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Treatment methods

Until the end of the seventies, treatment of RA consisted mainly of pain control through painkillers or anti inflammatory drugs. At that time, anti-rheumatic drugs that can alter the course of the disease were not commonly used. The outlook for patients was often poor and wheelchairs were commonly seen in the rheumatologists' waiting room.

During the past 20 years, the knowledge on treatment strategies for patients with early rheumatoid arthritis greatly increased. Due to a lot of research on treatment strategies, researchers in the nineties found out that starting a therapy in an early stage of the disease is of great importance for the course of RA in the future. For that reason, new patients are currently treated with an effective therapy as soon as possible.

Moreover, it was found that an intensive start of the therapy with a combination of anti-rheumatic drugs often has a better effect on disease activity than the treatment with only one anti rheumatic drug.
Thus in RA 'the first blow is half the battle'.

Modern RA treatment not only focuses on pain control, but also on control of disease activity, prevention of radiographic damage and maintenance of physical function.

Drugs

Besides painkillers (such as paracetamol/acetaminophen) and non steroidal anti inflammatory drugs  (NSAID's), there are more specific anti rheumatic drugs. These are called DMARD's (Disease Modifying Anti Rheumatic Drugs), because they can alter the natural course of the disease by decreasing disease activity and slowing progression of structural joint  damage. This way, future joint damage can be limited. Examples of frequently prescribed DMARD’s are : methotrexate, sulphasalazine, hydroxychloroquine. Leflunomide, cyclosporine and gold are less frequently used.
Furthermore, glucocorticoids, although traditionally not classified as DMARDs (such as prednisolone and cortisone) have proved to be very effective in suppressing disease activity and delaying joint damage. Prednisolone is often prescribed in combination with one or more classic DMARD’s, because it works well, and has a rapid onset of action. If only one or a few joints are affected, a local injection with glucocorticoids is often given .

In the last 10 years so called ‘biologicals’ are increasingly being used to treat RA. These drugs use biologically engineered antibodies to influence the immune response. Examples of these drugs are: infliximab, etanercept and adalimumab (TNF-blocking agents), and rituximab and abatacept.

 

 
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