Rheumatoid arthritis is a chronic systemic disease of connective tissue, which is characterized by inflammatory damage mainly to small joints. As a result of the pathological process, arthritis develops, which leads to deformation of the joint tissue and further dysfunction of the joints. In most cases, the disease occurs in middle-aged (over 35) and elderly people. (see “Rheumatoid Arthritis” for more details)
Modern medicine does not yet have the means to completely cure rheumatoid arthritis. However, complex drug therapy helps to achieve stable remission. Its purpose is:
The following groups of drugs are mainly used:
This group of drugs is prescribed to eliminate pain and reduce mild inflammation. In case of severe or prolonged course of the disease, their use is useless: NSAIDs cannot eliminate the consequences of the destructive effects of arthritis.
To achieve results, medications should be taken regularly and in strict dosage. The first results usually appear within a few days.
When using non-steroidal drugs, you must adhere to some rules:
1. Treatment begins with drugs that have minimal toxicity. They are easily absorbed and quickly eliminated from the body. The most commonly used:
2. Significantly more “heavy” drugs are prescribed in complex cases and mainly in patients with minimal risk of developing adverse reactions from the stomach, kidneys and cardiovascular system. They are eliminated from the body over a longer period of time. The main assets of this group are:
3. The main criterion for continuing treatment is the effectiveness of the drug used. If there is no result within 3 days to 1 week, it should be replaced with another one.
NSAIDs can have a number of side effects:
The main treatment for rheumatoid arthritis is basic drugs, or slow-acting second-line drugs. Experts believe that they influence the very root of the development of pathology.
The effect of taking them is to achieve a state of remission, prevent or slow down the destruction of the affected joints. They do not have an anti-inflammatory effect.
The basis of basic therapy currently is the use of the following groups of medications:
1. Cytostatics were borrowed from oncologists. However, in the treatment of rheumatoid arthritis, they are used in much smaller doses (about 5-20 times), so side effects appear less frequently and are not severe.
The patient's condition improves after 2-4 weeks.
The most popular drugs in this group are:
2. Antimalarials have been used for a very long time in the treatment of tropical fever. In the 20th century, they were found to affect the activity of rheumatoid arthritis when used over a long period of time. However, these remedies act very slowly: the first result appears after 6 months, sometimes even a year. Their advantages are minor side effects and good tolerability.
The following drugs are used for rheumatoid arthritis:
3. Sulfonamides are antimicrobial agents that have been successfully used in the treatment of arthritis.
In terms of effectiveness, drugs in this group are almost as effective as cytostatics.
Their main advantage is the rare occurrence of adverse reactions and good tolerability. The disadvantage is the need for long-term use - from 3 months to 1 year.
4. Penicillamine or cuprenil is prescribed if there is no effect from the use of cytostatics. The drug is quite toxic and often leads to the development of adverse reactions.
Medicines in this group are also called biological.
They are one of the newest types of drugs for the treatment of rheumatoid arthritis (preventing or reducing inflammation). Their action is to inactivate a special protein - tumor necrosis factor (briefly: TNF), which plays one of the main roles in the development of the inflammatory process.
The effect of using biological response modifiers manifests itself quite quickly (compared to basic agents). This requires 2 to 4 weeks.
Drugs in this group are used separately or simultaneously with other antirheumatic drugs: glucocorticoids, non-steroidal anti-inflammatory drugs or basic medications.
All products in this group are used in the form of injections. They should not be combined with each other due to the increased risk of side effects.
The main biological response modifiers:
It must be borne in mind that biological modifiers suppress the immune system (i.e., have an immunosuppressive effect). Therefore, their use is advisable only in the case of treating patients with dangerous forms of arthritis.
Glucocorticoids have a strong anti-inflammatory effect. This group includes prednisone and prednisolone.
In a short period of time they relieve the symptoms of the disease:
The drugs are administered orally, as well as through intravenous injections or injection directly into the affected joint.
When used alone, glucocorticoid drugs are not very effective in reducing damage to bone and cartilage tissue. They are mainly prescribed for severe rheumatoid arthritis, which significantly reduces the patient’s quality of life.
For these patients, the use of glucocorticoids is a means to relieve symptoms and maintain normalcy until other (more effective but slower-acting) medications take effect.
The main disadvantage of glucocorticoid drugs is the large number of side effects:
Due to the presence of many adverse reactions, drugs in this group are used only when absolutely necessary, in very small doses and for a short period of time.
Painkillers make patients feel better, but not all of them have an anti-inflammatory effect.
The main drugs in this group are:
Tramadol (a synthetic opioid) belongs to the group of narcotic drugs, but in the usual dosage it does not lead to the development of complications. It has a number of contraindications and is not recommended for long-term use.
The use of narcotic analgesics is not justified due to the long course of the pathology and the risk of developing painful dependence on these drugs.
Inflammatory joint disease can be caused by an abnormal immune response of the body, genetic factors, previous injuries, pathogenic infection that penetrates the skin, respiratory and urogenital tract. Such a wide range of causes of arthritis also implies a variety of treatment with medications, physiotherapy, and rehabilitation exercises. Treatment in each case is carried out individually, taking into account the stage of the disease, the severity of clinical symptoms, and the age of the patient. In this article we will look at the main drugs used to treat arthritis of the joints.
