Treatment of Rheumatoid Arthritis
Amina, a 44-year-old lady, diagnosed with rheumatoid arthritis two years ago, arrived at the hospital with complaints of joint pains, fatigue, headache, malaise, and sudden weight loss in the last two months. She claims that it has affected her daily life since she no longer goes to her business premises and never runs her home chores as she used to due to her worsening condition. She has been forced to hire a nanny to help her around. She has been on medication therapy, but the drugs have not relieved the symptoms since a few weeks ago. She has been on methotrexate and corticosteroid therapy.
Amina complains that the drugs have been causing stomach upsets, nausea, mouth sores, and hair loss, which has affected her self-esteem since she does not feel beautiful anymore. She also says that she has been adhering to the drug regime as advised by the doctor. Amina has also been doing gentle exercises applying ice packs on the joints to ease pain and inflammation. According to Amina, her husband and children have been supportive both emotionally and physically through the treatment period; however, that she feels depressed lately because of the sudden weight loss and her body’s inability to function normally.
Pathophysiology
Rheumatoid arthritis (RA) is an autoimmune disease that causes joints inflammation. Its main feature is a persisted inflammation of synovial membranes of joints in the upper and lower limbs (Ngian, 2010). The bone collagen is destroyed due to osteoclasts activation caused by cytokines, and partly by the synovial fluid which is highly inflammatory. The cartilage’s water content and resilience is destroyed by proteolytic enzymes (Bullock et al., 2018). The severity of the disease depends on the number of joints involved. It also affects other body organs such as the lungs, skin, and eyes. Rheumatoid arthritis is a chronic condition that can cause permanent destruction of joints and can lead to disability.
Although RA’s cause is not yet understood, some predisposing factors can make a person susceptible to the disease; a family history of the disease, smoking, being a woman, and obesity have been discovered in its development. Combining these factors can trigger an immune response of the body known as autoantibodies that consume joint linings(Ngian, 2010).. The reaction, in turn, leads to the production of chemicals such as fibroblast growth factor, which causes inflammation and the damage of the joint cartilage ligaments tendons and bones.
Treatment
The care and management of patients with rheumatoid arthritis include pharmacological and non-pharmacological therapies.
First–Line Treatment
The first-line management include Non-steroidal anti-inflammatory drugs (NSAIDs) and corticosterois (Wasserman, 2011). This treatment aims to reduce joint inflammation and pain. The (NSAIDs) drugs act fast and are effective. They include ibuprofen naproxen, acetylsalicylate(aspirin), and Lodine. Aspirin is significantly effective since it prohibits prostaglandins from being synthesized. The NSAIDs side effects are abdominal pain, nausea, and gastrointestinal bleeding. Nevertheless, they are less risky.
The corticosteroids are first-line medications that are more effective than the NSAIDs but have worse side effects. Thus they are only indicated for a short period at minimal doses.They reduce eosinophils action, which decreases inflammation (Bullock et al., 2018). Corticosteroids’ side effects include; immunosuppression and bone thinning. Careful consideration should be taken before prescribing the drugs. The other first-line drugs are opioids analgesics. They include the administration of weak opioids such as tramadol (Wasserman, 2011). They help to relieve pain related to RA. They are known to have adverse side effects; thus, other analgesics should be considered before opioid analgesics.
Second-Line Treatment
The drugs used in this line are called disease-modifying antirheumatic drugs (DMARDs). They work by slowing joint destruction and disability(Wasserman, 2011). They are slow-acting, and they take a long to be effective. However, they reduce their risks of patients developing RA related complications such as lymphoma. The DMARDs include; Methotrexate, which is an immunosuppressive drug that inhibits the binding of enzymes responsible for joint inflammation (Bullock et al., 2018). Since it causes bone deterioration, it is prescribed alongside folic acid and other second-line drugs. Hydroxychloroquine, sulfasalazine, and gold salts such as gold sodium thiomalate and auranofin are often used in RA treatment. DMARDs are known to damage the kidney and bone marrow; thus, a regular test should be done to note any body system abnormalities
From Amina’s biodata and history, she is likely to be experiencing Methotrexate and corticosteroid therapy side effects. The effects are bone thinning and stomach upsets; however, further tests and assessments and review may be recommended to determine the exact cause.
Newer Medications
Drugs like leflunomide reduce symptoms and progression of the disease and can be used along with Methotrexate. Its side effects include hypertension and neuropathy. Other drugs include biologics. They are considered direct therapy, which is effective in stopping bone damage(Bullock et al., 2018). The biologic such as Infliximab and golimumab are effective in symptoms relief. Anekira is another drug in this line that is used to treat complications of RA disease. Other therapies that can help Amina are omega-3 fatty supplements to relieve symptoms, Vitamin D, and calcium to prevent bone damage. (Ngian, 2010). Cumin can also be used to relieve inflammation. Lastly, physical and occupational therapy is recommended for Amina to maintain joint movement and strengthen muscles.
Rheumatoid disease is a severe disease that can cause disability. Therefore, early interventions should be taken to prevent damage and permanent distraction to the body.
