Rheumatoid Arthritis: What are the treatments?
Rheumatoid arthritis is a disease of the family of chronic inflammatory rheumatism, in which we also find lupus.
In France, it is estimated that about 300,000 to 600,000 people are affected by rheumatoid arthritis; this pathology affects mostly women and appears around 40 - 60 years, that is to say towards menopause.
What is rheumatoid arthritis?
Rheumatoid arthritis is an inflammatory disease that affects the joints, and it is also an autoimmune disease.
explanation: When we have rheumatoid arthritis, our immune system makes antibodies to the synovial membrane of the joints - it's a thin layer of tissue that covers the inside of the "capsule" that protects the joint. The synovial membrane also produces an "articular lubricant", the synovial fluid.
This inflammation of the synovial membrane leads to its thickening and excessive production of synovial fluid that accumulates in the joint. This has several consequences: the cartilage of the joint is eroded, the bone is demineralized progressively, tendons and ligaments become fragile, tissues harden and become painful ...
The rheumatoid arthritis is a disease that evolves by pushing: at each push (and in the absence of an effective treatment), the joints are destroyed more. If there is a great disparity in the severity of this disease (some forms are very destructive, others much less), rheumatoid arthritis is usually painful and can sometimes lead to disability.
The symptoms of rheumatoid arthritis are as follows:
- The joints are red and swollen. Most often, the disease attacks first the joints of the hands (wrists, fingers ...) and feet,
- There is a feeling of warmth and intense pain on contact with the swollen joint,
- There is a feeling of stiffness in certain joints, especially in the morning when you wake up,
- After several years, rheumatoid arthritis can lead to the deformation of certain joints (elbows, shoulders, knees, hips ...),
- More rarely, we can see extra-articular lesions: rheumatoid nodules (it is painless formations of firm consistency, usually located under the skin) appear in some patients,
- Fatigue, lassitude, loss of appetite.
What are the treatments for rheumatoid arthritis?
In the case of rheumatoid arthritis, the treatments have 3 distinct objectives: fight against inflammation, pain and immunodeficiency.
Good to know : in France, rheumatoid arthritis can be recognized as a "long-term condition" (ALD). Examinations and care related to this disease are then covered 100% by the Health Insurance.
Anti-rheumatoid arthritis (often referred to as "DMARDs") is a continuous treatment: these drugs block or slow the progression of the disease.
The best known is the methotrexate (Methotrexate®, Metoject®, Imeth®, Novatrex®): also used in oncology, it is the standard treatment for rheumatoid arthritis.
His role : to stop the destruction of the joints by fighting against certain substances (or cells) involved in the disruption of the immune defenses and the chronic inflammation of the joints.
This immunosuppressant is to be taken once a week - in the form of a tablet or injection. If side effects exist (nausea, abdominal pain, diarrhea ...), doctors usually prescribe vitamin B9 to reduce them.
- Symptomatic treatments
If these drugs have no effect on the course of the disease, they still help relieve the main symptoms of rheumatoid arthritis - joint stiffness, pain ...
We now favor the nonsteroidal anti-inflammatory drugs which have analgesic (against pain), antipyretic (against fever) and anti-inflammatory properties. Steroidal anti-inflammatory drugs (steroids) may also be prescribed in some cases, subject to regular monitoring of diet, blood pressure, metabolism, bone ...
The standard analgesic in rheumatoid arthritis is paracetamol. This non-opioid analgesic is used to reduce pain when it is mild or moderate.
In some cases (after a risk assessment by the doctor), level I or level II analgesics may be prescribed: dextropropoxyphene, codeine, tramadol ...
In parallel with "classic" treatments, paramedical assistants may also be considered: physiotherapy, balneotherapy, occupational therapy ... Moderate physical activity and adapted to the stage of the disease (soft gym, walking, water activities ...) is also recommended.
Painful joints: sometimes it is necessary to operate
If, in most cases, basic treatments are sufficient to stabilize rheumatoid arthritis (in addition, since the 2000s, other treatments - biotherapies - have increased the therapeutic possibilities), it is sometimes necessary to operate when the disease is old, and / or very active and / or the treatments are not effective enough.
Surgery has two main objectives: to prevent the destruction of a joint or restore mobility when the joint has been damaged too much.
There are 3 types ofsurgical interventions in case of rheumatoid arthritis:
- The synovectomy corresponds to the partial or total ablation of the synovial membrane: this makes it possible to reduce the inflamed part of the joint which becomes functional again.
- Thearthrodesis is to permanently block a joint (often the ankle or wrist) so that it is no longer painful. After the procedure, mobility is limited but the pain is gone.
- The prostheses (partial or total) can replace a damaged or destroyed joint. More specifically, for the joints of the fingers, it is possible to envisage implants in order to strengthen the joints damaged by rheumatoid arthritis.
National Association of Defense Against Rheumatoid Arthritis (ANDAR)
French Association of Polyarthritis and Chronic Inflammatory Rheumatism (AFPric)
Read also :
⋙ Diet: relieve inflammatory polyarthritis with green tea
⋙ Rheumatoid Arthritis: What You Need to Know
⋙ Laurence Boccolini confides in her illness, rheumatoid arthritis