HEALTHNET

What is Rheumatoid Arthritis?

Rheumatoid Arthritis is an autoimmune disorder, affecting around 1% population in the world. It is more commonly found in women.

(Posted on 4 October 2007)

What is Rheumatoid Arthritis (RA)?

Rheumatoid Arthritis is an autoimmune disorder, affecting around 1% population in the world. It is more commonly found in women. Patients would have their joints attacked by their own immune system, leading to chronic inflammation of the synovial tissue within the joints. Subsequent tissue proliferation usually invades surrounding cartilage and bone, which results in joint destruction and deformity as the disease progresses. Patients usually complain of swelling, pain and stiffness of involved joints. Symmetrical involvement of small joints of hands and wrists is a typical sign of RA. Extra-articular manifestations of the disease could sometimes be found in other organs, e.g. eyes and blood vessels.

What are the treatment options for RA?

Diagnosis is usually based on clinical signs and symptoms, while X-ray examination and blood test can also be used to diagnose RA. Various treatment options are currently available for RA patients and choices are usually made according to the severity of the disease. Drug treatments are generally preferred in patients with mild to moderate disease involvement, but surgery is usually the choice in more severe cases. Physiotherapy can also be considered to preserve mobility in RA patients.

As researchers are currently unable to rule out any causes of the disease (although its correlation with genetic predisposition has been reported), complete elimination of it is not yet possible. Drug treatment is usually directed towards symptomatic relieve of symptoms, preservation of joint function and prevention of disease progression.

Which medications are used by RA patients?

1. Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs can suppress inflammatory processes and provide fast relieve of pain, therefore they are the drugs of choice for symptom control. The class of drugs, however, cannot retard disease progression by its own, which explains why it is usually used in combination with DMARDs for disease control. These drugs should be taken after food or with antacids, as they can induce gastrointestinal disturbance and gastric ulcer in some patients. Patients with asthma or renal impairment should seek medical consultation prior to their initiation of NSAID therapy. Diclofenac, Ibuprofen and Aspirin are the more commonly used examples of the group.

2. Disease modifying anti-rheumatic drugs (DMARDs)

These include various immunosuppressive agents which can slow down disease progression. In order to preserve mobility in RA patients, DMARD treatment are usually initiated early in the disease. It takes around 1 to 6 months for the onset of their immunosuppressive action, long term treatment is thus warranted to reduce joint destruction. Since the class of drugs can bring a wide variety of side effects, patients taking DMARDs should be under close medical supervision with regular organ examination. Methotrexate and sulphasalazine are examples of the group.

3. Glucocorticoids (Steroids)

Steroids have strong anti-inflammatory properties and they are employed in many inflammatory disorders. In the case of rheumatoid arthritis, steroids can be directly injected into affected joints or, in more severe cases, taken orally to control inflammation over the whole body. As the long-term use of steroids is associated with a number of side effects, the dose and duration of steroid treatment should be minimized when the control of inflammation is adequate. Long term use of high-dose steroids can lead to development of glaucoma, osteoporosis and diabetes.

The mechanism of action, duration of onset and side-effect profile of one drug differs significantly from another. As beneficial effects could only be achieved when these medications are used according to individual needs, medical advice should be strictly followed by patients with rheumatoid arthritis.

Source: Hong Kong and Drug Education Resources Centre, The Society of Hospital Pharmacists of Hong Kong