The treatment regimen for post-traumatic or infectious arthritis is generally clear - it is:
The difficulty of treating rheumatoid arthritis is that with this disease, in addition to the need to combat the inflammatory process, there is a need to regulate immunological reactivity with the help of basic drugs
In this regard, rheumatoid arthritis must be treated with first, second and third line drugs, and treatment is delayed for a long period:
Today our pharmaceutical industry produces an abundance of anti-inflammatory medications.
The action of NSAIDs is based on the inhibition of cyclooxygenase, which is responsible for the synthesis of participants in inflammatory processes - prostaglandins
NSAIDs include traditional COX-1 inhibitors, which have been used for a long time, and newer COX-2 inhibitors, designed for longer use and with fewer side effects.
NSAIDs are available in the form of:
Before use, be sure to read the instructions, which should indicate:
Among the first-line NSAIDs, the following drugs are known:
Aspirin (acetylsalicylic acid) —
Diclofenac (Voltaren, Ortofen) is a traditional and inexpensive NSAID with good anti-inflammatory and analgesic properties and moderate antipyretic properties.
Ibuprofen (brufen, marcofen, burana) is a phenylpropionic acid derivative related to NSAIDs COX-1 inhibitors
Indomethacin (indomine, indobene, methindole):
In addition to these drugs, they are widely used in the treatment of arthritis:
All of the above NSAIDs have a number of side effects that prevent their long-term use:
COX-2 inhibitors include the following NSAIDs:
These drugs can be used for a long time, since they have fewer complications, however, the opinion of rheumatologists regarding the effectiveness of these drugs in the treatment of rheumatoid arthritis is ambiguous. We must not forget that all NSAIDs (inhibitors of both COX-1 and COX-2) only affect the symptoms, but not the nature of the disease itself. Therefore, they are recommended to be used in combination with basic products.
The basic drugs include the following basic drugs:
If first-line drugs turn out to be ineffective, and rheumatoid inflammation in the joints does not recede, then they resort to stronger drugs belonging to the group of glucocorticoid drugs - GCS. The effectiveness of these drugs is explained not only by their anti-inflammatory properties, but also by their partial immunosuppressive activity
GCS treatment is carried out both local and systemic:
The effect of cortisol is enhanced by simultaneous injection of an immunosuppressant into the joint: for example, cyclophosphamide - from 100 to 200 mg
These drugs lengthen the intervals between courses of intra-articular injections
The effect of taking GCS occurs very quickly, but disappears just as quickly after GCS is discontinued.
Corticosteroids are prescribed with great caution to children and adolescents, as well as the elderly.:
Third-line drugs include cytostatics - aggressive and harmful drugs.
In the treatment of rheumatoid arthritis, such a scheme is rarely used:
Cytostatics include:
Therapy with cytostatic drugs is carried out in a hospital setting, with constant clinical and laboratory monitoring:
Therapy is combined with the use of immunomodulators, for example, levamisole.
Genetic engineering biological therapy (GEBT) in the treatment of arthritis is a targeted medicine that, with a minimum of consequences, can selectively destroy target molecules responsible for autoimmune inflammatory processes
These cells are recognized as:
Examples of such monoclonal drugs are respectively:
These biological drugs are used in combination:
GIBT is a very effective treatment for RA, but it is not without its drawbacks. These include:
Drug treatment of joint inflammation takes a long time and is usually divided into three stages:
The selection of drugs, as well as their combinations at each stage is selected by a rheumatologist.
Independent choice of medications in the treatment of such a complex disease is completely unacceptable.
Video: Treatment of arthritis with homeopathic medicines
Numerous types of medications for rheumatoid arthritis can only be taken after consultation with a specialist. Under no circumstances should you experiment and diagnose yourself! Drugs for rheumatoid arthritis are quite strong, however, despite this, it is impossible to completely cure rheumatoid arthritis.
Rheumatoid arthritis is a systemic connective tissue disease that is chronic in nature. In rheumatoid arthritis, small joints are most affected. The disease entails deformation of the joints and disruption of their function. It is most often observed in people over 35 years of age. Currently, cases of rheumatoid arthritis are also found in younger people.
Doctors prescribe treatment measures only after a complete examination and confirmation of the diagnosis. Thanks to the combined use of medications, long-term remission can be achieved. Goals of treatment:
To provide adequate therapy, the following subgroups of medications are used:
Nonsteroidal anti-inflammatory drugs are used to relieve pain and reduce inflammation in the joint. If a person has a difficult course of this disease, then taking this subgroup of drugs will not have a significant effect. NSAIDs are not able to eliminate the destructive effects of rheumatoid arthritis.
Medicines are taken daily, and the dosage must be strictly observed. The improvement is noticeable within a few days of starting to take the medicine. There are several rules for taking NSAIDs for rheumatoid arthritis:
They rarely cause side effects from the stomach, intestines, urinary system, and heart. It takes much longer for drugs to be eliminated from the body.
Basic drugs are the main method of treatment for rheumatoid arthritis. Scientists believe that they significantly influence the cause of the disease.
Thanks to basic therapy, long-term remission can be achieved and the destructive effect on joints can be prevented. But these medications do not provide the anti-inflammatory effect that is so necessary for rheumatoid arthritis.
The following subgroups of medications are considered the most used:
Cytostatics are drugs that are used to treat rheumatoid arthritis and various cancers. Cytostatics are used in small dosages (unlike in the treatment of oncology). Side effects are very rare. After taking cytostatics, the result is observed after 2-4 weeks.
