Clinical managment of rheumatoid arthritis.pdf

Clinical management of rheumatoid arthritis

1. Clinical management of
rheumatoid arthritis

2. Diagnosis and assessment
•Confirm diagnosis: Through careful history, clinical examination, and
laboratory testing.
•Define goals: The primary goal is to achieve clinical remission. If not
possible, the alternative target is low disease activity.
•Monitor disease activity: Assess monthly for moderate to severe
disease, and every 3 to 6 months for low activity or remission.

3. Pharmacological management
•Start DMARDs early: Most patients should start DMARDs upon
diagnosis to alter the disease course.
•DMARDs:
•Conventional synthetic DMARDs: Methotrexate, sulfasalazine,
leflunomide, hydroxychloroquine.
•Biologic DMARDs: TumorNecrosis Factor (TNF) inhibitors (e.g.,
etanercept, adalimumab), abatacept, rituximab, tocilizumab.

4. Other medications
•Corticosteroids: Can be used, often as a bridge while DMARDs take
effect.
•NSAIDs: For symptom relief, but do not alter the disease course.
•Vaccinations: Crucial to be up-to-date before starting
immunosuppressant DMARDs, as they can be less effective after
starting treatment.

5. Non-pharmacological and supportive
management
•Physical and occupational therapy:
•Promotes joint mobility, strength, and function.
•Recommends low-impact exercises like swimming, yoga, and Tai Chi.
•Provides splints and assistive devices for daily activities.
•Pain management:
•Heat/cold therapy:Heat for stiffness, cold for acute pain and swelling.
•Complementary therapies:Massage, acupuncture, and stress reduction
techniques like meditation or deep breathing.

6. Non-pharmacological and supportive
management
•Nutritional support:
•Calcium and Vitamin D to prevent osteoporosis.
•Omega-3 fatty acids and curcumin (turmeric) may help with symptoms.
•Encourage a healthy diet, potentially including less red meat and more fish.
•Psychological support:
•Connect with others and find support groups, both online and in person.
•Address mental health, as depression can be common with severe RA.

7. Patient education and empowerment
•Shared decision-making: Involve the patient in treatment plan
decisions.
•Educate on the disease: Help patients understand RA, its potential
prognosis, and the importance of their role in management.
•Medication adherence: Emphasize the need for consistent use and
understanding of potential side effects.