Multimodal Approach is necessary
Usually rheumatoid arthritis has an insidious onset. In chronically progressive disease, patients initially suffer from painful morning stiffness of the small joints (e.g. fingers) which are tender on movement and palpation. Later, centripetal progression to larger joints and functional joint impairment occur. Painful symmetric swelling is also a typical symptom. In advanced stages, the joints often become deformed.
It is essential that patients regain or improve their mobility. In order to achieve this, a multimodal approach with physical therapy, pharmacotherapy and other treatment procedures is necessary.
Symptomatic treatment includes non-opioid analgesics (e.g. coxibes), especially non- steroidal anti-inflammatory drugs (NSAIDs), steroids. Combinations with opioids or tapentadol in case of severe pain.
As DMARDs (Disease Modifying Anti Rheumatic Drugs, immunosuppressants and anticytokines) intervene with the pathogenic process, they should be prescribed as soon as possible. The chosen substance should conform to disease activity.
Use of DMARDs1 has recently changed and it is now recommended to initiate them as early and as aggressively as possible to stop the disease at an early stage and avoid joint destruction.
1 Smolen JS, Aletaha D. Strengths and limitations of a systematic review on DMARDs for rheumatoid arthritis. Nat Clin Pract Rheumatol 2008;4:296–7.