Medicines in this group of drugs:
With the help of these funds, doctors are effectively fighting tropical fever in other countries. In the 20th century, scientists discovered that antimalarial drugs also have a fairly good effect in the treatment of rheumatoid arthritis. But the positive effect of taking medications is not observed quickly. The first positive changes can be noticed only 6 months after starting to use the medicine. The drugs are well tolerated by patients.
Antimalarial medications used for rheumatoid arthritis include:
Medicines of the sulfonamide subgroup have an antimicrobial effect and are highly effective in rheumatoid arthritis. The drugs are strong and not inferior to cytostatics.
They are well tolerated and have virtually no side effects. There is one drawback - taking sulfonamides is long-term, at least 3 months.
The drug has a synonym - cuprenil. It is prescribed if there is no effect from taking cytostatics for rheumatoid arthritis. Cuprenil is very toxic and often causes side effects.
Biological response modifiers are a biological group of drugs. They have been developed recently and are considered the newest drugs. They prevent the process of inflammation and reduce it. The main effect of these drugs is the destruction of tumor necrosis factors (this is a special protein that plays a leading role in the development of inflammation).
The effectiveness of the intake is high. A positive effect in the treatment of rheumatoid arthritis is observed after 2-4 weeks.
Usually the drugs are used in combination with:
Combinations of two drugs belonging to this group at once are unacceptable. You can use only one MBO drug, without combining it with drugs from other groups.
Medicines for rheumatoid arthritis are administered intramuscularly. The most commonly used drugs are:
Modifiers significantly reduce the body's immune defense. Experts recommend these medications only for dangerous forms of rheumatoid arthritis.
Glucocorticoid drugs are often used to treat rheumatoid arthritis. They provide a powerful anti-inflammatory effect. The most common drugs in this group are:
They are good at eliminating the symptoms of rheumatoid arthritis. The main action of glucocorticoids:
Medicines are used in three ways: through intramuscular injection, the use of tablet forms, and injection into the affected joints.
Glucocorticoids are quite strong, so they are recommended in severe stages of rheumatoid arthritis. Drugs in this group also have disadvantages:
Glucocorticoids for rheumatoid arthritis are prescribed in very small dosages for a short period. It is not recommended to take them for a long time.
It is the analgesic effect that improves the condition of a sick person with rheumatoid arthritis. But not all drugs can have two effects at once - pain relief and reduction of inflammation.
Non-narcotic analgesics include:
Sometimes doctors prescribe tramadol, although it is classified as a narcotic drug. It should not be taken for a long period. Before prescribing it, you need to familiarize yourself with all its possible side effects and contraindications.
Aurotherapy, or taking medications containing gold, has been used in medicine for about 100 years. These drugs were first used in the 20th century. Gold preparations are:
Previously, drugs of this group were actively used in the treatment of rheumatoid arthritis. But recently a drug called methotrexate was introduced, which was put in first place in the treatment of rheumatoid arthritis. Pros of methotrexate:
If the patient is not suitable for methotrexate, then doctors recommend gold medications.
Gold-based medicines are good for people with rheumatoid arthritis in the early stages of development. But such drugs have proven themselves well even at a progressive stage, severe pain in the joint. Gold preparations are mainly prescribed for seropositive rheumatoid arthritis.
Gold-based medicines are good at stopping the progression of the disease, thereby preventing the destruction of cartilage in the joints.
A positive effect is observed after 2-3 months of their use. The most significant effect will appear only after 6-12 months. If no positive dynamics are observed within 4 months, then gold preparations must be replaced with other medications.
Side effects are:
Many medications are free if the patient has a disability.
Additional points in the treatment of rheumatoid arthritis are:
If you have rheumatoid arthritis, you need to reduce your intake of these foods. It is necessary to eat as much seafood, fish, buckwheat, fresh vegetables and fruits as possible. Food should be boiled or stewed. Nutrition for rheumatoid arthritis is done in fractions and often.
Rheumatoid arthritis is one of the most common joint diseases. This disease is systemic autoimmune in nature and is difficult to treat. The disease mainly affects older people; in the absence of adequate therapy, the disease leads to severe and disabling complications.
The issue of choosing adequate therapy for a disease such as rheumatoid arthritis is very urgent; treatment should be carried out on a regular basis and under the supervision of a specialist.
How to treat rheumatoid arthritis? It is very difficult to choose the optimal treatment regimen for rheumatoid arthritis; treatment should include both drug and non-drug measures. The rheumatologist selects a comprehensive treatment regimen that includes the following principles for the treatment of rheumatoid arthritis:
Irreversible joint deformities can only be treated surgically.
What to treat rheumatoid arthritis should be selected by a specialist. Today, the problem of treatment is dealt with by rheumatologists, and the patient should get an appointment with them as soon as possible.
Treatment for rheumatoid arthritis seriously changes a person's life. It is necessary to adapt to new habits, do gymnastics regularly, and change your diet.
However, the most serious difficulties are associated with the selection of drug therapy. In the treatment of rheumatoid arthritis, various groups of drugs are used, which can be divided into several categories:
Drug treatment for rheumatoid arthritis can be achieved through a variety of means. We will try to understand the nuances of using each group of drugs.
