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Currently available treatments do not cure the disease, although they do reduce inflammation in the joints, relieve pain, and prevent or slow down joint damage. The goal is to enable the patient to lead an active life free from pain and inflammation.
Non-pharmacological therapy plays an important role in treating rheumatoid arthritis as it helps the patient to feel better and have an improved quality of life. For this reason, the following is recommended:
Regular physical activity. Exercise contributes to improving a person’s general condition. It is important for increasing flexibility and joint function. It should be carried out with the particular needs of each person in mind.
Rest. Joint rest is important, especially at times of joint flare up, but it is advisable to find a balance between rest and activity. The use of orthoses (wrist and knee braces) may be indicated at this point. Good quality sleep is very important.
Physiotherapy. This can help improve fitness, reduce stiffness and increase joint flexibility. It must be personalised to the patient.
Technical aids. If rheumatoid arthritis causes problems with daily tasks, there are devices and tools designed to protect the joints and increase personal independence and autonomy (bottle and jar openers).
Treatment with medication (drugs) is essential for all patients. The initial treatment, before the diagnosis is confirmed, involves non-steroidal anti-inflammatory drugs and low doses of cortisone (glucocorticoids). Once the diagnosis has been confirmed, which is usually within the first three months of the onset of symptoms, it is crucial to begin treatment with disease-modifying antirheumatic drugs (DMARDs), which not only control the pain and swelling, but also prevent structural damage to the joints. The most commonly used DMARD in initial treatments is methotrexate (MTX), taken either orally or subcutaneously. Other DMARDs used are leflunomide, sulfasalazine and, occasionally, hydroxychloroquine.
Targeted therapies. If the patient does not respond to this first line of treatment, targeted therapies should be used. These may be either biological therapies, administered subcutaneously or intravenously, or JAK inhibitor therapies, which are given orally. Biological therapies are aimed at blocking substances related to inflammation or the disease process. There are several types: anti-tumour necrosis factor (anti-TNF) therapies and anti-cytokine therapies (such as IL-6). Other biological therapies target the functions of immune system cells (T or B lymphocytes).
Joint replacements. Occasionally, and after many years of suffering the disease, some patients may require joint replacements (prosthesis), particularly of the hip or knee. The post-surgery results are usually similar to those of the general population who require joint replacements. Depending on the needs of a specific patient, it may be necessary to involve other specialities such as podiatry, physiotherapy, or functional re-adaptation.
A better understanding of the mechanisms involved in rheumatoid arthritis has made it possible to create new therapies (biological or JAK inhibitors). Thanks to this, disease remission is achieved in many patients, or the disease manifests itself less acutely, making it possible for the sufferer to lead a normal life, with no joint deformities. However, there is still a group of patients who do not respond adequately to the several lines of treatment, meaning further research into new molecules is needed.
At present, the onset of rheumatoid arthritis cannot be prevented. However, studies of the disease in early or incomplete stages in people with ACPA or RF antibodies have shown that quitting smoking and certain drugs may delay and even prevent the development of this disease.
Published: 21 January 2021
Updated: 21 January 2021
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