"How to treat rheumatoid disease" is a question that all patients with rheumatoid arthritis are concerned about, but fortunately, the answer is not complicated, because "oral drugs" are currently the main treatment.
But with so many drugs available to treat rheumatoid arthritis, which one should you choose?
Different doctors in clinical practice often give different suggestions, but this makes many patients confused, which doctor is right, and who should they listen to?
Don't worry, I'll solve your doubts from the following aspects.
First: What are the main drugs for the treatment of rheumatoid arthritis?
At present, oral drugs are still the main treatment method for rheumatoid arthritis, which can effectively control the progression of the disease, protect joint function, prevent joint ankylosis and deformity, and reduce the occurrence of complications of important organs and tissues such as lungs, pleura, and blood vessels.
There are five main types of drugs commonly used in the treatment of rheumatoid arthritis in clinical practice: non-steroidal anti-inflammatory analgesics, disease-modifying antirheumatic drugs, glucocorticoids, biological agents and botanical drugs.
Each of these categories contains different drugs, such as etoricoxib, celecoxib, meloxicam, diclofenac sodium, etc., which are non-steroidal anti-inflammatory analgesics;
Methotrexate, leflunomide, and hydroxychloroquine sulfate are disease-modifying antirheumatic drugs;
Prednisone acetate and methylprednisolone belong to the glucocorticoid class;
Tofacitinib citrate is a small molecule targeted drug, and tumor necrosis factor-α inhibitors are injectable biological agents;
Tripterygium wilfordii and white peony total glycosides belong to plant drugs.
Second, what are the mechanisms of action and adverse reactions of rheumatoid arthritis treatment drugs?
The mechanism of action and adverse effects of different types of drugs in the treatment of rheumatoid arthritis also differ.
For example, non-steroidal anti-inflammatory analgesics have a fast onset of effect, but they can only reduce joint swelling and pain, cannot control the progression of the disease, cannot be taken for a long time, and have adverse reactions in liver and kidney function, digestive tract and cardiovascular aspects.
Disease-modifying antirheumatic drugs can control the progression of the disease, but the onset of action is slow, it takes more than 3 months, the medication cycle is long, and the liver and kidney function and blood routine need to be monitored during the medication.
Glucocorticoids, small molecule targeted drugs, and biologics can quickly relieve joint swelling and pain and control the progression of the disease at the same time, but it is easy to recur when the drug is reduced or stopped, and tuberculosis, fungal and viral infections and tumor-related indicators need to be monitored before and during the treatment.
Although there are fewer adverse reactions of botanical drugs, the treatment power is weak and the onset time is longer.
In addition, the same rheumatoid arthritis treatment drug has different mechanisms of action and adverse reactions due to the different ingredients it contains.
For example, etoricoxib and celecoxib in non-steroidal anti-inflammatory analgesics have fewer gastrointestinal adverse reactions than diclofenac sodium.
Methotrexate and hydroxychloroquine sulfate are suitable for patients with rheumatoid arthritis with skin lesions, but hydroxychloroquine sulfate can cause damage to the fundus of the eye and should be vigilant.
Among the botanical drugs, Tripterygium wilfordii can affect women's menstruation, and the total glycosides of Paeonia alba can cause an increase in the frequency of stools.
Thirdly, the different conditions of patients determine the different medications
Because rheumatoid arthritis is a heterogeneous disease, the severity of the disease varies from person to person, and if a patient has only a few joint swelling and pain, non-steroidal anti-inflammatory analgesics and a disease-modifying antirheumatic drug or botanical drugs alone are sufficient.
Some patients have visceral damage in addition to polyarticular swelling and pain, and need to add glucocorticoids or biologics, combined with two or more disease-modifying antirheumatic drugs.
In addition, different patients have different individual physical conditions, and some patients have digestive tract diseases, so they need to be cautious when using non-steroidal anti-inflammatory analgesics and glucocorticoids.
Some patients have liver and kidney function impairment, and liver and kidney function need to be monitored in the use of drugs such as methotrexate and leflunomide.
Some patients have fundus lesions, and the use of hydroxychloroquine sulfate requires consultation with an ophthalmologist. Some patients are also allergic to multiple medications, which also determines the choice of drug in treatment.
Fourth, the patient's response to the treatment drug is a reference for adjusting the medication
Different patients also have different reactions to the same treatment drug, the same is methotrexate, some patients have a very good effect after taking it, and there are no adverse reactions, and some patients have a good effect after taking it, but it is accompanied by adverse reactions such as liver and kidney damage, and some patients have no adverse reactions after taking it, but the treatment effect is not good.
For the first group of patients, they can continue to take the drug, and the second type of patients need to add relevant hepatoprotective and kidney-protecting drugs according to the severity and development of adverse reactions, and reduce the dose of methotrexate, and if necessary, they can also stop and change the drug. For the third group of patients, the drug must be discontinued immediately and replaced with other treatments.
It can be seen that although there are many types of drugs for the treatment of rheumatoid arthritis, the treatment characteristics and adverse reactions are also different.
However, in general, rheumatologists will choose the appropriate type of drug according to the severity of the patient's condition and physical condition, and will also refer to the accumulated treatment experience, and adjust the response of the patient after taking the drug in the following treatment.
Although different rheumatologists may prescribe different medications for their patients, they are all medically based on the medical evidence, and patients should rest assured that they should not reduce or add medication on their own.
In the process of taking the medicine, it is also necessary to have regular follow-up visits and inform the doctor in detail of the changes in symptoms and signs after taking the medicine.
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