The disease we are describing is systemic in nature and includes not only arthritis; the rheumatoid process can also affect other organs. In this case, medications that relieve inflammation are needed.
Symptomatic medications for rheumatoid arthritis serve several purposes. These drugs allow you to:
Symptomatic remedies can be used in the form of tablets, ointments or injections. The choice of dosage form depends on the severity, type of joints affected, and the presence or absence of extra-articular manifestations.
Symptomatic medications for rheumatoid arthritis are almost always nonsteroidal anti-inflammatory drugs (NSAIDs). Also, to relieve symptoms at the height of inflammation, glucocorticosteroids, which were previously classified as basic drugs, can be used.
It is important to remember that symptomatic medications do not affect the prognosis, do not reduce the rate of disease progression, and do not reduce the frequency of exacerbations. That is why such medications are prescribed only in short courses.
NSAIDs are a very large group of drugs that belong to various chemical compounds. The means are united by a common mechanism of action:
All drugs from this group can cause side effects, so they are used with great caution. Adverse drug reactions include:
To minimize these side effects, special non-steroidal drugs have been developed, which are called selective:
These medications cause fewer side effects. To further reduce their negative impact on the stomach, proton pump inhibitors - omeprazole, pantoprazole, esomeprazole - are used simultaneously.
NSAIDs should not be used if there are contraindications:
Nonsteroidal drugs are available in a wide variety of dosage forms. If external agents are effective, systemic use of tablets and injections is not required.
Another group of anti-inflammatory drugs used to relieve the symptoms of arthritis are glucocorticosteroids. These drugs are analogues of our own hormones synthesized by the adrenal glands.
They effectively relieve inflammation both when used systemically (injections and tablets) and locally - gels and ointments, intra-articular injections.
Previously, corticosteroids were used for the basic treatment of arthritis, but today this strategy is gradually being abandoned. This is associated with a large number of side effects. The most popular drug from this group, prednisolone, can cause the following undesirable reactions:
That is why prednisolone is used systemically for rheumatoid arthritis to relieve inflammation. It is worth mentioning that sometimes steroids are used in the form of basic drugs in the following situations:
Prednisolone and its analogues are not used for:
The drug prednisolone is used systemically. The listed side effects can be avoided by using its analogues in the form of intra-articular injections - Diprospan, dexamethasone.
They are used for severe inflammation in a large joint; they effectively relieve symptoms, but have a destructive effect.
Basic drugs that eliminate arthritis play a key role in the treatment of the disease today; rheumatologists know how to treat the disease with these drugs.
Regardless of the chemical structure, all basic drugs have the following characteristics:
Today, the basis of basic therapy is cytostatics (methotrexate, leflunomide, sulfasalazine). Previously, gold preparations and the glucocorticosteroids described above were widely used for this purpose.
Methotrexate is now recognized as a first-line drug for the treatment of rheumatoid arthritis. The dosage of the medicine is determined by the doctor and increases it gradually until the most acceptable one is reached. Methotrexate tablets and injections are used once a week, and folic acid is used 24 hours after taking it to avoid side effects of the drug.
Methotrexate and other cytostatics suppress the activity of the immune system, preventing leukocytes from actively dividing and producing antibodies. This mechanism allows you to stop inflammation, but leads to unpleasant side effects:
When these effects appear, doctors try to replace methotrexate with analogues - leflunomide and sulfasalazine. However, these drugs are less effective in reducing the activity of the rheumatoid process.
Methotrexate should not be used if the following conditions are present:
An analogue of cytostatic therapy is the use of gold-based drugs - aurothiomalate and aurothioglucose. These drugs were synthesized at the beginning of the 20th century and were previously widely used for the treatment of arthritis, but were almost completely replaced with the beginning of treatment with methotrexate.
Today, medications can be used in rare situations and in the absence of side effects, which occur in a third of patients:
Medicines are used almost exclusively parenterally - in the form of intramuscular injections. You should not expect a quick effect after starting treatment. Like other basic products, gold preparations begin to act after 2-6 months.
There is a drug for oral administration - Auranofin. This medicine is less effective than parenteral forms, but is less likely to cause severe complications. In addition to the listed reactions, nausea, diarrhea and loss of appetite may occur after taking the drug.
Gold preparations can only be prescribed by a rheumatologist. The specialist should consider the use of other, more effective means, and only then use these medications.
Many scientists today are trying to find more effective ways to treat a disease such as rheumatoid arthritis; new generation drugs are called biological genetic engineering drugs.
Biological drugs for the treatment of rheumatoid arthritis belong to various chemical groups, but are most often monoclonal antibodies. They have a rather complex mechanism of action, which is still being studied by doctors and scientists.
Biological agents in the treatment of rheumatoid arthritis have the following properties:
Examples of drugs from this group: adalimumab, certolizumab, etanercept, golimumab, infliximab. These medications may be used along with methotrexate if necessary.
In order to decide whether to change the therapy, doctors always evaluate the activity of the disease before and after treatment. For this purpose, there is a special indicator DAS-28, improvement of which is one of the criteria for successful therapy.
The doctor determines remission in the following situations:
These indicators can indicate the success of the treatment. If they are not achieved, it is necessary to continue the selection of effective therapy for the disease.
Rheumatoid arthritis is a serious disease that a person has to fight from the moment of diagnosis for the rest of his life.
