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Management of Rheumatoid diseases

The Management of Rheumatoid diseases comprises of the following aspects:
  • Early diagnosis -

    only an early and accurate diagnosis will prevent joint damage and disability
  • Aggressive approach -

    early and aggressive treatment is aimed at for good salvage
  • Joint protection -

    joints have to be protected against damage when they are inflamed
  • Pain relief -

    physiotherapy, pain-killers and anti- inflammatory drugs
  • Disease modification -

    disease modifying drugs are essential for treatment
  • Regular follow-up -

    to monitor and modify the results and adverse effects of the treatment
  • Damage repair -

    repair of damaged joints by various methods
  • Counter Disability -

    help overcome the disabilities caused by the joint damage
  • Family Counseling -

    family should be educated about the needs of the patient
  • Patient support -

    Physically & Psychosocially help the patient to cope with the disease

Role of Exercise in Rheumatoid Arthritis

  • Exercise is very important in RA. The advantages are
    • Proper exercise relieves pain
    • Increase blood supply to the joints
    • Increases bone mineralization and strength
    • Improve joint function, and decreases stiffness
  • Rules of Exercise
    • Rest is advocate when the joints are hot & inflamed
    • Exercise should be carried out under proper advice & guidance

Medication in Rheumatoid Arthritis

Pain killers & Antiinflammatory Drugs

  • They have potentially serious side affects like Gastrointestinal Ulcers and Kidney Damage.
  • They should not be used indiscriminately & ‘Over the Counter' use should be avoided.
  • They are prescribed for pain relief and to decrease the inflammation.
  • They improve the quality of life.


  • They are strong Anti-inflammatory agents, and they also decrease pain.
  • They have major Gastro-intestinal side effects and also cause bone degeneration.
  • They are known as the double-edged sword of Rheumatology and should be used only under Medical Guidance.
  • They give excellent symptomatic relief but do not stop the disease process.
  • They have a rebound phenomenon when stopped & should be slowly tapered off.
  • If used locally in the form of injections the side affects are minimized.

DMARDs: Disease Modifying Anti-rheumatoid Drugs

  • They should not be stopped without proper medical advice as the sub-clinical levels exist for years and they have potential adverse effects.
  • They are essential in the treatment of
    Rheumatoid Arthritis.
  • They are potentially toxic which can be prevented and treated by proper follow-up and management.
  • They cannot be removed by Dialysis – specific washout procedure is followed.
  • They take time to start their effect.
  • They should not be taken by pregnant ladies, or breast-feeding mothers.


  • They are Humanized monoclonal antibodies or receptor antagonists.
  • They are targeted against specific cytokines or cell surface molecules like Tumor necrosis factor alpha (TNF-α), Interleukin (IL-1), T-cell surface molecules CD52w (CAMPATH), CD4, CTLA4 & B-cell surface molecule CD20.
  • The high cost and possible long-term toxicity of these therapies necessitate targeting to appropriate patients. In the first instance eligible patients are logically those with disease resistant to therapy with conventional drugs.
  • In addition, patients must have active disease capable of response as demonstrated by a modified DAS28 of greater than 5.1.

Food supplements

  • Calcium, Vitamins, Joint regenerators, Anti-oxidants, and other substances are given to facilitate treatment and prevent damages.

Why should i take treatment and is it expensive? -

Treatment is a must since Rheumatoid arthritis is a Progressive Degenerative Disease that causes:
  • Deformity -

    in the form of disfigured destructed joints
  • Death -

    if not treated it shortens life spans for about 10-15 years
  • Discomfort -

    in the form of pain
  • Disability -

    in the incapacitation to do work
The cost of treatment is very low if weighed against the advantages of treatment. The disease causes major economic loss because of loss of productivity of the disabled person. Further the loss due to dependency on others and useful man-hour lost in caring for the disabled should also be considered. There is a definite loss due to disease anxiety leading to family tensions and low productivity.