What To Expect From Rheumatoid Arthritis Treatment

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Rheumatoid arthritis is an autoimmune disease in which T cells attack healthy tissues in the body. This causes pain, inflammation and damage to the affected areas, which most frequently occurs in the knees, elbows, and joints in the hands and feet. If left unchecked, rheumatoid arthritis can lead to loss of joint function, increased pain and even deformation. The goals of rheumatoid arthritis treatment has always been, and remains, counteracting disease activity and achieving remission—the absence of signs and symptoms of inflammation. In the past, the best way of doing this has been left to individual doctors’ own discretion. But recently, a new method of treating rheumatoid arthritis has emerged that substantially improves the chances of achieving, and improves progress toward, these goals.

Treatment Goals and Evaluation

The overriding purpose of rheumatoid arthritis treatment programs is to stop inflammation in affected areas, ease the symptoms of the disease, prevent damage to joint tissue, improve the patient’s physical capabilities and general health and to mitigate any long-term complications from the disease. This is achieved through a variety of medications that quell inflammation, ease pain, and act on the autoimmune system to halt its attacks on healthy tissue. The results of these courses of treatment are measured according to the ACR Response Criteria. This scale was established by the American College of Rheumatology as an evaluative standard for the effectiveness of treatments and medications. Scores on this scale are notated as a percentage of improvement, determined by comparing two points in time. For example, a 20% improvement is ACR20. This is less desirable than ACR50 or ACR70, which indicate 50% and 70% improvement in conditions, respectively.

Treatment Methods

The traditional approach to treating rheumatoid arthritis is called routine care. Under a course of routine care, a physician will monitor their patient’s condition and adjust the treatment according to his or her own clinical opinion. An ACR between 50 and 70 is considered a successful result for this traditional treatment routine. Recently, another approach has come to the forefront, called treat to target. This method uses more frequent testing and more aggressive approaches to stop inflammation and tissue damage as quickly as possible, preserve joint function, lower disease activity and even achieve remission. The target-to-treat process involves the doctor setting a goal and monitoring a patient’s progress toward that goal. If enough progress is not seen, the patient’s medication and dosage will be adjusted according to a pre-set treatment protocol. This approach has proven extremely effective, particularly in early cases of rheumatoid arthritis, and has achieved sustained results in patient health.

Living the DREAM

In recent years, the Dutch Rheumatoid Arthritis Monitoring (DREAM) program has conducted the largest study to date of the target-to-treat method. Through this approach, doctors and patients managed to achieve low disease activity, high remission rates, limited radiographic damage (tissue damage incurred through diagnostic imaging), improved physical function and subsequently improved quality of life for patients. Moreover, nearly half of the patients studied were able to sustain their results over the course of three years, primarily using conventional anti-rheumatic drugs.

Effectiveness on Longstanding Rheumatoid Arthritis

DREAM was primarily interested in early rheumatoid arthritis cases, focusing on patients who had been diagnosed within the last year. Indeed, target to treat is most effective when it is begun within the first year after the onset of rheumatoid arthritis. However, a Canadian study also found that target to treat is also extremely effective in patients suffering from longstanding rheumatoid arthritis. As with early cases, doctors using the target-to-treat approach made more adjustments in their patients’ courses of treatment, which in turn led to improved conditions, lowered disease activity, and progress toward remission.

Drugs Used in Treatment

There are many different medications used in the treatment of rheumatoid arthritis. The most common are nonsteroidal anti-inflammatory drugs (NSAIDs), which are available over the counter and in prescription strength. Taken orally or applied as a patch or topical cream, NSAIDs reduce swelling and inflammation at the affected site. Another common treatment is corticosteroids. These quickly ease inflammation while in the interim before disease-modifying antirheumatic drugs (DMARDs) and NSAIDs to begin working. DMARDs modify the course taken by the disease; these can be taken orally or through topical application to affected areas. Another option is biologics, which act on certain points in the inflammation process without affecting the rest of the immune system. They can be taken orally or by injection. Biologics lowering the chance of dangerous infection and illness, and are often effective when other medications are not. Whether you’ve recently been diagnosed with rheumatoid arthritis or if you’ve been living with the disease for years, you’re likely to encounter the target-to-treat method in the near future if you haven’t already. Under this more proactive, aggressive method of treatment, traditional medications and frequent testing makes lowered disease activity and even remission more realistic and achievable goals.