* The term “inflammatory arthritis” signifies joint inflammation and should not be confused with joint pain for reasons other than inflammation, such as in osteoarthritis.
In days gone by, inflammatory arthritis was considered by the medical world to be a single disease, against which “little could be done”. The advice was to take colchicine, or willow bark and its derivatives, and cross your fingers. Despite being a serious illness, it is still a condition which is little understood by the general public, and it is often confused with other rheumatic conditions.
Rheumatoid arthritis (RA) is a chronic rheumatic condition which characteristically affects the peripheral joints (hands, feet, wrists, shoulders, elbows, hips and knees). It causes pain and swelling, secondary to inflammation of the synovial membrane, and stiffness, especially in the morning or after prolonged periods of rest.
As well as damaging joints and the surrounding soft tissue (tendons and muscles), which can cause decreased mobility and joint function, chronic inflammation can affect other organs such as the heart, lung or kidney. It is for this reason that rheumatoid arthritis is considered a systemic (generalised) disease. Additionally, if there is continuous, significant inflammation, it can lead to a high temperature, tiredness, asthenia, weight loss and loss of appetite.
A diagnosis of rheumatoid arthritis is based on the doctor’s opinion and clinical criteria, as there is still no established test which will determine with certainty that a person is suffering from the condition. It is important to manage attacks and keep the condition under control to prevent possible complications. Currently, thanks to prompt diagnosis and newly available treatments, the majority of patients manage to keep the disease controlled from a very early stage and therefore maintain their quality of life.
According to the EPISER study on the prevalence and impact of rheumatic diseases, performed by the Spanish Society of Rheumatology (Sociedad Española de Reumatología – SER), it is estimated that in Spain, more than 200,000 people suffer from rheumatoid arthritis and that around 20,000 new cases are diagnosed every year. This is significant considering rheumatoid arthritis is the most debilitating of the rheumatic diseases.
There is no cure for rheumatoid arthritis. However, in light of recent discoveries, it is more likely that remission from symptoms will occur when treatment is started early and includes strong medication known as “disease-modifying antirheumatic drugs (DMARDs)”.
Until recently, treatments for rheumatic arthritis were only targeted at relieving pain and alleviating symptoms of the disease, however, the existence of innovative and highly effective treatments have meant that it is now possible to talk about controlling the disease. In fact, remission or complete lack of any sign or symptom of the disease has become a realistic treatment goal, especially since the development of new targeted biological therapies to combat the cause of the disease.
The current therapeutic arsenal for the treatment of Rheumatoid Arthritis has only been developed in recent years, particularly during the last decade. Traditionally, they have tended to be divided into two large treatment groups: Anti-inflammatory and Analgesic drugs, and DMARDs.
● Anti-inflammatory and Analgesic Drugs.
Included in this group are drugs targeted at alleviating pain and inflammation in the short term. Amongst them are NSAIDs (non-steroidal anti-inflammatory drugs) and Glucocorticoids, both groups are useful for reducing inflammation and daily pain relief, but they do not contribute to modification of disease progression in the long term.
● DMARDs.
DMARDs are Disease Modifying Drugs. Treatment with this group of drugs does not only improve symptoms but can also stop the clinical progression of Rheumatoid Arthritis, reducing disease activity long term. The most common drug in this category is methotrexate (MTX).
Biological therapies are a leap forward in the clinical management of Rheumatoid Arthritis. They are drugs produced from cells which act on the immune system, limiting inflammation and therefore reducing signs and symptoms and delaying disease progression.
Frequently, biological therapies are prescribed in combination with other disease-modifying antirheumatic drugs (DMARDs). Currently one or other of the biological treatments is prescribed, depending on the clinical features of the ill person.
How are biological and biosimilar medications given?
These drugs cannot be taken orally. Depending on the drug, they are given as a subcutaneous, or even intravenous (directly into the vein) injection. In the case of subcutaneous administration, the patient is usually given the medication at home, whilst intravenous treatment requires the patient to spend a few hours in hospital for it to be administered.
Prompt diagnosis and treatment with DMARDs are important to halt progression of the disease and prevent joint deformities.
* Come and see us about your case. Rheumatoid arthritis can be controlled and managed if you see the rheumatologist at the time of the initial symptoms. The rheumatologist will decide on the prescribed treatment on an individual basis, to ensure you can continue with a full and satisfying life.
Sources: Fundación Española de Reumatología / Conartritis.org- asociación de pacientes / Mayo Clinic / Roche pacientes
March 20, 2019
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