Treatment & Prognosis
Rheumatoid arthritis is a progressive disease with poor long-term consequences if not treated.
Rheumatoid arthritis treatment goals:
- Pain relief
- Reduction of swelling
- Improved joint function
- Reduction or elimination of damage to the joint
- Prevention of ancillary or secondary disease progression
Aggressive treatment is critical to put the disease into remission.
Medical approach to treatment
The medical community will often express caution to RA patients regarding sweeping statements about the efficacy of any one course of treatment, as results will vary from person to person.
Physicians have discovered that effective treatment regimens are best tailored to each individual patient, due to the unique manifestation of the disease not only across the patient population, but also within a single patient over time.
In recent years, new research and understanding of the mechanisms of RA’s destructive progression, and the effects of drug therapy, have given the medical community greater confidence in the use of medications for treating RA sufferers.
The range of treatment options are presented below, in order of proven efficacy for halting the progression of the disease, and its symptoms, in a majority of patients.
- DMARDs (disease-modifying antirheumatic drugs), which have the ability to improve physical function by decreasing joint inflammation, and slowing or even prevention of structural joint damage. As soon as a diagnosis of rheumatoid arthritis has been made, patients will most likely be prescribed one of many available DMARDs for a minimum of one year – as it often takes 3 months for results to be seen. DMARDs may need to be taken indefinitely. Your physician may recommend that some DMARDs be used in combination with other medications. Examples of DMARDS include: methotrexate, hydroxychloroquine and leflunomide.
- BIOLOGICS. These medications are specifically designed to inhibit or block the molecules in the immune system that are known to be involved in rheumatoid arthritis. Examples include: Humira, Enbrel, Simponi, Remicade, Cimzia, Actemra, Orencia, Rituximab. These medications are often given in combination with DMARDS, or alone. These medications have changed the landscape in helping RA patients, by decreasing swelling, pain, healing erosions, and improving quality of life.
- NSAIDs (non-steroidal anti-inflammatory drugs), which reduce inflammation, pain, swelling and stiffness; care must be taken regarding long-term use, as NSAIDs have been shown to affect the gastro-intestinal tract and kidney functioning over the long-term. They often lead to high blood pressure.
- Corticosteroids (such as prednisone), are very helpful in halting the release of molecules responsible for inflammation in joints. Care must also be taken with dosages and duration, due to the potential for side effects, including diabetes, high cholesterol, low bone density and avasculular necrosis. Injection of corticosteroids into joints is a useful treatment for swelling and pain. Any one joint can be injected safely up to three times in a year.
- Calcium and vitamin D supplementation will help decrease the risk of osteoporosis. Bisphosphonates (to increase bone density) may be required in some patients, particularly if on long standing corticosteroids.
Patient education is one of the more important factors in treating rheumatoid arthritis, alongside application of drug therapy and the range of holistic treatments available.
A patient’s willingness and ability to pursue a positive health outcome – which is often influenced by socio-economic status, health-related beliefs, and level of commitment and desire for lifestyle change – will determine whether they can work with their physician on achieving an early diagnosis, and subsequent strategy for health improvement.
Thus, it is critical for patients presenting RA-type symptoms to be sufficiently educated on the value of regular visits with their physician, follow-up on referrals to rheumatologists, and subsequent commitments to follow-up appointments for diagnostic testing, monitoring and disease management.
The prognosis for rheumatoid arthritis patients over the long-term typically ranges from fair to excellent.
This depends on early diagnosis and treatment, as it is a disease in which sufferers can experience some measure of disability, affecting overall quality of life. Studies have shown that:
- Approximately one-third of working RA patients end up leaving the workforce within 5 years of onset of the disease.
- Mortality rates of RA patients are greater than that of the general population
- The average lifespan of RA patients is shorter than the general population
There are a wide range of factors that will determine the severity of rheumatoid arthritis and its outcomes, including overall prognosis and survival over the long-term.
However, the importance of early, aggressive drug treatment and other disease management techniques, as well as dedicated lifestyle modifications, are most important for the control, containment, and reduction of the severity of the effects of this disease.