J Korean Med Assoc.  2010 Oct;53(10):871-879. 10.5124/jkma.2010.53.10.871.

Medical treatment of rheumatoid arthritis (I): Nonsteroidal anti-inflammatory drugs, disease modifying antirheumatic drugs and glucocorticoids

• Koh EM

• KMID: 2188412
• DOI: http://doi.org/10.5124/jkma.2010.53.10.871

Abstract

The medical treatment of rheumatoid arthritis has been dramatically improved with the advances of newer disease-modifying antirheumatic drugs (DMARDs) and biologic agents during previous decades. To prevent joint damage, it is essential to start DMARD treatment early, especially within the first 3 months after diagnosis. Tight control of disease activity, and the thorough monitoring of the treatment's efficacy and the side effects of medications are also important. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually used to control pain and swelling of the joints. However, these drugs cannot alter the disease course of rheumatoid arthritis. It is therefore necessary to introduce DMARDs at the beginning of treatment, and, after achieving the effect of DMARDs, NSAIDs should be tapered as soon as possible. The main treatment should be DMARDs, which must be used wisely and appropriately. It is also important to adjust DMARD therapy during the course of treatment according to disease activity. Glucocorticoids have potent anti-inflammatory effects and can control inflammation dramatically. However, because of the diverse and serious side effects of glucocorticoids, the usage of glucocorticoids should be limited to low-dose oral therapy or intra-articular injection, unless otherwise indicated. Along with biologics, there are now various weapons available against rheumatoid arthritis, and it can be treated much more effectively than before.

Keyword

Rheumatoid arthritis; NSAIDs; DMARDs; Glucocorticoids

MeSH Terms

Anti-Inflammatory Agents, Non-Steroidal
Antirheumatic Agents
Arthritis, Rheumatoid
Biological Agents
Glucocorticoids
Inflammation
Injections, Intra-Articular
Joints
Anti-Inflammatory Agents, Non-Steroidal
Antirheumatic Agents
Biological Agents
Glucocorticoids

Reference

1. American College of Rheumatology Ad Hoc Committee On Clinical Guidelines. Guidelines for the management of rheumatoid arthritis; 2002 Update. Arthritis Rheum. 2002. 46:328–346.

2. Bathon JM, Cohen SB. The 2008 American College of Rheumatology recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis: Where the rubber meets the road. Arthritis Rheum. 2008. 59:757–759.

3. American College of Rheumatology Ad Hoc Committee On Clinical Guidelines. Guidelines for the management of rheumatoid arthritis. Arthritis Rheum. 1996. 39:713–722.

4. Schur PH, Maini RN. Treatment of early, moderately active rheumatoid arthritis in adults. UpToDate Website. Accessibility verified on July 21, 2010. Available at: http://www.uptodate.com/online/content/topic.do?topicKey=rheumart/15723&selectedTitle=1%7E150&source=search_result.

5. Wilske KR, Healey LA. Remodeling the Pyramid-a Concept Whose Time Has Come. J Rheumatol. 1989. 16:565–567.

6. Klippel JH, Stone JH, Crofford LJ, White PH, editors. Chapter 41, Nonsteroidal anti-inflammatory drugs. Primer on the Rheumatic Diseases. 2008. 13th ed. Atlanta: Arthritis Foundation;634–643.

7. Hawkey CJ. COX-2 inhibitors. Lancet. 1999. 353:307–314.

8. Chan FK, Lanas A, Scheiman J, Berger MF, Nguyen H, Goldstein JL. Celecoxib versus omeprazole and diclofenac in patients with osteoarthritis and rheumatoid arthritis (CONDOR): a randomized trial. Lancet. 2010. 376:173–179.

9. Deighton C, O'Mahony R, Tosh J, Turner C, Rudolf M. Management of rheumatoid arthritis: summary of NICE guidance. BMJ. 2009. 338:b702.

10. Tannenbaum H, Bombardier C, Davis P, Russell AS. An evidence-based approach to prescribing nonsteroidal antiinflammatory drugs. Third Canadian Consensus Conference. J Rheumatol. 2006. 33:140–157.

11. Fauci A, Braunwald E, Kasper D, Hauser S, Longo D, Jameson J, Loscalzo J, editors. Chapter 316, Rheumatoid arthritis. Harrison's Principles of Internal Medicine(Korean Language Edition). 2009. 17th ed. McGraw-Hill;2506–2516.

12. Hochberg MC, Silman AJ, editors. Chapter 42, Disease-modifying antirheumatic drugs 2:sulfasalazine. Rheumatology. 2008. 4th ed. London: Mosby;437–447.

13. Kremer JM. Use of methotrexate in the treatment of rheumatoid arthritis. UpToDate Website. Accessibility verified on July 21, 2010. Available at: http://www.uptodate.com/online/content/topic.do?topicKey=rheumart/5450&selectedTitle=6%7E151&source=search_result.

14. Hochberg MC, Silman AJ, editors. Chapter 44 , Disease-modifying antirheumatic drugs 4:leflunomide. Rheumatology. 2008. 4th ed. London: Mosby;461–469.

15. Hochberg MC, Silman AJ, editors. Chapter 47, Other drugs in rheumatic disease. Rheumatology. 2008. 4th ed. London: Mosby;487–493.

16. Saag KG, Teng GG, Patkar NM, Anuntiyo J, Finney C, Curtis JR, Paulus HE, Mudano A, Pisu M, Elkins-Melton M, Outman R, Allison JJ, Suarez Almazor M, Bridges SL Jr, Chatham WW, Hochberg M, MacLean C, Mikuls T, Moreland LW, O'Dell J, Turkiewicz AM, Furst DE. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008. 59:762–768.

17. Small RE. Use of glucocorticoids in the treatment of rheumatoid arthritis. UpToDate Website. Accessibility verified on July 21, 2010. Available at: http://www.uptodateonline.com/online/content/topic.do?topicKey=rheumart/8827&selectedTitle=45%7E150&source=search_result#.

18. Nieman LK. Pharmacologic use of glucocorticoids. UpToDate Website. Accessibility verified on July 21, 2010. Available at: http://www.uptodateonline.com/online/content/topic.do?topicKey=adrenal/12178&selectedTitle=2%7E150&source=search_result#.

19. Hoes JN, Jacobs JW, Boers M, Boumpas D, Buttgereit F, Caeyers N, Choy EH, Cutolo M, Da Silva JA, Esselens G, Guillevin L, Hafstrom I, Kirwan JR, Rovensky J, Russel A, Saag KG, Svensson B, Westhoven R, Zeidler H, Bijlsma JW. EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis. 2007. 66:1560–1567.