Question: What are the best treatments for rheumatoid arthritis?
Dr. Hibberd's answer:
The best treatment for rheumatoid arthritis is unquestionably a comprehensive program that involves a DMARD (disease-modifying anti-rheumatic drug) in combination with lifestyle modifications and medical, emotional, and social support.
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Pediatric arthritis differs from adult disease, and treatment depends upon the stage and symptoms. Adults should be managed aggressively to eliminate joint damage and to minimize the need for replacement or corrective surgery later. Mild RA responds well to aggressive treatment using DMARD agents such as methotrexate, usually combined with an anti-inflammatory. Advancing or aggressive disease needs an immediate treatment with immunosuppressive drugs for best results.
Drugs known as tumor necrosis factor inhibitors (such as Enbrel and Humira) have shown superb results and improved conditions for many. There is less long-term use of steroids (cortisone) today than 10-15 years ago. Plaquenil and sulphasalazine are useful for some.
Other options include: T-cell costimulation blockers such as abatacept (Orencia); and B cell depleting agents (Rituximab or Rituxan). Interleukin receptor antagonists (such Kineret, Imuran, and cyclosporine) are no longer used as often as years ago.
Selection of the appropriate DMARD for you should be done in conjunction with your rheumatologist. If you have not seen your specialist lately, I strongly advise you do, as treatment today is much more aggressive and effective than the older preparations used before the advent of the newer popular T-cell blockers. Physical therapy with heat, cold applications, and occupational treatment are also important, as well as stress management.
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