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Drug regimens for rheumatoid arthritis

By Sue Parkinson and Andrew Alldred

The goals of rheumatoid arthritis (RA) management are to relieve pain and inflammation, prevent joint destruction, preserve or improve functional ability, and maintain a patient’s normal lifestyle.

A multidisciplinary approach to treating RA patients is important. Physiotherapists, occupational therapists, clinical nurse specialists, podiatrists, social workers and pharmacists all have a crucial role. Education of patients is an important aspect of treatment because patients should have knowledge of the disease process and prognosis, as well as treatment strategies, in order to improve compliance.

There has been a major shift in the treatment of RA over the past decade. Traditionally, the therapeutic pyramid was employed, whereby initial treatment was conservative, using non-steroidal anti-inflammatory drugs (NSAIDs) for several years and only progressing to disease-modifying antirheumatic drugs (DMARDs) when the disease was not controlled. This approach has been replaced by early treatment with DMARDs, because there is evidence that most patients develop joint destruction within the first two years of their disease.1 The classes of drugs used in RA treatment are discussed below.

Analgesics

Paracetamol, paracetamol combinations and dihydrocodeine are all useful for simple pain relief. Although they have no anti-inflammatory properties, and do not affect the disease process, they do have a place in both the early and late stages of the disease. They may help with referred pain associated with muscle weakness and the general soreness associated with RA.

NSAIDs

The major pharmacological agents for the relief of pain and inflammation in rheumatic diseases are NSAIDs. Although NSAIDs come in a variety of chemical structures, they all have similar pharmacological properties, that is, antipyretic, anti-inflammatory and analgesic actions.

Patient response to NSAIDs is highly variable, and therapeutic trials with several NSAIDs may be necessary to determine the best agent. It is estimated that 60 per cent of patients will respond to any one NSAID. Despite numerous clinical trials, differences between NSAIDs, using objective measurements of efficacy, have not yet emerged. It is recommended that the drug should be changed after one week if there has been no response and an analgesic effect is the desired outcome, or after three weeks if an anti-inflammatory effect is desired. Approximately 10 per cent of patients will not find any NSAID beneficial.

Download the attached PDF to read the full article.

Citation: Hospital Pharmacist URI: 10975287

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