Most anti rheumatic drugs are "slow doctors"? Avoid these methods for treating rheumatoid arthritis

Rheumatism refers to a large category of diseases that affect bones, joints, and surrounding soft tissues, totaling more than ten categories and over a hundred diseases. Senile degenerative osteoarthritis is one of the rheumatic diseases

Rheumatism refers to a large category of diseases that affect bones, joints, and surrounding soft tissues, totaling more than ten categories and over a hundred diseases. Senile degenerative osteoarthritis is one of the rheumatic diseases.Rheumatoid arthritis is the most common rheumatic disease that harms middle-aged and young men and women.

Rheumatoid arthritis has an unknown etiology and is a chronic, symmetrical, destructive, and systemic disease involving small joints. It can be accompanied by external organ involvement such as pulmonary interstitial lesions, kidney, heart, and nervous system damage. Clinical manifestations include morning stiffness, swelling and pain in the wrist, metacarpophalangeal, and proximal interphalangeal joints of both hands, limited joint activity, and even joint deformities.

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Its onset may be related to genetics, infection, sex hormones, and environment. In a state of continuous inflammation, the disease continues to progress, and cartilage and bone tissue are constantly eroded and destroyed. In severe cases, joint deformities and even disabilities often occur without systematic treatment.

In China, the prevalence rate of rheumatoid arthritis is 0.4%, with a population of 7 million. The male to female ratio is about 1:4, and the disability rates for patients with a course of 1-5 years, 5-10 years, 10-15 years, and over 15 years are about 19%, 44%, 48%, and 61%, respectively. It can be seen that rheumatoid arthritis is one of the main diseases that cause labor loss and a decrease in quality of life.

Anti rheumatism, "hot tofu cannot be eaten in a hurry"

The main purpose of treating rheumatoid arthritis is toReduce joint inflammation response, inhibit disease development and irreversible bone destruction, try to protect joint and muscle function, strive to alleviate the condition, and improve the patient's quality of life. It involves many aspects, such as patient education, early treatment, combined medication, individualized treatment scheme, functional exercise, psychological support and other comprehensive treatment measures. Of course, medication is the most important means.

The drug treatment plan should follow the principle of individualization,The therapeutic drugs mainly include non steroidal anti-inflammatory drugs, glucocorticoids, drugs for improving the condition (methotrexate, leflunomide, hydroxychloroquine, sulfasalazine tablets, etc.), biological agents (etanercept, adalimumab, rituximab, etc.) and botanical drugs (tripterygium wilfordii, sinomenine, total glucosides of paeony, etc.).

Many people have been ill for many years and have tried various medications. Not only have they not been cured, but they have also become increasingly serious. Why is it that some people can cure the same disease and medicine, but their condition repeatedly fails to cure? Organize the medication and treatment history of these patients,The following misconceptions have been identified,It may also be the reason why their condition is not well controlled.

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Myth 1:Frequent dressing changes.

There is a saying that goes, "You can't eat hot tofu in a hurry." Drugs for treating rheumatoid arthritis generally take longer to take effect, such as methotrexate and leflunomide, which are slow acting drugs that need to wait for a period of time to take effect. The onset time varies from person to person, and some patients may even need 6 months to take effect. For example, methotrexate generally takes 1-2 months to take effect, while Tripterygium wilfordii takes 3 months to take effect.

Some patients are not very familiar with this, and after taking it for a period of time, they feel that the medicine is not effective and want to try other special drugs. Such blind dressing changes not only fail to achieve therapeutic effects, but also delay the progression of the condition, making it increasingly difficult to treat.

Mistake 2:Unauthorized withdrawal of medication.

After taking medication for a period of time, the swelling and pain in the joints have disappeared. Some patients, thinking that their illness has improved, arbitrarily stop or reduce their medication. In fact, it's just that the condition is just beginning to improve, and stopping the medication at this time is prone to recurrence.

Joint swelling and deformation are visible symptoms, but indicators such as erythrocyte sedimentation rate, CRP (C-reactive protein), and anti CCP (cyclic citrulline peptide) antibodies are not visible to the naked eye. When you think the swelling and pain disappear, the disease is cured, but in fact, those invisible inflammatory indicators are still at a high level, and the consequences of stopping medication at this time are very serious. After reaching the treatment standard, medication discontinuation should follow medical advice and be gradually carried out according to the situation.

Given the numerous poor prognosis of chronic diseases such as rheumatoid arthritis, it is not recommended to completely discontinue traditional anti rheumatic drugs.

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Mistake 3:Multi drug combination.

Some patients have poor disease control, causing great harm to their physical and mental health. In order to achieve faster results, they also consult different doctors and use multiple drugs without authorization, or even increase the dosage without authorization. This can actually lead to recurrence of the condition.

Rheumatoid treatment is a slow process that cannot be stopped immediately if it does not cause pain, nor can one trust folk remedies with unknown ingredients. Even if the medication is stopped, it should be gradually reduced according to the recovery situation and according to the doctor's advice in a planned manner. The patient's immune function also needs to adapt slowly during the reduction process. Patients with rheumatoid arthritis who have good control gradually improve their immune function, and after years of follow-up after treatment, there is basically no recurrence.

Myth Four:There is no regular review.

Review or follow-up is very important in chronic disease control because:

One is to check the body's responsiveness to drugs, whether the disease progression has been effectively controlled, to facilitate subsequent adjustments in medication, whether methotrexate needs to be maintained or increased in dosage, and whether corticosteroids should be taken for a long time. It is necessary to decide whether to reduce or stop based on the results of the follow-up examination.

Also, check if any adverse drug reactions have harmed human health. Many drugs need to be metabolized in the liver, and if the drugs damage the liver, it can cause great trouble for the body.

Moreover, such drugs can sometimes cause severe bone marrow suppression, and follow-up examinations can help everyone detect and prevent these serious adverse reactions early.

Author | Xu Nongzhang, Deputy Chief Pharmacist of Zhoupu Hospital Affiliated to Shanghai Health Medical College

Li Zhongdong, Chief Pharmacist and Doctor of Huashan Hospital Affiliated to Fudan University

Source: Family Medicine, April 2023, Issue 7

Editor | Li Jiahua

Proofreading by Zheng Ke

Second instance | Zhang Yue

Final Trial | Liu Huiying, Zhang Ruxian

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