There are many diseases which fall into the group of conditions known as autoimmune inflammatory arthritis such as rheumatoid arthritis, systemic lupus erythematous, psoriasis with psoriatic arthritis, vasculitis and many others. The treatment of an autoimmune inflammatory arthritis involves multiple approaches. These include:

1. Medications
2. Supplements, and
3. Lifestyle changes

These different approaches work together to help improve symptoms and to control the disease. The aim of treatment is to bring the autoimmune condition into remission (“shut down”). the process of bringing the diseases into remission is slow and can sometimes take months.

However, whilst waiting to start specific treatment, and for them to have their effect, there are medications that can be used to help improve the patient’s symptoms. Medications can therefore be dived into two groups

1. Medications used for improvement of symptoms such as pain, swelling and stiffness, and
2. Medications used to treat the underlying disease

Medications used to treat the patient’s symptoms

Medications used to treat the patient’s symptoms can be divided into two groups:

1. Steroids and
2. Painkillers

Steroids

• Steroids can be used as “bridging therapy” to treat joint pain, swelling and stiffness. The onset of action of steroids is usually fast and allows the patient to be able to continue functioning with all activities of daily living. However, the use of steroids should be short-term whilst the patient is being assessed, and a diagnosis is being made. Treatment with steroids is usually continued in the early stages of the management of the patient’s disease whilst awaiting other medications to have their maximum effect.
• Steroid treatment can be in the form of tablets (Calcort, prednisolone or dexamethasone) or injections (in the muscles of in the veins). When using steroid tablets, these are usually recommended to be used after breakfast. Steroid tablets can sometimes cause irritation of the lining ofthe inside of a patient’s stomach. In order to provide protection to the lining of the stomach when using steroids, medications such as omeprazole, pantoprazole, etc. are to be used. These medications for protection of the stomach should be used 30 minutes before breakfast. The steroid tablets can be taken after eating breakfast.

Pain killers

• Pain killers are available in many different forms such as paracetamol/acetaminophen, non-steroidal anti-inflammatory drugs and other medications.
• Paracetamol is available in many different preparations such as Panadol, Ultra Strength Panadol, Tylenol, Tylenol Arthritis etc. These medications are easily available over the counter (OTC). However, a doctor may give a written prescription with specific instructions for use.
• Non-steroidal anti-inflammatory drugs (NSAIDs) are available in many forms such as ibuprofen, diclofenac, naproxen, celecoxib, etoricoxib etc. There are many different brand names for the NSAIDs. As with oral steroids, it is usually recommended that these medications be taken after meals and together with medications for protection of the stomach. NSAIDs should ideally be prescribed with specific instructions for use.
• Prescription painkillers such as Tramadol can also be used to alleviate joint pain.
• Steroid tablets. paracetamol and NSAIDs can be used in combination depending on the patient’s symptoms. When using both steroid tablets and NSAIDs it is recommended that they be taken at different times of the day in order to allow for better control of symptoms.

Medications used to treat the underlying disease

These are usually called Disease Modifying anti rheumatic drugs (DMARDs) or immunosuppressive agents

Disease-Modifying Treatment includes:

1. Oral Disease-Modifying Anti-Rheumatic Drugs (DMARDs) e.g. methotrexate, sulphasalazine and leflunomide are oral tablets that are used to slow down the progression of rheumatoid arthritis and prevent joint damage. They work by suppressing the immune system and controlling inflammation, as well as the disease process. These medications can take longer to start working compared to drugs used for symptomatic relief. Patients can start seeing effects within 4-8 weeks; however, it may take up to 4-6 months in order to see the full effect of the drug.
2. Biologic Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) e.g. Actemra, Humira, Enbrel, Remicade and other new ones are treatments for rheumatoid arthritis that are given in the form of injections. They target specific parts of the immune system and slow the progression of the disease.

Dr. Haramnauth Dyaanand
Rheumatologist