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Conventional Rheumatoid Arthritis Treatments

Updated on September 25, 2015
Progression of rheumatoid arthritis
Progression of rheumatoid arthritis | Source

Rheumatoid arthritis is a degenerative condition that can lead to crippling deformities. It is an autoimmune disease caused by the immune system mistaking the body’s own tissues for foreign invaders and attacking them. This causes chronic inflammation which leads to the characteristic deformities of the disease.

Because rheumatoid arthritis can be so painful, there are a number of different treatments available most of which are pharmaceuticals. The most common of these include painkillers for pain management and Disease-Modifying Antirheumatic Drugs or DMARDS. Other treatments include physical and occupational therapy and surgery.

Medications for Rheumatoid Arthritis

Disease-Modifying Antirheumatic Drugs (DMARDS) are the most common and most successful medications used in the treatment of rheumatoid arthritis. These drugs not only reduce pain, they also slow down the degeneration process the disease causes.

Probably the most well-known of these medications are Methotrexate and Plaquenil (hydroxychloroquine). Methotrexate is by far the most commonly prescribed, but Plaquenil is a very close second.

Structure of dihydrofolate reductase complexed to methotrexate.
Structure of dihydrofolate reductase complexed to methotrexate. | Source

Methotrexate was originally used as a chemotherapy drug, but it is now mainly used as an immunosuppressant. It works by inhibiting the metabolism of folic acid. More specifically it inhibits dihydrofolate reductase.

Plaquenil is a bit different. It is an antimalarial drug that is most commonly used to treat autoimmune diseases such as rheumatoid arthritis and Sjogren’s syndrome. It works by reducing the inflammation caused by the immune response.

Other immunosuppressant medications used to treat the underlying cause of rheumatoid arthritis include:

  • Arava (leflunomide)
  • Myochrysine (injectable gold)
  • Neoral (cyclosporine)
  • Imuran (azathioprine)
  • Humira (adalimumab)
  • Orencia (abatacept)
  • Enbrel (etanercept)
  • Remicade (infliximab)

A 20mg Prednisone Tablet
A 20mg Prednisone Tablet | Source

Steroids are another type of medication that can be used to treat the inflammation caused by rheumatoid arthritis. The most common of these are Prednisone and Celestone (betamethasone).

Sometimes the above medications can alleviate much of the pain the disease causes; however, there are times when these medications merely “take the edge off.”

In these cases, the patient often requires the use of pain management medications such as opiate painkillers and anti-inflammatories. The most common of these include:

Ultram, Voltaren gel and Ibuprofen are three of the most common medications used to treat rheumatoid arthritis.
Ultram, Voltaren gel and Ibuprofen are three of the most common medications used to treat rheumatoid arthritis. | Source
  • Vicodin (hydrocodone)
  • Oxycodone
  • Ultram (tramadol)
  • Celebrex (celecoxib)
  • Mobic (Meloxicam)
  • Indocin (Indomethacin)
  • Clinoril (sulindac)
  • Voltaren (diclofenac) oral or gel form
  • Ibuprofen
  • Naproxen sodium
  • Aspirin

The main problem the pharmaceutical treatment of rheumatoid arthritis is the side effects the drugs can cause. For example, Plaquenil can cause a red/green deficiency in a patient’s color vision known as “Plaquenil toxicity” or “cholorquine retinopathy.” This side effect is irreversible and becomes progressively worse as treatment progresses. Discontinuing treatment can help prevent further damage to the retina, but it will not reverse damage that has already been done.

Performing physical therapy
Performing physical therapy | Source

Treating Rheumatoid Arthritis with Physical & OccupationalTherapy

Treatment for RA can also involve occupational and physical therapy. Physical therapists will help you to maintain some flexibility, and occupational therapists will help you to maintain the ability to continue your daily activities.

Physical therapy will focus on function of the joints, muscle strength and overall level of fitness. Since these therapists focus on the joints and muscles they are able to suggest exercises that will keep the joints flexible and strengthen the muscles, which will help minimize pain and improve (and maintain) coordination.

