By Dr Ananya Mandal, MD
Since there are several forms and conditions that are classified under rheumatic disorders, their treatments are also varied in nature.
Rheumatism is a loose layperson term that encompasses both inflammatory and non-inflammatory forms of pain and arthritis syndromes.
Within the inflammatory variety of rheumatism (termed rheumatic disorders) there are those that affect the joints and those that affect the whole body or other soft tissues as well.
There is no single medication or treatment which improves the conditions of arthritis or inflammatory pain syndromes. Some agents are more effective for some individuals than others.
The treatment aims and modalities include:-
Management and relief of pain
This is the primary goal of treatment of all forms of rheumatism associated disorders whether they are inflammatory or non-inflammatory.
Pain may be managed in two ways – with the use of traditional pain relievers and with the use of pain relievers that also reduce inflammation. The former include opioid analgesics or opioids like morphine and codeine that may ease the pain but do not have any effect on inflammatory processes.
The other group includes agents called non steroidal anti-inflammatory agents (NSAIDs) including ibuprofen, diclofenac, naproxen etc. These agents relieve pain and also reduce the inflammatory processes. This is intensely beneficial to those suffering from inflammatory joint disease.
However, due to risk of severe side effects like gastric ulcers, kidney, heart and liver damage over long term use, these agents are not prescribed for long term use in those with inflammatory rheumatic disorders.
Reduction of inflammation at the joints or other tissues
Another major therapy goal is to reduce and prevent inflammation at the joints. This may be achieved using corticosteroids. These agents reduce the inflammation and over time they may prevent joint damage progression.
Although long term use of corticosteroids is fraught with risks of side effects, these agents are still the mainstay of treatment of most of the rheumatic disorders. Agents used to combat acute inflammation in other arthritis conditions like gout include Colchicine.
Inflammation is also reduced using newer agents called biological response modifiers or BRMs. These are widely used in rheumatoid arthritis and these agents target the inflammatory markers that lead to joint damage. Agents include Adalimumab, Etanercept etc. that inhibit inflammatory mediators like Tumor Necrosis Factors (TNFs).
Reduce and prevent joint damage and preserve joint mobility
Most of the rheumatic disorders lead to severe disability due to affliction of the joints by the inflammatory processes. An important therapy goal is to prevent further progressive joint damage and through physical therapy and exercises maintain optimum joint mobility and relative independence of the patient.
Joint damage is also prevented and halted in the case of rheumatoid arthritis using agents termed as Disease modifying anti rheumatoid arthritis drugs (DMARDs). These agents include methotrexate, leflunomide, gold salts, hydroxychloroquine etc.
They can prevent progressive joint damage and prevent the disability associated with rheumatoid arthritis.
In gout the agents used to prevent joint damage are those that reduce uric acid in blood including Allopurinol.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)