Q: I am 64 years old housewife suffering from Rheumatoid arthritis. I am on early treatment of rheumatoid arthritis with practically little disease activity (no pain, good freedom of movement of all joints but RA high and erosion and oedema in all the carpal bones of one wrist). Is a non-steroidal anti-inflammatory drug (NSAID) like Neproxen with disease-modifying, anti-rheumatic drugs (DMARD) like Sulfasalazine better than DMARD alone? Can proton pump inhibitor like Omeprozole be prescribed along with Sulfasalazine? Can enteric coated tablet be taken along with food to prevent gastric symptoms?

A:Patient should be immediately contacting an experienced well-trained rheumatologist. The rheumatologist must immediately perform the internationally accepted proper evaluation of rheumatoid arthritis using internationally accepted disease activity measures namely Disease Activity Score including 28 joints (DAS28), Clinical Disease Activity Index (CDAI) or Simplified Disease Activity Index (SDAI) for rheumatoid arthritis. Based upon the value – the treatment is guided using the standard anchor drug for treating rheumatoid arthritis, namely low dose methotrexate (LD-MTX). NSAIDs have absolutely no effect on the disease activity.

I am not aware of any role of omiprazole along with sulfasalazine, unless the patient has an unrelated peptic ulcer.

As a rule, if the patient requires painkillers for rheumatoid arthritis, it usually reflects badly on the treating doctor that he/she is not treating her properly and the disease is not under control. In the majority of such cases it has been shown that the patient is on suboptimal doses of LD-MTX.