Treatments for Rheumatoid Arthritis
by Beth G. Hodges, MD

Before treatments for rheumatoid arthritis can be selected or initiated, the diagnosis must first be suspected and confirmed. This is done through x-rays that look for typical patterns of joint destruction, a careful history of symptoms taken by a health care provider, a physical exam by same, and finally, blood tests.

Confirming the presence of rheumatoid arthritis

Blood tests commonly done include a sedimentation rate, which can indicate inflammation in the body. A sedimentation rate is a useful tool in that patients with rheumatoid arthritis usually have a fairly elevated marker, indicating the presence of significant inflammation, but it is a nonspecific test, as anything causing inflammations -- not just rheumatoid arthritis -- will cause such an elevation.

Eighty percent of patients with rheumatoid arthritis will have what is called a positive rheumatoid factor. This is a specific test that indicates the presence of rheumatoid arthritis in the body. Unfortunately, that means that twenty percent of sufferers have a negative rheumatoid factor even though they, too, have the disorder. This phenomenon is called seronegative rheumatoid arthritis. In patients with seronegative arthritis, over time, the rheumatoid factor can become positive.

Citruline antibody (abbreviated as anti-CCP) is another useful marker for rheumatoid arthritis, as is a positive antinuclear antibody (ANA.) While these markers each alone are not specific for rheumatoid arthritis, the combination present in a person with the suspect symptoms is compelling for a diagnosis.

Treatment Options

Once the diagnosis of rheumatoid arthritis has been confirmed, a treatment regimen can be begun. Studies have shown that early aggressive treatment leads ultimately to better outcomes.

For patients with mild disease, nonsteroidal anti-inflammatories are the mainstay of treatment. This category includes, but is not limited to celecoxib (Celebrex), meloxicam (Mobic), naproxen, ibuprofen, etodolac (Lodine), and many others.

For those with only slightly more severe disease or those with very limited financial resources, steroids can be very helpful. It is to be noted, however, that steroids do have potentially serious longterm side effects, such as stomach ulceration, adrenal insufficiency, osteoporosis, and depression of the immune system.

Tetracyclines, a class of antibiotics, have shown some success in treatment of the disease process, though it is not clearly understood why this happens.

Common older treatments include d-penicillamine and oral and injectable gold, though these are really not utilized anymore.

Disease modifying drugs are considered the current mainstay of therapy. One such drug is methotrexate, an oral chemotherapeutic agent. Hydroxychloroquine (Plaquenil) has been successful for many patients, though a dilated eye exam by an eye doctor should be done every six months to monitor for problems related to use of the drug.

The newest disease modifiers are injectable drugs that suppress the disease by suppressing the immune system. These drugs include Humira, Enbrel, and Remicade. They are very expensive and are usually used only under the direction of a doctor who specializes in rheumatoid arthritis, called a rheumatologist.

Treatments for rheumatoid arthritis have come a long way over the years and there are more therapeutic options than ever before in the history of the disease.

Published - October, 2009