Rheumatoid Arthritis is a chronic systemic inflammatory disease of unknown etiology with predilection for joint involvement. Its etiology is not known, but is presumed to involve autoimmune reactions.

Diagnosis: American College of Rheumatology criteria: 4 of the 7 criteria must be present.

Treatment:

Non-Drug treatment:

• Should be managed by co-ordinated multidisciplinary care (including Physiotherapy and Occupational therapy).

• Acute flare-ups: Rest affected joints, use of day and/or night splints

Drug Treatment:

First line

Non-steroidal anti-inflammatory Drugs

Aspirin, 600-1200mg p.o. tid daily

S/E: gastritis, gastrointestinal bleeding, salicylism (tinnitus, decreased hearing, vertigo)

C/I: gastric, duodenal ulcers, haemorrhagic diathesis, hypersensitivity to salicylates and other similar substances.

Dosage forms: tablet, 100mg (soluble), 300mg, 500mg(enteric coated)

OR

Ibuprofen, 400-800 mg p.o. 3 times daily

(For S/E, C/I and Dosage forms, see page 36)

Comments:

Reduced NSAID doses have to be used in the elderly and inpatients with impaired renal function. Concomitant use of more than one NSAID only increases toxicity, and has no additional benefit.

If no improvement, refer the nearby district hospital.