Definition
Rheumatoid arthritis is a chronic and debilitating inflammatory process, the cause of which seems to go back to an alteration of the immune system; rheumatoid arthritis patients complain of joint pain, heat and stiffness. In most cases, the disease degenerates in a symmetrical manner, which means that it affects the same joint tissues, tendons and muscles on both sides of the body.
Causes
The precise cause implicated in the manifestation of rheumatoid arthritis is unknown even if, in all probability, the disease is closely related to an alteration of the immune system. It is noted that rheumatoid arthritis occurs to a greater extent among women, especially those between the ages of 40 and 60; however, even young people can be affected.
Symptoms
Rheumatoid arthritis is responsible for pain, heat and stiffness in the joints which, over time, tend to deform and become damaged. When the tissue covering the joint becomes thicker, rheumatoid arthritis also involves ligaments, cartilage and bones. Other symptoms include: general fatigue, depression, difficulty in falling asleep, weight loss, low-grade fever, progressive loss of mobility.
Information on Arthritis - Medicines for the Treatment of Rheumatoid Arthritis is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Arthritis - Rheumatoid Arthritis Treatment Medicines.
drugs
To date, unfortunately, there is no universally recognized pharmacological cure as effective for treating rheumatoid arthritis; nevertheless, drugs and some non-pharmacological therapeutic strategies (physiotherapy) can control the symptoms and relieve pain. In more serious cases, surgery may be the last therapeutic option, in a desperate attempt to correct joint damage; some patients with severe rheumatoid arthritis require joint replacement.
The cardinal goal of rheumatoid arthritis is not represented simply by the control of symptoms, but also and above all by the reduction of pathological progression, in order to avoid damage to the joints.
Generally, as long as the disease is not established but only presumed, the affected patient can take NSAIDs or corticosteroids, which are useful for controlling pain; if the diagnosis is confirmed, the patient can take specific (antirheumatic) drugs, able to intervene directly in the pathogenetic mechanisms of rheumatoid arthritis.
NSAIDs : even if they are able to mask pain and burn, long-term administration of NSAIDs can cause more or less serious side effects, such as stomach pain, nephropathy, ulcers, traces of blood in the stool, hypersensitivity reactions.
- Acetylsalicylic acid (eg. Aspirin, Vivin, Ac Acet, Carin): in general, the posology required to treat rheumatoid arthritis is 3 grams per day, divided into several doses. The dosage can possibly be changed by the doctor.
- Ibuprofen (eg. Brufen, Moment, Subitene): start therapy for rheumatoid arthritis by taking 400-800 mg of drug per day, every 6-8 hours. The maintenance dose can be increased up to a maximum of 3200 mg / day.
- Naproxen (eg. Aleve, Naprosyn, Prexan, Naprius): indicatively, for the control of pain in the context of rheumatoid arthritis, take 250-500 mg of naproxen or 275-550 mg of oral naproxen sodium, twice a day . For the maintenance dose, it is possible to increase the dosage up to 1500 mg of naproxen or 1650 mg of naproxen sodium, fractionated in two doses, for a period of six months.
- Diclofenac (eg. Fastum Painkiller, Dicloreum): in the form of tablets, take 50 mg of drug, 3-4 times a day or 75 mg, orally, twice a day. For slow-release tablets, take 100 mg orally. A dose greater than 225 mg per day is not recommended for the treatment of rheumatoid arthritis.
- Celecoxib (eg Aleve, Naprosyn, Onsenal, Prexan, Naprius): newer NSAID. While offering the same beneficial therapeutic effects as the NSAIDs described above, this active substance seems to avoid the risk of ulcers. Take a dose of 100-200 mg per day, orally.
Corticosteroids : long-term administration of corticosteroids to treat pain associated with rheumatoid arthritis can create thinning of bones, bruising, weight gain, cataracts, diabetes, hypertension, swelling of the face. Do not suddenly stop the treatment with corticosteroids. Consult your doctor.
- Prednisone (eg. Solprene, Deltamidrina): indicatively, take 5-60 mg per day of active ingredient, fractionated in 1-4 daily doses. It has been observed that administering 7.5 mg of drug per day can slow down the rate of joint damage that accompanies rheumatoid arthritis. Prolong therapy for 2-4 years; in addition to this period, it is recommended to reduce the dosage to avoid long-term side effects.
