis affects approx­i­mately 1 per­cent of the U. S. pop­u­la­tion and can cause irre­versible joint defor­mi­ties and func­tional impair­ment. The cause of this autoim­mune dis­ease remains obscure, but greater under­stand­ing of the under­ly­ing mech­a­nisms has facil­i­tated the devel­op­ment of new drugs and rev­o­lu­tion­ized treat­ment. Joint dam­age occurs early in the course of rheuma­toid arthri­tis; 30 per­cent of patients have radi­ographic evi­dence of bony ero­sions at the time of diag­no­sis, and this pro­por­tion increases to 60 per­cent by two years. Unfor­tu­nately, bony ero­sions and defor­mi­ties are largely irre­versible. Ini­ti­a­tion of ther­apy with DMARDs within three months after the diag­no­sis of rheuma­toid arthri­tis is cru­cial; a delay of as lit­tle as three months in the intro­duc­tion of these med­ica­tions results in sub­stan­tially more radi­ographic dam­age at five years. There­fore, early diag­no­sis, although chal­leng­ing, is crit­i­cal. The diag­no­sis can­not be estab­lished by a sin­gle lab­o­ra­tory test or pro­ce­dure but is aided by the use of seven diag­nos­tic cri­te­ria that favor clin­i­cal fac­tors and, there­fore, depend on the clin­i­cian ’ s ask­ing insight­ful ques­tions and rec­og­niz­ing the often — sub­tle early phys­i­cal find­ings. The diag­nos­tic cri­te­ria are the pres­ence of morn­ing stiff­ness, arthri­tis of three or more joint areas, arthri­tis of the hand joints, sym­met­ric arthri­tis, rheuma­toid nod­ules, ele­vated lev­els of serum rheuma­toid fac­tor, and radi­ographic changes. Many other syn­dromes, includ­ing self — lim­it­ing viral con­di­tions last­ing sev­eral weeks, mimic rheuma­toid arthri­tis. There­fore, the first four cri­te­ria must be present for a min­i­mum of six weeks before a diag­no­sis of rheuma­toid arthri­tis can be made. This approach, how­ever, leads to diag­nos­tic uncer­tainty that may delay appro­pri­ate ther­apy for months or years. Serum anti­bod­ies have been detected that may help define sub­groups of patients. Guide­lines con­cern­ing ther­apy for rheuma­toid arthri­tis have been pub­lished recently by the Amer­i­can Col­lege of Rheuma­tol­ogy. arthri­tis drug

rheuma­toid arthritis

No treat­ment cures rheuma­toid arthri­tis; there­fore, the ther­a­peu­tic goals are a remis­sion of symp­toms involv­ing the joints, a return of full func­tion, and the main­te­nance of remis­sion with DMARD ther­apy. A use­ful inter­me­di­ate goal is to have all patients eval­u­ated by a rheuma­tol­o­gist within three months after the onset of symp­toms, so that essen­tially all patients will be receiv­ing DMARDs by the time they have had symp­toms for three months. Dis­ease — mod­i­fy­ing antirheumatic drugs ( DMARDs ) is a cat­e­gory of oth­er­wise unre­lated drugs defined by their use in rheuma­toid arthri­tis to slow down dis­ease pro­gres­sion. The term is often used in con­trast to non — steroidal anti — inflam­ma­tory drug, which refers to agents that treat the inflam­ma­tion but not the under­ly­ing cause. The term ” antirheumatic ” can be used in sim­i­lar con­texts, but with­out mak­ing a claim about an effect on the course Med­ica­tions that are used to treat rheuma­toid arthri­tis are divided into three main classes: non­s­teroidal anti­in­flam­ma­tory drugs ( NSAIDs ), cor­ti­cos­teroids, and DMARDs ( both syn­thetic and bio­logic ). NSAIDs are par­tic­u­larly help­ful dur­ing the first few weeks in which a patient has symp­toms, because the drugs pro­vide par­tial relief of pain and stiff­ness until a defin­i­tive diag­no­sis of rheuma­toid arthri­tis can be estab­lished. NSAIDs have not been shown to slow the pro­gres­sion of the dis­ease; there­fore, in long — term care, NSAIDs should be used together with DMARDs. 21 Although both these classes of med­ica­tions are well tol­er­ated for short peri­ods, long — term admin­is­tra­tion may result in gas­troin­testi­nal ulcer, per­fo­ra­tion, and hem­or­rhage. Every year 1. 5 per­cent of patients with rheuma­toid arthri­tis are hos­pi­tal­ized with gas­troin­testi­nal prob­lems.  The risk of these com­pli­ca­tions increases with older age, cor­ti­cos­teroid use, and a his­tory of pep­tic ulcer disease.

Key­word: rheuma­toid arthri­tis drug treatment