Rheumatoid arthritis is a painful and chronic condition and has to be treated and managed.

Rheumatoid arthritis is an auto-immune disorder, often systemic in nature. The body attacks itself and causes lots of problems, including pain, stiffness, swelling in the joints and even fever. It often a debilitating disease and since nobody knows why it occurs, there is no single line of treatment for it, particularly since it attacks different people in various ways. In fact rheumatic arthritis is an umbrella terms for many joint disorders.

Once you have a diagnosis of rheumatoid arthritis then you have to learn how to manage the disease with the help of the doctor, medicines and other remedies including massage, physiotherapy and perhaps even alternative remedies. There are new medicines which keep on getting released and you have to keep yourself abreast of new treatments.

The first line of treatment

If diagnosed early enough, as the first symptoms are pain and stiffness, these are treated with NSAIDs (non-steroid anti-inflammatory drugs). Among the drugs which are commonly prescribed are

* Aspirin
* Ibuprofen
* Naproxen
* Etdolac
* Cox2 inhibitors like Celebrex

Unfortunately when taken in high doses and over long periods of time, these can have side effects like digestive problems, stomach ulcers or bleeding because they irritate the digestive tract. So they are often prescribed with acid reducing or neutralizing medicines like zinetac or proton pump inhibitors like pantoprazole, omeprazole and other such medicines.

The second line of treatment

When there is a severe flare-up or the disease is not responding to NSAIDs, then the doctor prescribed corticosteroid drugs taken orally or injected into the affected areas. These are usually given for short periods of time as they irritate the digestive tract even more. If taken for long, they have serious side effects like weight gain, puffiness, cataracts, easy bruising, thinning bones, muscle wasting and even destruction of joints.
Oral drugs should ideally be tapered off and not stopped abruptly, though some of the newer ones can be stopped.

The third line of treatment

These are DMARDs or disease modifying anti-rheumatic drugs. Unlike the earlier ones, they take time to act and will not give immediately relief from pain, but they do stop the damaging effects of RA. DMARDs can help arrest the progress of the disease and, if successful in combinations, they can even afford remission. These are strong drugs and the person taking them must be monitored as they can have serious side effects. The dugs include

* Sulfasalazine (Azulfidine) - decreases inflammation
* Leflunomide (Arava) - interferes with immune system cells and reduces inflammation
* Gold salts (aurothiomalate, auranofin [Ridaura]) - these are medicines conaitning gold and help reduce inflammation.
* D-penicillamine - helps reduce various toxic agents from the body.
* Hydroxychloroquine (Plaquenil): Reduces immune response which results in RA. Can lead to eye problems.
* Azathioprine (Imuran) - stops cells from being formed which are associated with the immune response causing RA.
* Cyclosporine (Neoral) - Originally developed for use in people undergoing organ transplantation or bone marrow transplantation, this strong medicine suppresses the immune response.
* Methotrexate (Rheumatrex, Folex PFS) - reduces inflammation and inflammation caused problems.

These drugs should only be taken under doctor's supervision and according to prescription. Patients taking these drugs need to be monitored with blood tests to show that they are not suffering from long term adverse effects which may be caused by the drugs.

The fourth line of treatment

These are the newer Biologics. They include abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), etanercept (Enbrel), infliximab (Remicade) and rituximab (Rituxan). Some, called anti-TNF agents or TNF inhibitors, work by helping bind the tumor necrosis factor (TNF). Others work in different ways.

The last line of treatment

This is surgery. Some kinds of RA may be helped by various surgeries, but this has to be decided by a phalanx of doctors in consultation with the patient, because surgery is the last option. All patients of RA are not candidates for surgery and all surgery is not effective.