Arthritis - Medical Management (Reubban)

ARTHRITIS – MEDICAL MANAGEMENT
No known cure for RA, but many different types of treatment can reduce symptoms , treat pain or modify disease process.
RA can be managed pharmacologically through several drug types. These drugs are prescribed depending on initial disease presentation.
- Patients presenting with previously undiagnosed possible RA require symptomatic treatment with NSAID treatment and should be rapidly referred for definitive diagnosis and the introduction of DMARD (disease-modifying anti-rheumatic drugs) therapy (to reduce damage to joints and bones). Delay of as little as 2-3 months in DMARD initiation can lead to irreversible joint damage.
- In patients with known disease, rheumatoid flare can occur. Symptoms are increased pain, edema and loss of function. Treatment consists of NSAIDs, DMARDs, short steroid courses and possible intraarticular steroid injections. Narcotic analgesics may be used for pain relief.
- Patients can present with Felty syndrome, a triad of RA, neutropenia (a lack of white cells) and splenomegaly (enlargement of the spleen caused by hyperfunction). Patients are prone to bacterial infection, and thus require prompt diagnosis and antibiotics.
- Keratoconjunctivitis sicca occurs in ¼ patients with RA. Symptoms are ocular discharge, dry eye, and foreign body sensation. Treatment includes artificial tears, NSAIDs (local and systemic), systemic steroids and cyclophosphamide (a prodrug used to treat auto-immune diseases).