Treatment is complex and includes a number of drugs and techniques:
Let's start our conversation with basic therapy, since it, as the name suggests, is the basis of the treatment of rheumatoid arthritis, and every patient with this serious disease has to deal with it.
Why is the word “basic” in the title? Mainly, not because this is the main method of treatment, but because drugs from this group affect the very essence of rheumatoid arthritis, that is, its “basis”. They do not cause relief for several days or even weeks after starting to take it. These drugs give a pronounced effect no sooner than after a few months, and they are taken in the hope of slowing down the course of the disease, or better yet, driving RA into deep remission.
The long wait for results is not the only disadvantage of basic therapy. Each of the drugs included in it is effective in its own way. But the reaction of different patients is different, so when drawing up a treatment plan, the rheumatologist has to rely not only on medical statistics. You need to include your medical intuition and evaluate each patient as an individual.
Modern basic therapy includes drugs of five groups:
Let us consider in detail the pros and cons of each of the five components of basic therapy and try to understand how to achieve the best effectiveness and good tolerability of treatment for rheumatoid arthritis.
The beautiful word “aurotherapy” refers to the ingestion of gold salts for therapeutic purposes. This technique is very old - it has been known since 1929, and it has been used to treat patients with rheumatoid arthritis for almost 75 years. By the way, until about the beginning of the 21st century, it was gold preparations that served as the basis for the basic therapy of rheumatoid arthritis, but with the advent of other, more effective and safe drugs (primarily methotrexate), aurotherapy faded into the background. However, aurotherapy has not lost its ground at all, because there are patients for whom methotrexate simply does not help.
It is better to start taking gold medications at the very beginning stage of RA. They are most effective in the treatment of acute, rapidly developing disease with severe pain and early degenerative changes in the joints. Gold preparations should be prescribed especially if non-steroidal anti-inflammatory drugs do not bring relief to the patient.
Another reason for the immediate start of aurotherapy is the early appearance of bone erosions (usur) on x-rays and the detection of RF titers in the patient’s blood. In other words, gold preparations are almost always highly effective in the treatment of seropositive RA, but almost useless in the treatment of seronegative RA.
Gold salts, if taken for a long time, slow down the formation of cysts and cysts in the joints of patients with seropositive rheumatoid arthritis. Particularly successful are cases where aurotherapy improves the general condition of bone tissue, increases the level of its mineralization, and sometimes even heals existing bone lesions in the patient’s small joints (in the hands, feet).
Gold preparations are clearly recommended for patients with severe complications due to RA: Felty and Sjögren's syndromes. They do not eliminate the so-called “dry syndrome”, but significantly reduce its unpleasant manifestations. Also, aurotherapy is always prescribed for childhood and adolescent seropositive rheumatoid arthritis, since it is gold preparations that can slow down the development of the disease.
Perhaps the main advantage of aurotherapy over methotrexate is that gold preparations can be taken even with concomitant inflammatory diseases and malignant tumors. In addition, clinical trials revealed that gold salts inhibit the growth of fungi and some bacteria, including Helicobacter - the culprit of gastritis and peptic ulcers.
Statistics show that aurotherapy is effective in approximately 75% of cases of treatment of seropositive rheumatoid arthritis. Only this becomes clear only 2-3 months after starting to take gold preparations. If even after 4-5 months no positive changes are observed, then aurotherapy is not suitable for the patient, and it is time to cancel it. Well, a pronounced and lasting positive effect from drugs in this group is usually observed about a year after the start of therapy.
Over the years of using autotherapy in the practice of treating rheumatoid arthritis, doctors have established a certain golden, pardon the tautology, rule - the course should be completed when the total amount of gold received by the patient during treatment reaches 1 gram. By this point, all possible benefits from aurotherapy will be extracted, and there will be no point in continuing it.
However, many patients experience severe relapses of the disease some time after completing the gold treatment course. And then the question arises about re-prescribing gold preparations. But, alas, all subsequent “golden attacks” on rheumatoid arthritis end in almost complete capitulation. If you have already started taking gold salts, it should not be interrupted for as long as possible. That is why modern rheumatologists put their patients on aurotherapy for years, unless, of course, this does not entail serious complications.
Side effects while taking gold preparations occur to one degree or another in almost a third of patients. But it is curious that as soon as aurotherapy gives complications, it also brings the long-awaited effect: the condition of the patient’s joints finally improves significantly. After discontinuation of gold preparations, the side effects disappear, the progress achieved in treatment is maintained, therefore the possibility of complications itself is not considered as a valid reason for refusing aurotherapy.
Most often, taking gold salts is complicated by the so-called “golden dermatitis”. These are skin rashes in the form of small pink spots and blisters filled with clear liquid. The areas affected by dermatitis are very itchy. All these unpleasant symptoms usually disappear 3-7 days after stopping gold medications. But sometimes an itchy rash bothers the patient for months, and even taking antihistamines does not bring relief.
Golden dermatitis is aggravated by exposure to ultraviolet radiation, so if the patient has this complication, he is contraindicated for long periods of time in the sun. In advanced cases of dermatitis, the skin becomes brown and the rash itself becomes bluish. These are inclusions of gold that come out through the skin. In medical practice, there have even been episodes of necrosis of small areas of skin in patients who did not cancel aurotherapy in time. The patient must be carefully monitored in order to diagnose golden dermatitis in time and not confuse it with banal eczema or lichen.
