Conventional Medical Treatment
Standard medical treatment of rheumatoid arthritis involves the use of physical therapy along with drugs. The physical therapy may include:
The first drug used in the treatment of RA is aspirin. It is often quite effective in relieving both the pain and inflammation. It is also relatively inexpensive. However, the therapeutic dose required is relatively high. This may result in toxicity that can lead to complications such as tinnitus (ringing in the ears) and gastric irritation.
Other medications often prescribed are called non-steroidal anti-inflammatory drugs (NSAIDs). These are used when aspirin is ineffective or is intolerable. Examples of NSAIDs used are:
NSAIDs are more expensive than aspirin. They are also not superior to aspirin in terms of their effectiveness. NSAIDs also have their own side-effects and other complications such as gastrointestinal upset, headaches and dizziness.
If conservative therapy does not offer benefit, more aggressive and potentially more toxic treatments are available.
Gold salt injections aid about 60 per cent of patients, but severe side effects occurs in nearly one-third of patients.
Other powerful drugs are used including d-penicillamine and hydroxychloroquine, but benefit often does not substantiate toxicity. Corticosteroids are also used during acute worsenings of the disease. Long-term use of corticosteroids in RA is not advised due to side effects.
A new drug, Arava, is an immune suppressant that diminishes the body's attack on the joints without compromising its ability to fight infection. It is also the first drug that has been clearly shown to inhibit the progression of RA.
Preliminary information about the new COX-2 drugs (cycloxygenase inhibitor nonsteroidals, e.g., Celebrex) indicate that risks of gastrointestinal irritation and bleeding should be less common. A synthetic compound mimicking joint fluid, called Synvise, has also recently been approved for injection into affected joints.
Joint surgery and replacement are reserved for the most severe cases
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