Management of Rheumatoid diseases
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
- 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.
- 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