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    Getting a Grip on Rheumatoid Arthritis Pain

    Options for managing the pain and damage of severe chronic RA.

    Other Treatment Options for Chronic Rheumatoid Arthritis: Steroids, NSAIDs, and Pain Relievers

    DMARDs and biologic response modifiers are important agents used to treat chronic rheumatoid arthritis. But they aren’t the only options. Several other medications can be used to treat severe RA, including the following:

    • Steroid medications, such as prednisone. Steroids can quickly reduce RA pain and swelling and slow damage to the joints. They aren’t recommended for long-term use. That’s because they become less effective over time, and they can have serious side effects, including cataracts, diabetes, and thinning bones.
    • Nonsteroidal anti-inflammatory drugs or NSAIDS. NSAIDS such as ibuprofen (Motrin, Advil) and naproxen sodium (Aleve) help relieve pain and inflammation, and are often used together with DMARDs.
    • Pain relievers such as acetaminophen (Tylenol). These medications are another option for relieving pain. They don’t, however, affect joint inflammation.

    RA Therapy Is Trial-and-Error

    Often it takes several attempts to find the right drug or combination of drugs that effectively treats chronic RA. “That’s one of the most frustrating things in rheumatology today, that it is very much trial and error,” Ruderman says. “We end up trying something, and if it doesn’t work, we try something else."

    John Melendez tried several different medications, including prednisone and Enbrel, with varying degrees of success. Then Samuels put him on a combination of methotrexate and Humira. “When I talk with Dr. Samuels, he calls it ‘cocktails,’” Melendez says. “He’s trying to find the right cocktail for the right person.”

    Samuels started him on the steroid prednisone, which he says helped with the swelling. Then he began taking the biologic drug Enbrel. “I did improve, but it was very slight,” he says. “The doctor and I weren’t very happy with the progress.” After a few months, he switched to his current “cocktail” -- a combination of methotrexate and Humira. Although the methotrexate tends to upset his stomach, Melendez has tolerated his medications pretty well.

    Non-Medication Options for Severe RA

    Ruderman tells WebMD that medication has become so effective at preventing joint degeneration that joint replacements for chronic RA are a lot less common than they used to be. But for patients whose RA doesn’t respond to medication, surgery to repair damaged joints may still be an option. Surgery involves replacing the entire joint (arthroplasty), repairing the tendons around the joint, or removing the joint lining (synovectomy).

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