New drugs have significantly improved the therapeutic options of RA in recent years. In addition to the treatment of the symptoms - mainly pain - modern drugs can also directly intervene in the underlying inflammatory process. The drug therapy of RA usually takes place in several steps with the aim to achieve a remission.
- Conventional basic drugs (DMARDs = disease-modifying antirheumatic drug) as sole treatment, often in combination with cortisone *
- Combination (s) of conventional basic drugs when under a basic drug no improvement of the symptoms (remission) occurs
- Targeted synthetic DMARDs (eg Janus kinase inhibitors) or biological DMARDs
* Cortisone and analgesics can be used for symptomatic therapy in all stages of treatment.
Your doctor should check the activity of RA and treatment success at regular intervals (half yearly or quarterly). The therapeutic goal is the decline of the symptoms (remission) or, if this is not possible, a low disease activity. For this he will usually use the so-called DAS28 score (disease activity score). As with the diagnosis, several examination results are used here as well:
- Joints: Number of swollen joints (SJC, swollen joint count) and number of joints with pressure pain (TJC, tender joint count)
- Blood test: ESR or CRP (see section Diagnostics)
- Feeling of the patient: Patient marks on a scale (VAS, visual analogue scale) his condition, eg. Pain
The higher the DAS value, the higher the disease activity; If the value is below 2.6, your doctor will speak of a remission. Your feedback and self-assessment is important! If necessary, your doctor changes the drugs or their combination.
Accompanying therapy measures
In addition to the drug therapy and physiotherapy, occupational therapy, physical therapy or supportive measures for example, psychotherapeutic counseling may be helpful in maintaining the functionality of your joints and improving your health. Ideally, rheumatologist, family doctor, orthopedist, physiotherapist, occupational therapist and psychotherapist work closely together to achieve the greatest possible therapeutic success.
Today, RA can be treated well with medication and many people with RA can lead a relatively uncomplicated life. In rare cases, however, it may be necessary to consider surgery, especially if the hands are severely affected and very limited in their ability to move. Your doctor can advise you if necessary.
Therapy pays off
For the success of the treatment, it is also crucial that you comply with the treatment recommendations of your rheumatologist; Adherence to prescribed therapy leads to superior outcomes.
Adherence to therapy means: you should "collaborate" and
- take the prescribed medication according to plan,
- perform recommended movement exercises,
- follow the advice and tips of your treatment team, eg on nutrition or smoking,
- tell your doctor if you have any difficulties or side effects in the implementation of your treatment.
It is therefore important that you are aware of your illness and treatment and understand why the instructions of the doctor, practice team, physiotherapist, occupational therapist and psychotherapist are important. Join in - because whether your therapy is successful is also in your hands!