Along with exercises, physical therapists can also employ a variety of other treatments including heat and ice therapy, as well as massage. For those with chronic pain, these treatments can be indispensable in helping to alleviate pain at home.

Occupational therapy will help you maintain your independence. An occupational therapist can help you find the easiest way of doing a mundane, yet frustrating, activity as well as evaluate what you might be doing or how you may be doing it that may be causing unnecessary strain on your joints.

They can then suggest changes that may help you to accomplish a task more efficiently, or an alternative way to doing something that makes the task much easier to accomplish. They may also be able to suggest a device that may assist you in your daily activities.

Treating Rheumatoid Arthritis with Surgery

Although most commonly a last resort, surgery can be the best option for those with RA. Typically, RA surgery involves replacing a hip or knee joint. The weight bearing joints are usually the most painful in people with this disease.

There are other procedures that can be performed including:

  • Carpal tunnel release
  • Synovectomy
  • Joint (or bone) fusion

Carpal tunnel release is usually performed to alleviate pressure on a nerve in the hand. Because the fingers and hands are used so frequently, this type of surgery is becoming more common. This is also the reason hands and digits are commonly affected by RA.

Synovectomy involves removing the lining (or synovium) surrounding the joint in an effort to prevent it from eroding away the cartilage found on the tips of the bones that comprise the joint. Sometimes this surgery ends up having to be repeated because the synovium does eventually grow back.

Joint fusion or arthrodesis can be used to alleviate pain in many joints including:

  • Hip
  • Ankle
  • Fingers
  • Thumbs
  • Spine
  • Wrists

In arthrodesis, the joint itself is essentially removed by fusing the two bones together that create the joint. While this does alleviate any further pain and inflammation, it also severely limits a person’s mobility in the fused joint. This is especially difficult when several joints in the spine are fused together. Many patients end up unable to turn their neck or bend their back.

© Copyright 2013 - 2015 by Melissa "Daughter of Maat" Flagg ALL RIGHTS RESERVED

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    • BlissfulWriter profile image

      BlissfulWriter 3 years ago

      Because Rheumatoid-Arthritis is an autoimmune condition, it might be worth looking into what is causing the autoimmunity and how to treat the autoimmunity. There is ample evidence that gluten is linked to autoimmunity and I wrote hub explaining why anyone with autoimmune condition (including rheumatoid arthritis) should avoid gluten: https://hubpages.com/health/People-with-Autoimmune...

      Also do a web search for "Autoimmune Protocol" by Paleo Mom.

    • jpcmc profile image

      JP Carlos 3 years ago from Quezon CIty, Phlippines

      The picture really made me more concerned about arthritis. i just don't want to live with such a condition.

    • phoenix2327 profile image

      Zulma Burgos-Dudgeon 3 years ago from United Kingdom

      It does look terribly painful. How effective are painkillers?

    • Pamela99 profile image

      Pamela Oglesby 3 years ago from United States

      This is surely one of the painful autoimmune diseases. It would be nice if they would actually come up with a cure rather than just treating the symptoms of all these autommune diseases. This is a well-written article that covers the current treatments. I have lupus and another connective tissue disorder and pain pills just take the edge off so you can function, but never all the pain in my experience. Voted up, useful and intereseting.

    • tillsontitan profile image

      Mary Craig 3 years ago from New York

      Very comprehensive hub! With at least one percent of the population lookng forward to RA it is a good thing to know as much as you can. Treatments have improved as you've noted, and hopefully they will continue to improve.

      Voted up, useful, and interesting.

    • Mel Carriere profile image

      Mel Carriere 18 months ago from San Diego California

      I am a rheumatoid arthritis sufferer on Methotrexate and I never understood the importance of taking folic acid until now. Maybe if the doctor had explained it better I would take it more regularly. Thank you for this informative hub.

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