In second place in terms of the frequency of complications during aurotherapy are various inflammatory processes on the mucous membranes: in the mouth, eyes, vagina, pharynx and intestines. In third place are non-infectious hepatitis and jaundice of the skin. All these problems can be solved very quickly by canceling aurotherapy and prescribing prednisolone.
But there is also a truly terrible side effect - “golden nephropathy”. This complication can lead to complete kidney failure. Therefore, gold preparations are generally not included in the basic therapy of rheumatoid arthritis if red blood cells and protein were found in the patient’s urine tests. Accordingly, if bad tests are obtained already during treatment with gold preparations, their use is immediately stopped.
Complications and side effects during aurotherapy either appear almost immediately (after 2-3 months) or do not occur in the patient at all, although, of course, there are exceptions. The attending physician carefully monitors the condition of his patient at the initial stage of gold therapy: examines the skin, pharynx and eyes, regularly takes blood and urine tests (at least once a month). If a rash appears, mouth ulcers, red blood cells and protein in the urine, gold preparations are discontinued. A poor blood test (decrease in the number of red blood cells, platelets, hemoglobin, neutrophils) is also a reason to cancel aurotherapy.
Why, with such an impressive list of possible complications, do gold preparations still remain relevant? First of all, because their effectiveness is on average higher than that of other components of basic RA therapy. In addition, aurotherapy is a proven method that has been tested over the years on thousands of patients. It is always difficult to give up the well-forgotten old in favor of the poorly known new.
The shorter word “cytostatics” usually refers to drugs from the group of immunosuppressants (Remicade, Arava, methotrexate, cyclosporine, azathioprine, cyclophosphamide and many others). All of these drugs suppress cellular activity, including the activity of immune cells. As you know, rheumatoid arthritis is autoimmune in nature, so it is not surprising that it is treated with cytostatics. And the technique itself was adopted by rheumatologists from oncologists who use cytostatics to fight another terrible threat - cancer.
It was cytostatics, and primarily methotrexate, that moved gold from its leadership position in the treatment of RA. Not only rheumatoid arthritis, but also psoriatic arthritis are successfully treated with immunosuppressants. Drugs in this group currently form the basis of basic therapy for RA. This fact itself often frightens patients, because almost completely losing immunity is scary. But keep in mind that in rheumatology much lower doses of cytostatics are used than in oncology, so you should not be afraid of such terrible side effects as are observed in cancer patients.
The first advantage of cytostatics is their high effectiveness at a relatively low dosage. Patients with rheumatoid arthritis are prescribed a 5-20 times lower dose of immunosuppressants than patients with oncology, but in almost 80% of cases this is enough to achieve an excellent therapeutic effect. Cytostatics have proven themselves best in the treatment of severe forms of rheumatoid arthritis with a high rate of disease progression.
The second undoubted advantage in favor of taking cytostatics is the low frequency and low severity of side effects. Only a fifth of patients complain of unpleasant symptoms:
Loose stools or constipation;
Feeling like “goosebumps” are crawling on the skin.
Once the drugs are stopped or the dosage adjusted, these side effects disappear on their own. For prevention, blood and urine tests are taken from the patient once a month in order to detect the problem in time. Malfunctions of the kidneys, liver and inhibition of hematopoiesis are possible. But usually cytostatics are well tolerated, and already a month after the start of therapy, improvements in the condition of the patient with rheumatoid arthritis are visible.
To treat rheumatoid arthritis, modern rheumatologists use three immunosuppressants: methotrexate, Arava and Remicade. Let's look at the advantages and disadvantages of each drug.
We have already mentioned methotrexate several times before, and this is no coincidence, because this particular cytostatic is the recognized leader in the basic therapy of RA. It is very convenient to take: once a week the patient needs to drink one capsule with a dosage of 10 mg. Usually the doctor and the patient agree on what day of the week they will now have “methotrexate” for many months. For example, on Mondays or Thursdays the patient will now have to take these pills, so it is difficult to mix them up or forget them.
You can usually talk about an improvement in your well-being after 4-6 weeks from the start of taking the drug, and persistent and pronounced progress in treatment – after 6-12 months. There is one important note: on the “methotrexate” day you cannot take NSAIDs, which in most cases are also included in the basic therapy for RA. On any other day of the week, you can safely continue treatment with non-steroidal anti-inflammatory drugs.
Arava is considered a very promising immunosuppressant, and many rheumatologists are transferring their patients to this new drug. But there are also doctors who consider arava to be a heavier medicine with worse tolerability compared to methotrexate. In general, we can say that Arava is prescribed as an alternative to methotrexate if the latter caused side effects in the patient.
Arava is recommended for patients with a very rapid course and rapid development of rheumatoid arthritis, when, already in the first year of the disease, serious problems with the joints appear, including loss of mobility. About a month after starting treatment, the first positive changes are usually visible, and after six months - a lasting improvement in bone condition.
Another new product in the arsenal of rheumatologists is the drug Remicade.
It differs from methotrexate, Arava and other immunosuppressants in two ways:
Very high cost.
