Experts recommend that.
1, rheumatoid arthritis patients should first correctly understand the disease, establish confidence in overcoming the disease; in addition, it is important to recognize that the treatment of rheumatoid arthritis requires a long-term process and a certain amount of patience.
2, determine the disease activity and factors affecting the prognosis is important for the selection of treatment options, such as long-term smoking, high titers of rheumatoid factor (RF) and anti-cyclic citrulline (CCP) antibodies, early radiological bone erosion suggests that patients have a poor prognosis and require active treatment.
3, in rheumatoid arthritis treatment process emphasizes early, combined and targeted treatment strategies.
4, non-steroidal anti-inflammatory drugs (NSAIDs) are ubiquitous and can be used in all stages of rheumatoid arthritis. They are the most widely used group of drugs that can rapidly relieve patients’ symptoms and are divided into two categories: topical and oral. In the process of application emphasizes the type and dosage of individualized, generally choose a NSAIDs full dose of treatment, ineffective switch to another, avoid the use of two or more NSAIDs at the same time.
5, early treatment refers to the patient once the diagnosis of rheumatoid arthritis should be started to change the condition of drugs (DMARDs) treatment, these drugs are also known as slow-acting anti-rheumatic drugs. Among them, methotrexate and leflunomide are the basic drugs and can be the first choice of treatment. For patients with no poor prognostic factors and moderately active disease, antimalarials or sulfasalazine may also be used.
6.Combination therapy is the choice for active patients whose disease cannot be relieved by a single drug or with multiple poor prognostic factors. The combination of DMARDs (two or three) or the combination of DMARDs and biological agents can be chosen.
7.Target therapy means to achieve disease remission or low disease activity in as short a time as possible by continuously adjusting the treatment regimen and regular evaluation, and finally to achieve sustained maintenance of remission or low disease activity.
8.Biological agents are a new treatment for rheumatoid arthritis, and currently the main application in China is tumor necrosis factor (TNF) antagonists. The treatment of rheumatoid arthritis needs to be combined with DMARDs (such as MTX).
9, when a TNF antagonist treatment is ineffective, another TNF antagonist can be used, or other biological agents, such as Abciap, rituximab, IL-6 receptor monoclonal antibody, etc.
10. Patients with refractory rheumatoid arthritis who have contraindications to biologics or traditional DMARDs may choose azathioprine (AZA), cyclosporine (CsA), and cyclophosphamide (CTX) as monotherapy or combination therapy.
11, glucocorticoid treatment of rheumatoid arthritis should be strictly controlled indications, systemic treatment should be applied in combination with slow-acting anti-rheumatic drugs. Indications: (1) Patients for whom other drug treatments are ineffective, emphasizing small doses and short courses of treatment. (2) In patients with severe rheumatoid arthritis such as combined vasculitis, glucocorticoids can be used for rapid control of the disease. (3) Local application, such as a single arthritis is obvious, intra-articular injection can effectively relieve the inflammation of the joint.
12.A variety of botanicals have been used for rheumatoid arthritis, such as Radix et Rhizoma Polygoni, Radix et Rhizoma Paeoniae Generalis and Radix et Rhizoma Green, which can assist other drugs to quickly relieve patients’ clinical symptoms and achieve clinical remission, but their mechanism of action needs to be further explored.
13.Immunopurification therapy can remove pathogenic factors in blood (such as autoantibodies, a large number of circulating immune complexes and hyperimmunoglobulins, etc.) to rapidly improve patients’ clinical symptoms. Immunopurification therapies commonly used today include plasma exchange, immunosorbent and lymphocyte/monocyte removal.
14. If the patient achieves sustained remission, a gradual reduction of the drug may be considered, first by reducing or discontinuing glucocorticoids and second by reducing biologics, especially when biologics are used in combination with other heirloom DMARDs. If the disease continues to remit, cautious adjustment can be made to reduce the dose of MTX or other traditional DMARD.
15. When adjusting the treatment plan, in addition to assessing the disease activity, a combination of factors such as the presence of progressive bone erosion, comorbidities, and the safety of the drug should be considered.
Precautions.
1, in the process of treating rheumatoid arthritis, the disease activity should be evaluated periodically and the treatment plan should be adjusted in a timely manner. Generally evaluated every 3-6 months.
2, regardless of the application of drugs, should be regularly monitored for adverse drug reactions, regular checks of liver, kidney function and blood, urine, stool routine. Problems found in time to adjust the medication.
3, for patients with gastrointestinal adverse reactions, timely addition of protective gastric mucosa agents.
4. Patients applying glucocorticoids should pay attention to the addition of vitamin D and calcium to reduce the risk of osteoporosis and fracture in patients. For long-term application, changes in blood glucose and blood pressure should be detected.
5.Before choosing biological agents, tuberculosis, hepatitis virus, active infection and tumor should be screened.
6.Fundus examination should be done regularly when applying antimalarial drugs.
7.Pay attention to smoking cessation, physical therapy, joint function exercise and treatment of complications during the treatment.