Clinical Immunology focuses on the immune system’s health. Learn about the diagnosis and treatment of allergies, autoimmune diseases, and immunodeficiencies.
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The treatment landscape for rheumatoid arthritis has undergone a revolution in recent decades. The approach has shifted from merely managing pain to modifying the course of the disease to prevent joint damage. At Liv Hospital, the management strategy is aggressive and proactive, often utilizing a “treat-to-target” approach where therapy is escalated until specific remission goals are met. Treatment typically involves a combination of medication, physical therapies, and lifestyle management, tailored to the severity of the disease and the individual patient’s needs.
Methotrexate is the gold standard and usually the first line of treatment. It works by interfering with the production of cells that cause inflammation.
These drugs do not just mask pain; they alter the underlying disease process. Other conventional DMARDs include leflunomide, hydroxychloroquine, and sulfasalazine, which may be used alone or in combination.
Biologics are genetically engineered proteins that target specific parts of the immune system that fuel inflammation, such as Tumor Necrosis Factor (TNF) or Interleukins.
Unlike pills, biologics are administered via subcutaneous injection or intravenous infusion. They are typically prescribed when conventional DMARDs are not sufficient to control the disease.
Common classes include TNF inhibitors, T-cell costimulation modulators, and B-cell depleting agents. Each targets a different pathway in the immune cascade.
Janus Kinase (JAK) inhibitors represent a newer class of advanced therapy. Unlike biologics, these are oral medications.
They work by blocking the signaling pathways inside the cell that tell the immune system to produce inflammatory cytokines. They offer an alternative for patients who prefer pills over injections but need advanced therapy.
Corticosteroids like prednisone are fast-acting anti-inflammatory drugs. They are often used as a “bridge” to control symptoms quickly while waiting for DMARDs to take effect.
Non-steroidal anti-inflammatory drugs (NSAIDs) help reduce pain and swelling but do not alter the disease progression. They are used as adjunctive therapy for symptom relief.
Due to side effects like bone thinning and weight gain, steroids are typically tapered to the lowest effective dose as soon as possible.
Physical therapy is essential for maintaining range of motion and strengthening the muscles surrounding the joints to provide better support.
Occupational therapists teach patients how to perform daily activities with less stress on painful joints. This includes using assistive devices like jar openers or button hooks to preserve hand function.
In cases where the joint lining is severely inflamed and not responding to medication, a synovectomy may be performed to remove the diseased synovium.
For joints that are severely damaged, total joint replacement is the most effective option to restore function and eliminate pain. Hips and knees are the most common, but small joint replacements in the hands are also possible.
Inflammation can cause tendons to loosen or rupture. Surgical repair can restore the integrity of the tendon and improve muscle function.
Management involves frequent check-ups to measure disease activity scores (DAS28). If the target (remission or low disease activity) is not reached, therapy is adjusted immediately.
This strategy prevents clinical inertia, ensuring that the patient is always on the most effective regimen possible to prevent long-term disability.
Understanding the disease is a form of treatment. Educated patients are better at adhering to complex medication schedules and recognizing early signs of flares.
Chronic pain takes a mental toll. Management often includes counseling or support groups to help patients cope with the emotional aspects of a lifelong condition.
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Methotrexate is considered the anchor drug for RA treatment. Most treatment plans start with it because of its proven track record in reducing inflammation and preventing joint damage.
Most likely, yes. Because RA is a chronic condition, long-term medication is usually needed to keep the disease in remission. However, doses can often be lowered once the disease is under control.
Biologics are advanced, protein-based drugs that target specific parts of the immune system. They are used when standard drugs aren’t enough and are given by injection or IV.
No. While a healthy diet can help lower inflammation and improve overall health, it cannot stop the immune system from attacking the joints. Medication is necessary to prevent permanent damage.
Remission means there are few to no signs of active disease. The joints are not swollen or tender, and blood markers of inflammation are normal. The goal of treatment is to reach and maintain this state.
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