Considering the latter feature, Remicade usually acts as something of a lifeline for patients with a severe form of rapidly progressing rheumatoid arthritis, who are absolutely not helped by methotrexate and other affordable cytostatics. Two more reasons for replacing methotrexate with Remicade are poor tolerability and the need for an urgent reduction in the dose of corticosteroids, which are also part of the basic therapy of RA. As you can see, there are enough reasons to prescribe Remicade, but sometimes they are outweighed by the high cost of the drug.
The high efficiency and speed of action of Remicade has a downside: this medicine has many side effects and contraindications. Before starting to take the drug, you need to carefully examine the patient and heal absolutely all inflammatory processes detected in him, even hidden and sluggish ones. Otherwise, after starting therapy in conditions of suppressed immunity, all these infections will “raise their heads” and lead to serious problems, including sepsis.
It is recommended to preventively combat possible side effects, including an itchy rash, with the help of antihistamines. It is very important for women to carefully protect themselves while taking Remicade, since both pregnancy and breastfeeding are absolutely impossible during this period. Moreover, you can think about motherhood at least six months after finishing treatment with Remicade.
Of course, there are other immunosuppressants, including more affordable ones:
But all these drugs did not perform well during clinical trials - the frequency of side effects is very high, and complications, as a rule, are more serious than when taking the same methotrexate. Therefore, abandoning the three most popular cytostatics in the basic therapy of RA is advisable only if they do not provide any effect or are poorly tolerated.
The drugs delagil (resoquine, chloroquine, hingamine) and plaquenil (hydrochlorin, hydroxychlorin) have been used in medicine for a very long time as a remedy against the tropical disease malaria. But what does rheumatoid arthritis have to do with it, you ask? The fact is that in the middle of the last century, scientists who were looking for at least some new and effective medicine for the treatment of RA tried almost all types of anti-inflammatory drugs, because rheumatoid arthritis had long been considered just a special type of infection. One of these studies brought good news - delagil and plaquenil slow down the course of RA and reduce the severity of its manifestations.
However, antimalarial drugs occupy, perhaps, the most modest place in modern basic therapy for RA, since they have only one advantage - good tolerability. But they have one drawback, and a very serious one at that - they act very slowly (improvement occurs only after six months or a year) and even if successful, they provide a weak therapeutic effect.
A natural question, because there are drugs that act faster and work better. But medicine is one of those branches of science where prejudices and the elementary force of inertia are very strong. Thirty years ago, basic therapy for RA was based on the following principle: first delagil and plaquenil, then gold, if that doesn’t help, D-penicillamine or immunosuppressants, and if all else fails, corticosteroids. That is, the direction was chosen from the most harmless to the most potentially dangerous. But if you think about it, this principle of constructing basic therapy is criminal in relation to the patient.
Suppose a person has acute, rapidly developing rheumatoid arthritis with severe pain and rapidly degrading joints. Is it reasonable to wait six months for antimalarial drugs to work (the question is: will they work?), if stronger and more effective drugs can be prescribed? Even if side effects occur, it is better than just watching a person suffer and see how the condition of his joints catastrophically worsens every day.
But there are, nevertheless, cases when antimalarial drugs are still relevant:
The patient tolerates all other drugs from the basic therapy of RA very poorly;
Drugs considered more effective did not produce any effect;
Rheumatoid arthritis is very mild and develops slowly, so there is no need to resort to the most powerful but dangerous means.
Salazopyridazine and sulfasalazine are two sulfonamide drugs that have been successfully used in the treatment of rheumatoid arthritis.
If you try to create a hit parade according to the degree of effectiveness among drugs for basic therapy of RA, it will look something like this:
In first place is methotrexate;
On the second - gold salts;
In third place are sulfonamides and D-penicillamine;
In fourth place are antimalarial drugs.
Thus, sulfonamides cannot be considered among the leaders in effectiveness, but they have huge advantages:
Good tolerability (incidence of side effects – 10-15%);
Low severity of complications, if any;
Sulfonamides have only one drawback, but a significant one - they act slowly. The first improvements are visible only three months after the start of treatment, and sustained progress is usually observed after a year.
D-penicillamine (distamine, cuprenil, artamine, trolovol, metalcaptase) is almost never included in the basic therapy of RA if the patient tolerates methotrexate and aurotherapy well. It is somewhat inferior to the listed drugs in terms of effectiveness, but significantly exceeds them in the number of possible side effects, the frequency of their occurrence and the severity of complications. Therefore, the only reason for prescribing D-penicillamine is the lack of progress in treatment with gold and methotrexate, or their poor tolerability.
D-penicillamine is a highly toxic substance that causes negative side effects in almost half of the cases of treatment for seropositive rheumatoid arthritis, and in a third of cases of treatment for seronegative RA. Why is it still used by doctors?
Because sometimes there is simply no other choice. We tried aurotherapy and cytostatics, but there was no result. Or had to be canceled due to poor tolerance. And the disease progresses quickly. Then the rheumatologist has only one, albeit dangerous, but, in fact, the only strong drug left in his arsenal - D-penicillamine. This is exactly the situation when the end justifies the means. If a negative reaction of the body occurs, the medicine can always be discontinued. Therefore, it is better to prescribe it than to do nothing at all.
D-penicillamine also has an ace up its sleeve - this drug helps those patients whose RA has caused complications in the heart, kidneys or lungs - for example, amyloidosis has developed. With satisfactory tolerability, D-penicillamine is taken for 3-5 years in a row, then take a break for a couple of years and repeat the course. In this case, the medicine does not lose its effectiveness, like, for example, gold salts, which are best left in place for a long period. Unfortunately, in a small proportion of patients (approximately 10%), after a temporary improvement in well-being, a sharp deterioration occurs.