- Dexamethasone (eg. Soldesam, Decadron): the dose should be established by the doctor after accurate diagnosis of the patient.
Opioid analgesics : indicated for moderate to severe treatment and resistant to other painkillers. Consult your doctor.
- Hydrocodone (eg Vicodin, not sales in Italy): often formulated in association with NSAIDs (eg Ibuprofen), it is recommended to take 1 tablet every 4-6 hours, as needed. Consult your doctor.
Anti-arthritis and immunomodulators : they block the degeneration of the disease, through a stimulation of the immune system.
- Penicillamine (eg Sufortan): start therapy with a single dose of 125-250 mg of drug per day, increasing the dosage, at 1-3 month intervals, of 125-250 mg per day. The maintenance dose must be personalized and can be modulated during therapy. Many patients with rheumatoid arthritis benefit with a dose of 500-750 mg per day.
- Hydroxychloroquine (eg Plaquenil): the antimalarial drug is indicated for the treatment of mild rheumatoid arthritis, especially in the early stages, as well as being widely used in therapy for the treatment of systemic lupus erythematosus. Start the treatment with 400-600 mg of active, to be taken orally once a day. The maintenance dose is expected to take 200-400 mg of the drug once a day.
- Chloroquine (eg Chloroquine, Cloroc FOS FN): also chloroquine, like the previous drug, is used in the treatment of inflammation in the context of moderate rheumatoid arthritis (even if used less frequently because it is tolerated less), and in the treatment of lupus erythematosus. For the dosage, consult your doctor.
- Methotrexate (eg. Reumaflex, Methotrexate HSP, Securact): the drug is an antagonist of folic acid synthesis, able to heavily influence the body's immune response. In this regard, it is widely used in the treatment of rheumatoid arthritis. The active ingredient is widely used for this purpose because it is well tolerated. Orally, take 7.5 mg of active per week; gradually increase the dosage up to 15 mg, to be taken once a week. For the severe and acute form of rheumatoid arthritis, take 7.5 mg of active per week, subcutaneously, intramuscularly or intravenously.
- Sulfasalazine (eg Salazopyrin): an anti-inflammatory-immunomodulatory drug widely used in therapy for the treatment of rheumatoid arthritis, as it is well tolerated. It is recommended to take the drug orally, in the form of gastro-resistant tablets: initially, take 500 mg of the drug, twice a day; subsequently increase the dosage of 500 mg per week. Do not exceed 2-3 grams of medication per day.
- Leflunomide (eg. Leflunomide medac, Arava, Leflunomide Teva, Leflunomide Winthrop, Repso): it is an immunomodulatory drug very used in therapy for the treatment of rheumatoid arthritis. Indicatively, take 100 mg of drug, once a day, for 3 days. Next, take 10-20 mg of active per day.
- Azathioprine (eg Azathioprine, Immunoprin, Azafor): the drug belongs to the class of immunomodulators; it is recommended to start therapy with an active dose of 1 mg / kg, orally or intravenously, administered in 1-2 doses. The dosage may be increased by 0.5 mg / kg per day, up to a maximum of 2.5 mg / kg per day. The maintenance dose should be reduced to avoid side effects and to reduce the risk of toxicity.
Biological drugs : they are drugs that inhibit the tumor necrosis factor alpha; their use is reserved exclusively for patients with active rheumatoid arthritis, where the use of classic antirheumatic drugs has not reported any benefit after 2 years of treatment. If treatment with biological drugs does not improve after 6 months, it is advisable to change the type of active ingredient.
- Adalimumab (eg Humira): it is recommended to inject a dose of 40 mg once every other week subcutaneously. Indicated for the treatment of severe rheumatoid arthritis. Some patients are advised to combine methotrexate with this drug, increasing the dose by 40 mg every other week.
- Infliximab (eg Remicade): Initiate therapy by taking 3mg / kg of drug intravenously, at the first, second and sixth week; follow with a 3 mg / kg maintenance regimen every 8 weeks. The dose can be increased up to 10 mg / kg. Often the drug is given in combination with methotrexate. The drug is indicated to treat moderate and severe rheumatoid arthritis.
