Rheumatoid arthritis is a chronic, autoimmune, slowly progressing disease characterized by inflammation of the connective tissue with predominant joint damage. Its prevalence reaches 0.5 – 2% of the total population in industrialized countries. In this article, we will consider the medical treatment of rheumatoid arthritis. Medication for rheumatoid arthritis

Medication for rheumatoid arthritis

Given the particular course of the disease in a particular patient, drugs are selected strictly individually, the likelihood of side effects, compatibility with other drugs, etc.

The main tasks in the fight against rheumatoid arthritis are:

  • Slow down and pause systemic manifestations.
  • Reduce as much as possible problems with the musculoskeletal system.
  • Prevention of side effects of drugs.

Non-steroidal anti-inflammatory drugs.

These remedies are used to reduce pain and inflammation in the joints, as well as relieve swelling.

Non-steroidal anti-inflammatory drugs do not contain hormones, do not cause serious abnormalities in the form of diabetes mellitus, hypertension. They represent the basis for the treatment of rheumatoid arthritis. Since this is a chronic disease and is accompanied by bright pain syndrome, it is necessary to take drugs, not for a short course, as recommended, but for months. These include:

Airtal. It is well absorbed (absorbed) in the gastrointestinal tract.  The greatest effect is observed 1 to 2 hours after administration. Due to its high activity, the drug eliminates pain, reduces morning stiffness and swelling of the joints. With renal failure and severely impaired renal and hepatic function, as well as chronic heart failure, use with caution. Adverse reactions: dizziness, nausea, headaches, vomiting, tinnitus, etc.Medication for rheumatoid arthritis

“Arcoxia.” A selective COX-2 inhibitor, in therapeutic concentrations, blocks the formation of prostaglandins and has an anti-inflammatory, analgesic, antipyretic effect and is accompanied by a decrease in the severity of clinical symptoms associated with the inflammatory process, while there is no effect on the mucous membrane of the gastrointestinal tract. The benefits are a very quick analgesic effect. The action begins in 20 to 30 minutes.

Nise. This drug is less likely to cause side effects. It well neutralizes morning stiffness and swelling of the joints. It inhibits the formation of toxic substances and has antioxidant properties. The maximum effect is observed after 1.5 – 2 hours. Side effects when taking this drug: nausea, diarrhea, heartburn, stomach pain, fluid retention, etc.

Basic preparations.

Basic therapy means are slow, their effect becomes noticeable no earlier than 2 months after the start of treatment. A general improvement is observed only after 6-8 months. However, it is these drugs that help slow the rate of joint destruction. These include sulfasalazine and methotrexate.

Methotrexate is perhaps the best of the best basic formulations for treating rheumatoid arthritis. It is a modifying immune-depressive antirheumatic drug. Reduces the activity of the immune system, which may be overly active in some cases. Methotrexate modifies the underlying disease process to limit or prevent joint damage and disability, and not just treat symptoms. 

This is a long-term medication for rheumatoid arthritis, so it can be 3 to 12 weeks before you begin to notice improvements. If you have serious side effects from the drug, then consult a doctor immediately. In other cases, it is very important to continue taking the drug:

  • Even if it does not seem to work at first.
  • Even when your symptoms improve (as this will help keep the disease under control).

“Sulfasalazine” – antimicrobial agents successfully used in the basic treatment of rheumatoid arthritis. By the strength of the therapeutic effect, sulfonamides are slightly inferior to “methotrexate”. 

The main advantage of these drugs over other basic drugs is their good tolerance – they almost do not give complications even with prolonged use. With prolonged use, side effects develop only in 15-30% of patients, and these side effects are almost never severe.

The lack of sulfa drugs is the slow development of their therapeutic effect. Some improvement in the treatment with these drugs is usually observed only after three months of therapy, and the “peak form” is reached after 6-12 months from the start of treatment.

The best effect is observed with the simultaneous administration of several means of basic therapy, which are prescribed by the doctor.

Also, quite jointly with NSAIDs and basic drugs, intra-articular injections of hormonal agents (diprospan, Kenalog) are used in rheumatoid arthritis, which are injected into the joints no more than 1 time in 3 months.

External therapy: creams with NSAIDs to relieve pain, ointments (Voltaren – gel, fastum – gel, etc.). They act not so effectively, since the skin does not allow more than 5-7% of the active substance to pass through, and this is clearly not enough for the development of a full anti-inflammatory effect. But then these ointments almost never cause those side effects that occur from the internal use of non-steroidal anti-inflammatory drugs. That is, they are practically harmless.

Janus kinase inhibitors.

Your doctor may prescribe these drugs if NSAIDs or biological products do not work for you. These drugs affect the genes and activity of immune cells in the body. They help prevent inflammation and stop damage to joints and tissues.

