Guidelines for Rheumatoid Arthritis
by Wendy Travis
The treatment protocol for rheumatoid arthritis (RA) was modified in 2008 by the American College of Rheumatology. The new guidelines encompass medications that have been found helpful in not only treating current symptoms of RA, but preventing joint damage and disability by controlling inflammation more effectively. These new guidelines were not meant to restrict doctors in their treatment options for patients, but to provide assistance to physicians with up-to-date information about the most effective medications currently available.
Most of the new rheumatoid arthritis guidelines revolve around a group of medications known as disease-modifying anti-rheumatic drugs or DMARDs. These medications have proven to be quite helpful in limiting joint damage and are often prescribed as early as possible after a diagnosis of rheumatoid arthritis to slow the effects of the disease. One of the most common medications used for rheumatoid arthritis in this category is methotrexate. New guidelines involve combining methotrexate with other medications for best results. The other medications used depend on the stage of the disease and the degree of activity. The guidelines suggest using a combination of methotrexate and leflunomide for most patients, with modifications for those with more active forms of the disease or a poor disease prognosis.
Terms of DMARD Use
The new guidelines take certain factors into consideration with the prescribed use of DMARDs. These include the length of time that the patient has had RA and the severity of symptoms at the present time. They also consider how and when a tuberculosis screening should be done, which is necessary before taking any DMARD. Other factors include potential side effects of the medication, cost and patient preference. Doctors are advised to weigh all of these variables when choosing the best treatment programs for their rheumatoid arthritis patients.
Some of the key recommendations in the guidelines for rheumatoid arthritis include:
A combination of methotrexate and leflunomide for most rheumatoid arthritis patients.
Patients with severe symptoms can be prescribed a combination of methotrexate and an anti-TNF agent. Anti-TNF medications work by reducing pain, stiffness and inflammation in RA patients. They may also help to stop the progression of the disease. Common anti-TNF agents include etanercept and infliximab.
Stopping treatment in patients with an active bacterial infection or other health conditions.
Avoiding anti-TNF medications with patients who have a history of heart failure, multiple sclerosis or lymphoma.
Avoiding DMARDs like methotrexate in patients who are pregnant or trying to become pregnant.
These recommendations were primarily designed for use by rheumatologists, but can be helpful to RA patients as well. However, do not be concerned if your doctor is not following these recommendations to the letter. The guidelines are in place simply to provide assistance to doctors treating this condition. Physicians have the ability to modify procedures based on a patient's medical history and current condition.