Rheumatoid Arthritis is a chronic autoimmune and inflammatory disorder that can affect multiple joints, causing pain, stiffness and swelling and eventually cause damage and deformity. The goals of treatment are to reduce symptoms, slow progress of the disease and preserve joint health and integrity.
Traditional management involves initiating therapy with disease modifying antirheumatic drugs (DMARDS) such as plaquenil, methotrexate, and sulfasalazine. As a result of increasing medical knowledge of how rheumatoid arthritis progresses, several biologics have been developed over the past decade to treat it. Biologics are synthetic proteins that have been genetically engineered. They are designed to inhibit key components of the immune system that are involved in causing inflammation. All approved biologic agents—which work best in early stages of the disease—have been shown to slow or prevent disease progression and joint damage. These agents are often added to the traditional DMARDS prescriptions.
Approved biologics include the TNF (tumor necrosis factor) inhibitors such as Enbrel, Humira, Cimzia, and Remicade; interleukin-6 inhibitors, such as Actmera; B-cell targeted therapies, such as Rituxan; and T-cell targeted therapies, such as Orencia. They are administered either through subcutaneous injection or intravenous infusion.
Prior to initiating any biologic, it is necessary to establish and record disease activity, screen for other health conditions, establish the patient’s vaccination record (certain vaccines cannot be administrated while on these agents), and order a complete set of blood work, which includes screening for tuberculosis and hepatitis B and C. Possible side effects of biologics include infections, malignancy, and injection-site or infusion reactions. Therefore, close monitoring and regular follow up care with your rheumatologist is important.
The Patient’s Part
In addition to medication, patient education, rest, exercise, and physical and/or occupational therapy provide added benefit and improvement to the quality of life. Patients with RA should:
- Perform stretching and range of motion exercises for at least 10 minutes every day.
- Engage in aquatic therapy a few times a week to improve range of motion and get therapeutic relief.
- Modify activities and, if possible, the physical environment to reduce stress on joints, conserve energy and reduce inflammation.
- Flex and move the joints to minimize fixed positioning, which can limit range of motion.
- Maintain proper posture to reduce stress on the joints.
Dr. Farah M. Ashraf, is board certified in Rheumatology, earned her medical degree from the University of New England, College of Osteopathic Medicine in Biddeford, Maine and completed a Rheumatology fellowship at Winthrop University Hospital in Mineola, NY.
To make an appointment with Dr. Ashraf please call #845.454.9500