Q: SOME OF THE NEW DRUGS FOR THE TREATMENT OF RHEUMATOID ARTHRITIS LIKE ARIFLEX -A PAIN RELEIVER ARE AVAILABLE IN EUROPE AND OTHER COUNTRIES. HOW EFFECTIVE ARE THESE DRUGS? AND THEIR AVAILABILITY TO INDIAN DOCTORS? I WANT TO HAVE A FEEDBACK AS MY MOTHER IS SUFFERING FROM RA FOR THE LAST 30 YEARS AND IN THE OLD AGE THIS HAS TAKEN THE WORST TURN. KINDLY ADVISE.

A:Rheumatoid arthritis treatment is as complex as treating a malignant tumor. The disease has to be staged (early, established, late) and severity assessed (mild, moderate, severe). For such assessment detailed history, physical examination, calculation of tender joints, swollen joints, pain score, functional capacity, health-assessement questionnaire, ESR, level of CRP, number of x-ray erosions in the hand joints and the status of rheumatoid factor, level of haemoglobin (and in more refined staging methods) certain shared epitopes (a type of genetic information), need to be analysed. Once this is done then, there are 3 stages in the treatment
1. Debulking of the disease for which some very new agents - the anti-TNF agents (extremely expensive but available in (India)) are used.
2. Induction of remission using the standard agents in combination that includes methotrexate as the central drug that may be combined with sulfasalazine, or cyclosporine or leflunomide.

Then, finally the maintenance therapy using a single agent of which, methotrexate is the most effective, most safe and the most popular drug in the whole world.As you can see, there is hardly any therapeutic role of pain killers in treating rheumatoid arthritis.

I strongly recommend that you may like to read the American College of Rheumatology Guidelines for the treatment of rheumatoid arthritis that has been published in the journal Arthritis & Rheumatism February 2002 issue.

I would suggest that all rheumatoid arthritis patients are treated according to these guidelines.