Rheumatoid arthritis (RA) is a chronic condition that causes pain, swelling, and stiffness in the joints. Affecting about 1% of the population, it is one of the most common types of inflammatory arthritis. RA is a systemic rheumatic disease, which means that it can affect the entire body.
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Dr. John Wade, MD, FRCP(C), talks about the various treatment options for Rheumatoid Arthritis including revolutionary second line therapies.
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Dr. Kam Shojania, MD FRCPC, Rheumatologist, discusses rheumatoid arthritis management.
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Dr. Kam Shojania, MD FRCPC, Rheumatologist, discusses rheumatoid arthritis symptoms.
Rheumatoid Arthritis Treatment Options
Rheumatoid arthritis is a common type of arthritis. It’s seen in about one percent of the general population, more common in women than men – about three to one. And it often presents with pain, swelling and stiffness in the small joints, typically of the hands and feet, but it can go on and involve the larger joints, such as the ankles, the elbows, the wrists or the knees.
Typically, when we talk about treatment for rheumatoid arthritis, often patients have already tried some over-the-counter medications such as anti-inflammatories, things like ibuprofen or naproxen. These medications can be effective in controlling symptoms, they take away pain, but they’re not effective in reducing the long-term swelling or damage we see in rheumatoid disease. A local chiropractor may work with your local massage therapist and your local physiotherapist to create the best health or rehabilitation plan for your situation.
After patients have often tried anti-inflammatories, then their physician or typically rheumatologist will recommend starting on disease-modifying agents – we call them DMARDs. There are four common types of DMARDs that we’ll use, and those include methotrexate, anti-malarials, sulphasalzine, and laflumonide.
These medications are usually taken by pill, typically on a daily basis or a weekly basis, and they’re given over a period of weeks to months. And often these medications, if used appropriately in the right situation, at the right dose, will be effective in controlling the symptoms of the inflammation of rheumatoid arthritis.
If your rheumatologist has tried you on first-line therapy for arthritis, so if they put you on medications at good doses for good lengths of time, either alone or in combination, and if you’ve failed after a number of months in responding to these first-line therapies, then your rheumatologist may be looking at offering you a second-line therapy.
Second-line therapies are a major advance to the treatment of rheumatoid arthritis. We now have therapies that are second in line that are both pills, typically given either once a day or twice a day, injections under the skin that may be given anywhere from once a week, to every two weeks, to every month, or there may be some therapies that are given by intravenous. And the intravenous therapies can be given anywhere from every four weeks, some every eight weeks, and there’s one that we give in infusions every six months.
If you have rheumatoid arthritis and you’ve failed first-line therapies, you need to go and talk to your rheumatologist about these newer therapies available to treat rheumatoid disease, whether it’s an oral therapy, or an injection, or an infusion, these new therapies have revolutionized the treatment of rheumatoid arthritis.
NOw Health Network Featuring Dr. John Wade, MD, FRCP(C), Rheumatologist
Management of Rheumatoid Arthritis
When someone is diagnosed with rheumatoid arthritis, this is an urgent situation.
The disease needs to be treated. There are lifestyle measures that are important. Smoking increases the onset of rheumatoid arthritis and makes it more difficult to treat. So quitting smoking is essential in managing rheumatoid arthritis. Often seeing a local doctor or family physican is crucial to getting the right referral to a rheumatologist
The most important thing, however, is getting on medications that will slow or stop the disease. In the past, we were more hesitant on using these medications. Now we realize if we use them aggressively at the beginning in stopping the disease, we can often withdraw them or reduce the dose and people can do very well. Often a physiotherapist can help with some forms of rheumatology.
So these medications are called disease-modifying anti rheumatic drugs. For short we call them “DMARDs” - D-M-A-R-D, small S. These DMARDs slow the progression of rheumatoid arthritis and in many cases improve life expectancy and function. The most common DMARD we use is methotrexate.
There are other DMARDs that are also used in rheumatoid arthritis, and in the past ten years it's been very exciting that we have options of medications we call biologics. These are relatively expensive, but they work very well in halting the disease progression and making people feel a lot better.
So there has a revolution in the way we manage rheumatoid arthritis. Fifteen, twenty years ago we helped people live with rheumatoid arthritis. Now we try to stop the disease.
Key points about rheumatoid arthritis are that it is a systemic disease that requires urgent treatment. Now going back if you want to prevent it or not get rheumatoid arthritis in the future, the most important thing we know right now is quitting smoking. Smoking increases rheumatoid arthritis by about seven times, and if you smoke, it's harder to treat. So quitting smoking is really important. Otherwise, getting the disease under control with medications is extremely important, and once the disease is under control we use physiotherapy, lifestyle measures to improve function back to where it should be. Presenter: Dr. Kam Shojania, Rheumatologist, Vancouver, BC
Now Health Network Local Practitioners: Rheumatologist