Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. It is a disabling and painful inflammatory condition, which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and muscles.

Treatment

Pharmacological treatment of RA can be divided into disease-modifying antirheumatic drugs (DMARDs), anti-inflammatory agents and analgesics {{ref|ODell}}. DMARDs have been found to produce durable remissions and delay or halt disease progression. This is not true of anti-inflammatories and analgesics.

Related Topics:
Pharmacological - Disease-modifying antirheumatic drug - Anti-inflammatory - Analgesic

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

DMARDs

DMARDs can be further subdivided into xenobiotic agents and biological agents. Xenobiotic agents are those DMARDs that do not occur naturally in the body, as opposed to biologicals.

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

Xenobiotics

Xenobiotics include:

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

• azathioprine
• cyclosporin A
• D-penicillamine
• gold salts
• hydroxychloroquine
• leflunomide
• methotrexate (MTX)
• minocycline
• sulfasalazine (SSZ)

The most important and most common adverse events relate to liver and bone marrow toxicity (MTX, SSZ, leflunomide, azathioprine, gold compounds, D-penicillamine), renal toxicity (cyclosporine A, parenteral gold salts, D-penicillamine), pneumonitis (MTX), allergic skin reactions (gold compounds, SSZ), autoimmunity (D-penicillamine, SSZ, minocycline) and infections (azathioprine, cyclosporine A). Hydroxychloroquine may cause ocular toxicity.

Related Topics:
Liver - Bone marrow - Skin

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

Biological agents

Biological agents include:

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

• tumor necrosis factor (TNFα) blockers - etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira)
• interleukin-1 blockers - anakinra

Anti-inflammatory agents and analgesics

Anti-inflammatory agents include:

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

• glucocorticoids
• Non-steroidal anti-inflammatory drug (NSAIDs, most also act as analgesics)

Analgesics include:

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

• acetaminophen
• opiates
• lidocaine topical

Other therapies

Other therapies are weight loss, physiotherapy, joint injections, and special tools to improve hard movements (e.g. special tin-openers).

Related Topics:
Weight loss - Physiotherapy - Joint injection

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

Severely affected joints may require joint replacement surgery, such as knee replacement.

~ ~ ~ ~ ~ ~ ~ ~ ~ ~