From the Guidelines
Rheumatoid arthritis symptoms typically include symmetric polyarthritis with joint swelling, especially of the hands and feet, morning stiffness lasting 1 hour or longer, and characteristic subcutaneous nodules and other extra-articular disease manifestations. These symptoms can lead to significant disability and reduced quality of life if left untreated or undertreated. According to the study published in the Mayo Clinic Proceedings in 2012 1, rheumatoid arthritis can develop in persons of any age, with the typical age at onset of about 55 years, and the prevalence increases considerably with age. The clinical features of rheumatoid arthritis include joint pain, swelling, stiffness, fatigue, and warmth or redness in affected joints, which often begin in smaller joints like fingers and toes before progressing symmetrically to larger joints.
The management of rheumatoid arthritis involves a combination of pharmacologic and non-pharmacologic interventions. The 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis 1 recommends the use of traditional disease-modifying anti-rheumatic drugs (DMARDs), biologic DMARDs, and tofacitinib, as well as glucocorticoids, to manage symptoms and slow disease progression. Additionally, the guideline emphasizes the importance of a treat-to-target approach, tapering and discontinuing medications, and screening for tuberculosis in the context of biologics or tofacitinib.
In terms of specific treatments, NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) can help with pain and inflammation, while disease-modifying antirheumatic drugs (DMARDs) such as methotrexate (starting at 7.5-10mg weekly, potentially increasing to 20-25mg) are the cornerstone of treatment to slow disease progression 1. Corticosteroids like prednisone (5-10mg daily) may be used short-term for flares, and physical therapy, regular gentle exercise, and hot/cold therapy can also help manage symptoms. Weight management reduces joint stress, while adequate rest balances activity.
It is essential to note that early treatment is crucial in managing rheumatoid arthritis, as joint damage can become permanent if left untreated or undertreated. Therefore, consulting a rheumatologist promptly if experiencing persistent joint pain and swelling is highly recommended. The National Institute for Health and Clinical Excellence (NICE) guideline on the management of rheumatoid arthritis 1 also emphasizes the importance of early recognition and treatment of the disease to avoid pain and disability.
From the Research
Symptoms of Rheumatoid Arthritis (RA)
The provided studies do not directly discuss the symptoms of Rheumatoid Arthritis (RA). However, they do mention the treatment options and goals for managing the disease, which can be inferred to be related to alleviating its symptoms.
Treatment Goals and Options
- The main goal of disease-modifying antirheumatic drugs (DMARDs) treatment is to achieve remission and monitoring of disease activity and adverse events should guide decisions on choice and changes in treatment strategies 2.
- Treatment options include conventional synthetic DMARDs (e.g., methotrexate), injectable biologic DMARDs, and targeted synthetic DMARDs (oral) 3.
- Methotrexate is considered the anchor drug and should be used first in patients at risk of developing persistent disease 2.
- Biologic agents such as tumor necrosis factor-alpha (TNF-alpha) inhibitors have been efficacious for improving disease activity and inducing remission, and inhibiting radiographic progression when used in combination with methotrexate 2.
Disease Management
- Current clinical practice guidelines recommend starting biologic agents if patients have a suboptimal response or are intolerant to one or two traditional DMARDs 4.
- The combination of methotrexate with DMARD or biological agents with different mechanisms of action greatly expands the treatment options for patients with RA 5.
- A treat-to-target strategy with a goal of low disease activity or remission should be aimed for by frequently monitoring disease activity and escalating treatment 3.