Fast Diagnosis and Treatment Key to Managing Rheumatoid Arthritis
Steroids are potent suppressors of inflammation and can be used to control severe or widespread disease until the DMARDs take effect, which may take several weeks to months. However, steroids cause serious side effects, such as infection and increased blood sugar. Matteson recommends that they not be used alone in RA therapy and should be tapered and ultimately discontinued as soon as other agents start to work. DMARDs also can be tapered in a patient who has no active signs of disease for at least a year.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and a new class of drugs called Cox-2 inhibitors, such as Celebrex (celecoxib) and Vioxx (rofecoxib), can relieve pain and inflammation but seldom eliminate the signs and symptoms of arthritis completely. Cox-2 inhibitors are no more effective therapeutically than traditional NSAIDs, Matteson says. Their advantage is that they are associated with fewer side effects, mainly stomach bleeding. "These agents are good for people who have a high risk of stomach bleeding, such as the elderly or those with a history of [stomach] bleeding," he tells WebMD. "They are valuable adjunctive therapy." Klippel adds that they provide "a new therapeutic alternative for patients who don't respond to traditional NSAIDs."
RA is "a very treatable, manageable disease that can be successfully controlled," Matteson says. He and Klippel both state that early diagnosis and prompt initiation of treatment are the most important aspects of effective management. Says Klippel, "A decade ago we would have waited and used mild drugs until the disease was out of control. Today there is clear reason to believe that if RA is recognized and treated early, we can have a profound impact on the course of this disease."
- The key to managing rheumatoid arthritis, one of the most common causes of disability, is early diagnosis and prompt, appropriate treatment.
- The mainstay of therapy should be methotrexate or tumor necrosis factor antagonists, according to one expert.
- Steroids or nonsteroidal anti-inflammatory drugs may be used in conjunction with the other drugs to treat some patients at certain times.