Treating Rheumatoid arthritis

The goal of treatment of RA is the control of synovitis (joint inflammation) and prevention of joint injury. Depending on the severity of the disease, therapy with medications will be initiated along with other therapies. We will start with talking about medications.

Medication therapy is directed at achieving remission or low disease activity by control of inflammation and use of disease-modifying antirheumatic drugs (DMARD). The best outcomes come when there is early recognition and diagnosis. A rheumatologist can provide expert care in the management of these medications. Following are the principles that guide treatment.

• Early use of disease-modifying antirheumatic drugs (DMARDs) for all patients diagnosed with RA.  Used alone or in combinations, with methotrexate being a first line drug. Methotrexate suppresses synovitis and prevents articular bone erosions. DMARD therapy is initiated early in the disease.
• Methotrexate is contraindicated in:
• Women who are contemplating becoming pregnant
• Women who are pregnant
•  Patients with liver disease or excessive alcohol intake
• Patients with severe renal impairment
• Methotrexate requires monitoring of bone marrow, liver and lung toxicity
• Alternatives to methotrexate include TNF inhibitors, nonbiological traditional DMARDs, or other alternatives. For more information visit
• Additional information http://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/basics/treatment/con-20014868
•  Importance of tight control with target of remission or low disease activity
• Use of antiinflammatory agents, including nonsteroidal antiinflammatory drugs (NSAIDs) and glucocorticoids, only as adjuncts to therapy, never alone. They are used for temporary control of inflammation, but do not provide long-term control of the disease.
•  Disease activity and response to therapy should be monitored regularly
• Those with moderate to sever RA will require ongoing therapy. A minority who reach a sustained clinical remission of greater than 1 year can reduce DAMRD doses while monitoring closely, although this is controversial.

Additional treatment of RA include

1. Nutritional therapy: there is no special diet, balanced nutrition is important. Fatigue, pain, depression, limited endurance and mobility deficits can accompany RA. Maintaining balanced nutrition can assist in combating these. Additionally, if taking corticosteroids, unwanted weight gain can occur. 
2. Therapeutic exercise: this is an integral part of the treatment plan, and an individualized one is best done by a physical therapist or other professional. Exercise can prevent progressive joint immobility and muscle weakness. Over-exercise can also cause pain, inflammation or other damage, so it is important to be careful. 
3. Rest and joint protection: gentle range of motion exercises can be done regularly to keep joings functional. Water can provide a two-way resistance that asks more of muscles and less of joints. 
4. Heat and cold applications: Can relieve stiffness, pain and muscle spasm. During disease exacerbation, ice is especially helpful. Heat sources that are superficial such as heating pads, moist hot packs, and warm baths or showers can relieve stiffness and allow more participation in therapeutic activity. 
5. Complementary and alternative therapies
1. herbal products
2. movement therapies

References:

Schur, P. F., & Cohen, S. (2015). Initial treatment of moderately to severely active rheumatoid arthritis in adults. Up to Date. Retrieved form http://www-uptodate-com.offcampus.lib.washington.edu/contents/initial-treatment-of-moderately-to-severely-active-rheumatoid-arthritis-in-adults?source=search_result&search=rheumatoid+arthritis+treatment&selectedTitle=1~150

Lewis, Heitkemper. Medical-Surgical Nursing, 8th Edition.