When you work on the Verrazano-Narrows, one of the biggest suspension bridges in the world, the cold temperatures and heavy lifting can really take a toll on your body. Construction worker John Melendez thought the pain and swelling he was experiencing in his hands, arms, and legs were just side effects of his job. Eventually, the pain became so severe that the 52-year-old Staten Island resident was unable to work at all. “My fingers were so swollen that I couldn’t bend them,” Melendez recalls. “I couldn’t even walk.”
When he finally went to see Jonathan Samuels, MD, an attending rheumatologist at New York University’s Langone Medical Center, Melendez was in so much pain that he had to be practically carried into the office. Tests revealed that he had rheumatoid arthritis or RA. RA is a degenerative autoimmune disease that attacks the joints. Melendez immediately thought of his mother, who also has RA and now lives in a nursing home. He worried that he would share her fate.
The main treatment goals with rheumatoid arthritis are to control inflammation and slow or stop the progression of RA.
Treatment is usually a multifaceted program that consists of medications, occupational or physical therapy, and regular exercise. Sometimes, surgery is used to correct joint damage. Early, aggressive treatment is key to good results. And with today’s treatments, joint damage can be slowed or stopped in many cases.
Had he been diagnosed 20 or 30 years ago, that might have been the case. People with severe rheumatoid arthritis once had to look forward to a lifetime of chronic pain and disability. But today’s treatments have dramatically improved the outlook. “With the new medications, we’re able to stop the disease process,” Samuels says.
Disease-Modifying Medications for Severe RA
In the past, most patients with rheumatoid arthritis took pain relievers to alleviate their symptoms. But the drugs did nothing to slow the progressive joint damage that occurs with chronic RA. Today, patients are diagnosed earlier and treated more aggressively. And the medications used can actually change the course of their disease and reverse joint damage. “The earlier you catch somebody and the earlier you start effective therapy, the more likely you are to get them into remission,” says Eric Ruderman, MD. Ruderman is associate professor of medicine at the Northwestern University Feinberg School of Medicine. He’s also an attending physician at Northwestern Memorial Hospital. “We are becoming more and more aggressive in the way we treat people,” he says. “So the goal really is remission.”
Aggressive treatment for chronic rheumatoid arthritis typically begins with disease-modifying antirheumatic drugs, or DMARDs. These drugs do more than just reduce symptoms, Ruderman tells WebMD. They address some of the root causes of rheumatoid arthritis.
The gold standard DMARD is methotrexate. “We’re going to try to start with methotrexate if we can,” Samuels says, “because it has the longest track record of doing very well.” Methotrexate has a number of distinct advantages:
It is relatively inexpensive.
It works quickly.
It can slow RA damage to the joints.
It is generally well tolerated.
If methotrexate doesn’t work, doctors may try another DMARD, such as leflunomide (Arava), hydroxychloroquine (Plaquenil), or sulfasalazine (Azulfidine).
Methotrexate and the other DMARDs are very effective. But they don’t provide instant relief. In fact, they may not start working for weeks or even months. DMARDs aren’t right for every patient. If these drugs don’t relieve symptoms, other drugs are available that also target the processes behind chronic RA.