Is Rheumatoid Arthritis Treatable? What Are The Treatment Options?
In this article, we explore if RA is treatable, the various treatment options for RA, drugs prescribed for this condition and much more.
RA is now very much treatable and with timely treatment most of the patients can lead a normal life
A chronic autoimmune disease, rheumatoid arthritis (RA) is a condition which affects roughly around 1 crore Indians, mainly females as quoted by Dr Mahendranath, Former President of the Indian Rheumatology Association. It is a condition characterised by pain and swelling in joints. RA usually begins with affecting hands and feet, and then progresses to other joints and organs. A person with RA will experience symptoms like stiffness of joints in the morning, along with fatigue and weakness.
Through a series of articles, we are making an attempt to raise awareness about rheumatoid arthritis. We have previously discussed some important concerns about RA, like who's at risk of rheumatoid arthritis, signs and symptoms of RA to watch out for, RA in women, Prevalence and survival rate of people with RA and how to diagnose RA at an early stage.
In this article, we explore if RA is treatable, the various treatment options for RA, drugs prescribed for this condition and much more. Following are excerpts from conversation with Dr Padmanabha Shenoy from Kochi:
Is RA treatable?
RA is quite common in our country. Around 20 years ago, there were not many treatment options available for RA. Only steroids and painkillers were available and this was primarily symptomatic treatment. With such treatment, quality of life of patients was quite poor.
However, the situation has improved since then, thanks to the scientific research and development in this field. RA is now very much treatable and with timely treatment most of the patients can lead a normal life. Research has shown that by the end of 10 years, 75 to 80% people with RA can live a normal life and continue with their jobs and responsibilities
If left untreated, how worse can RA get?
It has to be understood that RA is an autoimmune disease. It is a condition where the immune system attack the joints. The joints first get swollen and then cause restriction of movements due to pain and eventually damages the joints. Untreated RA can lead to joint deformities and makes a person unable to perform day-to-day activities.
In later stages immune system can attack organs other than joints like heart , lung and eye, leading on to even death .
Can lifestyle modifications help in improving the condition?
It is important to note that lifestyle has no major role in the treatment of RA. It is an autoimmune disease and environment has only a minor role to play in the causation of RA. Having said that, a healthy lifestyle, regular exercise and quitting smoking are some lifestyle changes that can reduce the severity of RA symptoms.
When it comes to treatment of RA, a patient's family also plays an important role. Patient's family has to understand the pain that she /he is going through, and give proper help and assistance. Family help can enable RA patients to have great outcomes in the long run.
These are the latest kinds of drugs which have been made for RA, and have been available in Indian markets for around 5 years. Unlike conventional DMARDs, targeted DMARDs show very fast results in RA treatment. Pain relief response occurs as early as 3-5 days."
Dr. Padamanabha ShenoyMedical Director, Centre For Arthritis and Rheumatism (CARE), Cochin
What are the treatment options available for RA?
According to Dr Shenoy, there are two big issues regarding RA treatment in India:
1. Diagnosis: Most people suffering from RA opt for alternative systems of medicine, or just take painkillers. Average diagnosis of a person suffering from RA is done after four to five years of experiencing symptoms. By this time, a lot of damage occurs in the joints. Hence timely diagnosis is extremely important for RA treatment.
2. Treatment: Outcomes of RA are best when it is treated by a rheumatologist and not a physician, orthopaedic surgeon or any other specialist. But, the problem is that there are not enough rheumatologists available in the country. There are very few rheumatologists in India, that is around 1000 doctors to treat around a crore RA patients.
Drugs prescribed for RA treatment
There are three classes of drugs for RA:
1. Conventional Synthetic Disease-modifying antirheumatic drugs (csDMARDs): These drugs prevent joint deformation and other organ damage caused by RA. These drugs have been available for more than 20 years in the country and are effective for 80% RA patients. These drugs help in controlling RA symptoms effectively. Along with conventional DMARDs, RA patients are also prescribed low dose steroids. These steroids are used as bridge therapy. Conventional DMARDs take around two to three months (sometimes even six months) to show results. Low dose steroids help in bridging this gap by offering relief from pain and joint stiffness to RA patient. Conventional DMARDs and steroids are prescribed in combinations. These drugs need to be initiated as early as possible after making the diagnosis of RA.
2. Biological DMARDs (bDMARDS): These target the cytokines, which are molecules secreted by the autoimmune cells and mediate the inflammation in the joints. Biological DMARDs are quite expensive and are injectable. They are not easily available in smaller cities in the country. Many people cannot afford biological DMARDs. Biological DMARDs are considered when there is failure to multiple conventional DMARDs and also when there is extra articular manifestation i.e. involvement of lungs, eyes etc.
3. Targeted Synthetic DMARDs (tsDMARDS): These are the latest kinds of drugs which have been made for RA, and have been available in Indian markets for around 5 years. Unlike conventional DMARDs, targeted DMARDs show very fast results in RA treatment. Pain relief response occurs as early as 3-5 days, according to Dr Shenoy. These are available as tablets and patient compliance is also better.
Are there any side effects of drugs prescribed for RA?
Yes, RA drugs can cause side effects like transaminitis (liver injury), decrease in blood counts, etc. Although the benefit is much higher when compared to risk, these drugs have to be taken under supervision. This is the reason why regular blood test monitoring should be done every two to three months and drug dosage should be titrated accordingly by Rheumatologists.
Important note: RA drugs should not be taken over-the-counter without being monitored by a rheumatologist.
(Dr. Padmanabha Shenoy MD, DM is the Medical director at the Centre for Arthritis and Rheumatism or CARE, Cochin)
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