by G. Lee

Created on: March 01, 2008

Rheumatoid arthritis is a systemic inflammatory disease that, at least initially, focuses on synovial joints. The prevalence of rheumatoid arthritis is about 1%, and women are more commonly affected than men. The prognosis of treated rheumatoid arthritis has substantially improved in the last 20 years, with the use of disease-modifying antirheumatic drugs (DMARDs) resulting in better control of inflammation and less joint damage. These better outcomes contrast with those for untreated rheumatoid arthritis.

The aims of rheumatoid arthritis therapy have radically shifted from palliation to early induction of disease remission, to prevent joint damage. The treatment for rheumatoid arthritis can be categorized into two groups, namely symptomatic management and DMARDs.

SYMPTOMATIC MANAGEMENT

(a) Nonsteroidal Anti-inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are an effective therapy but are associated with a high incidence of adverse drug reactions. If gastrointestinal, cardiovascular or renal risk factors are present, careful monitoring is necessary. Alternatively, paracetamol, fish oils, or low-dose glucocorticoids may allow NSAID use to be avoided.

(b) Fish Body Oil

Fish oil in doses sufficient to deliver 3 to 4g of long chain omega-3 fats daily has been shown to reduce symptoms and recourse to NSAIDs in rheumatoid arthritis, and to reduce production of pro-inflammatory eicosanoids and cytokines. It also has an antiarrhythmic effect, improves blood pressure control and arterial compliance, and reduces raised triglycerides. It should be noted that the symptomatic benefit of fish oils can be delayed for 6 to 12 weeks. Typically, 0.2g/kg is needed, and this equates to approximately 14 standard 1g capsules per day or 15ml of fish oil. This substantially exceeds amounts taken as self-medication. It is easier to take the fish oil as bottled product or juice.

(c) Glucocorticoids

Glucocorticoids (oral, intra-articular or intramuscular) are effective, but usually associated with significant adverse effects. Oral glucocorticoids should be considered in those with acute severe disease, and in those for whom other treatment strategies have failed or are contraindicated. Prednisone or prednisolone 5 to 10mg orally each morning are used in such people.

These relatively low doses of oral prednisone and prednisolone may be effective in patients with rheumatoid arthritis, and doses higher than 15mg daily should be avoided if possible. If oral prednisone or prednisolone

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