RA Present, Past and Future
Not so long ago, rheumatoid arthritis (RA) patients ended up bedridden. Their joints mangled, they were unable even to care for themselves. There were no joint replacements for the 17-year-old with Juvenile RA. The only treatment was aspirin, the first NSAID, and it was hailed as a miracle drug.
Think about how little pain and inflammation relief an aspirin gives you and how desperate our forebears must have been that they hailed it a miracle and were thankful.
In the last few decades, research by U.S. Department of Health and the drug companies have given us a comparative large array of treatment choices to make with our doctors.
Non-steroidal anti-inflammatory drugs have helped millions of RA sufferers. The brand names include aspirin, ibuprofen, Naprosyn, and others. They work by reducing the production of prostaglandins, which are the chemicals that cause your inflammation, fever and pain.
Steroids have been used for some time to reduce inflammation. They are given by pill, cream or injection. The synthetic cortisol decreases inflammation the same way your body does. They are also known as triamcinolone, cortisone and prednisone.
Methotrexate is a disease-modifying anti-rheumatic drug (DMARD), immunosuppressive drug or slow-acting anti-rheumatic drug (SAARD). It actually interferes with the production of DNA. It is not known exactly how it works in rheumatoid arthritis, but the effect is to reduce moderate to severe inflammation. This may be a good choice for a patient with limited insurance or financial means.
These newest drugs are weekly injections given by the patient. If the patient is not helped by a DMARD drug, biologicals such as Humira, Enbrel or other brand names can be used. The treatment is quite expensive but effective.
Orthopedic surgeons routinely replace the joints of rheumatoid arthritis patients. The development in surgical techniques to replace any joint, from knees to hips, shoulders or fingers has been rapid and successful. Surgeons probably have done as much to save patients from becoming crippled by destroyed joints as medications.
Physicians called “physiatrists” are experts in rehabilitation and the management of pain. These doctors should be practicing at major medical centers, not a store front! They are indispensable to the RA patient. The doctor can properly prescribe all the pain medications the patient takes, leaving the rheumatologist to take care of inflammation. Every RA patient should see one of these specialists regularly.
Physical therapy can help stretch involved muscles and keep joints from stiffening. Much physical therapy can be done at home with stretch bands, chair yoga, yoga for seniors, Tai Chi DVDs or water therapy. There is a solution for every pocket and every ability.
There are many treatments in the pipeline, some in early mouse experiments and others ready for human trial. Many seem to replace the current biologicals with pills rather than injections that will eliminate many of the biological side-effects. Some are combined with methotrexate. There is a lot of hope for the future, working toward a day when RA is remembered as distant history.