Inhibitors associated with Janus kinase include:

  • Tofacitinib.
  • Baricitinib.

Baricitinib is a new drug that is being tested. Studies show that this works for people who are not successful with NSAIDs.

The more common side effects of these drugs include:

  • Headache.
  • Upper respiratory tract infections such as sinus infections or colds.
  • Stuffy nose.
  • Runny nose.
  • Sore throat.
  • Diarrhea.

Acetaminophen.

Acetaminophen is available without a prescription. It is supplied as an oral preparation and rectal suppository. Other drugs are much more effective in reducing inflammation and treating pain in RA. This is due to the fact that acetaminophen can treat mild to moderate pain, but it does not have anti-inflammatory activity. This means that it is not very suitable for the treatment of RA.

This medication carries a risk of serious liver problems, including liver failure. You should only take one drug that contains acetaminophen at a time.

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Biological Agent Medicines

Replace obsolete drugs, which had many side effects and worked slowly, came a new generation of funds – biological agents.

Genetic engineering medications for rheumatoid arthritis are based on the principle of suppressing cytokine cell production. Cytokines are specific proteins similar to hormones that are synthesized by various cells in the body: cells of the immune system, blood cells, spleen, thymus gland, connective tissue and other types of cells. The bulk of cytokinesis formed by lymphocytes. They are responsible for the development of the inflammatory process and damage to the joint tissue. Their main advantage is that they affect only one group of components of the immune system, without interfering with all other mechanisms. Biological agents allow you to get a positive result much faster, about a few weeks after the start of administration, and the effect of them is more pronounced.

Causes of Rheumatoid Arthritis

The specific cause of rheumatoid arthritis has not yet been determined, despite decades of medical research. Although we do not know specifically what causes rheumatoid arthritis, we know that this is the result of an autoimmune disorder. Autoimmune disorder occurs when immune cells begin to attack the body. In the case of rheumatoid arthritis, the body attacks its healthy joint tissue, called the synovial membrane. A synovial bag is what produces a clear liquid substance known as synovial fluid. This fluid lubricates healthy joints and gives the cartilage and bones the nourishment needed to remain effective and mobile.

After the autoimmune disorder is caused by rheumatoid arthritis, antibodies are produced and they continue to attack. Antibodies secrete chemicals that cause inflammation of the synovial membrane, inhibiting its ability to produce synovial fluid. The less fluid, the more joints become stiff and motionless.

As the synovial membrane becomes thicker without fluid lubrication, the cartilage of the joint can destroy and eventually weaken the connective tissue between the bones. Once the cartilage is destroyed, the ligaments that connect it to the bone also begin to weaken. And also affects the tendons connecting the bones to the muscles.

When the ligaments and tendons weaken, they can no longer keep the joints in shape because they are stretched. This can lead to a serious loss of configuration so that the connection, in this case, can be completely destroyed.

 There are several factors due to which this disease is most likely to develop:

  • Stress, overwork, depression.
  • Genetic predisposition.

It is believed that the likelihood of getting sick is much higher if cases of rheumatoid arthritis have been observed in close relatives.

And also if patients have special antigens, a certain type of HLA-27, HLA-DP4, etc.

  • Infections (rubella virus, hepatitis, flu, tonsillitis, etc.).
  • Excessive exercise.

Symptoms of  Rheumatoid Arthritis

Even before the appearance of severe clinical symptoms of joint damage, the following are noted:

  • Weakness.
  • Muscle pain.
  • Sweating.
  • Stiffness of joints.

Common signs:

  • Fatigue.
  • A slight increase in body temperature.
  • Swollen lymph nodes.
  • Weight loss.
  • Joint pains appear.
  • There is morning stiffness of the joints (more than 1 hour).
  • Swelling of the joints.
  • Increased ESR.
  • The presence of rheumatoid subcutaneous nodules on the extensor or protruding surfaces near the joints.
  • The presence of rheumatoid factor in the blood serum (not in all cases).

Joint damage.

Regular symmetrical damage to the joints (for example, the right and left shoulder joints are affected).

Joint pain is characterized by a number of signs:

  • The pain is inflammatory in nature.
  • Constant.
  • Aching.
  • The pain may increase in the evening (wave-like character).
  • It is eliminated when taking NSAIDs (anti-inflammatory drugs).

Diagnostics

  • Medical examination.
  • Complete blood count (CBC).
  • Blood chemistry.
  • X-ray of the joints.
  • Rheumatoid factor in the blood.
  • Anticytrulline antibody test.
  • Antinuclear antibodies.
  • Analysis of synovial fluid (contained in the joint cavity).

Medication for rheumatoid arthritis


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