We have looked at the pros and cons of all five groups of drugs included in the list of so-called basic therapy for rheumatoid arthritis. In this story, phrases about complications, side effects and dangers flashed so often that one involuntarily wants to ask - what kind of compulsory treatment of rheumatoid arthritis is this, if on the one hand it cures (and even then not always), and on the other hand it cripples (almost always )?
This question, of course, comes to the minds of all patients with rheumatoid arthritis immediately after making a disappointing diagnosis. Many people sit on medical forums and listen to angry rebuke there, the essence of which can be formulated in one sentence: “I became a victim of a medical error, and in general, doctors themselves do not know how to treat rheumatoid arthritis.” This statement is not far from the truth in the part where it talks about ignorance. Because only the Lord God can know exactly how to cure a person from a serious illness of an inexplicable nature.
On average, it takes about six months to select basic therapy drugs for each specific patient with rheumatoid arthritis. Finding the most suitable medicine in a shorter period of time is almost impossible, no matter how professional the rheumatologist is, and no matter how brutal his instincts are. And no one can predict how the drugs will be tolerated.
So maybe we shouldn’t start this basic therapy? Why torture a person? Well, yes, let the disease develop as quickly as possible so that the person dies early, then he will certainly stop suffering. Practice shows that if basic therapy is started immediately, immediately after diagnosis, then there is a more than decent chance of slowing down the course of the disease or even achieving stable remission. But medicine does not know of cases when a patient with rheumatoid arthritis did not receive any treatment and suddenly recovered.
Think for yourself, if there is even a slight chance to prolong your life or the life of a loved one, will you think about the side effects? The disease itself will give you side effects that drugs never dreamed of, and very quickly.
In the rest of the story, we will refer to non-steroidal anti-inflammatory drugs by the abbreviation NSAIDs, as it is more convenient. This group includes:
Ketoprofen (ketorolac, ketanov);
In the treatment of rheumatoid arthritis, these medications act as first aid for joint pain. They reduce not only pain, but also inflammation in articular and periarticular tissues, so taking them is advisable in any case. Why didn’t we include diclofenac or ibuprofen in the group of drugs for basic therapy of RA? Because they do not treat the disease itself and do not slow down its development in any way. They act symptomatically, but at the same time qualitatively improve the life of a patient with rheumatoid arthritis.
Of course, you have to take NSAIDs constantly, and with long-term use, it is rare that a medicine does not cause side effects. That is why it is important to choose the right NSAID for a particular patient and use the drug wisely without exceeding the dosage. We'll talk about how to do this further.
The first criterion is toxicity, therefore, first of all, patients with RA are prescribed the least toxic NSAIDs, which are quickly absorbed and quickly eliminated from the body. First of all, these are ibuprofen, ketoprofen and diclofenac, as well as the selective anti-inflammatory drug movalis, which we will discuss in detail below. Ketorolac, piroxicam and indomethacin take longer to be eliminated from the body; in addition, the latter can cause mental disorders in elderly patients. That is why these three drugs are usually prescribed to young patients who do not have problems with the liver, kidneys, stomach and heart. Then the likelihood of side effects and complications is low.
The second criterion is the effectiveness of NSAIDs, and here everything is very subjective. A patient with rheumatoid arthritis usually takes each of the medications recommended by the doctor for a week to evaluate the results based on his own feelings. If a person says that diclofenac makes everything hurt, but ibuprofen helps well, the doctor usually agrees with this.
Speaking of subjectivity, one cannot fail to note the power of suggestion that the usual instructions for the drug have. Thus, many patients, having read the annotation for diclofenac, where all its possible side effects are honestly and frankly described, clutch their heads in horror and say that they will never take such pills. In fact, diclofenac is no more dangerous than aspirin, which people drink almost by the handful for any reason. It’s just that aspirin doesn’t come in a box with detailed instructions inside.
To summarize, let’s say that when assessing the effectiveness of NSAIDs, you need to take into account not only your feelings (helps/doesn’t help), but also data from regular examinations demonstrating the general condition of your body and diseased joints in particular. If there are side effects (the functioning of internal organs has deteriorated) and the joints become increasingly inflamed, it makes sense to switch to another NSAID on the advice of a doctor.
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This group of drugs includes movalis, a relatively new medicine that was created specifically for long-term continuous use in order to minimize possible side effects. Returning to the subjectivity of assessments, let's say that the majority of RA patients find movalis to be no less, and sometimes more effective, analgesic. At the same time, movalis is very well tolerated and rarely causes negative reactions in the body, which cannot be said about NSAIDs, the use of which is often accompanied by digestive disorders.
Under the supervision of a doctor, Movalis can be taken for several months or even years in a row, if necessary. It is also very convenient that to relieve pain, one tablet is enough, which is taken either in the morning or before bed. There is also Movalis in the form of rectal suppositories. If the pain is very intense, you can resort to injections of Movalis. During an exacerbation of rheumatoid arthritis, the patient often has to take injections for a whole week, and only then switch to tablets. But the good news is that movalis, firstly, helps almost all patients, and secondly, has almost no contraindications.
Another “firefighter” and symptomatic method of alleviating the condition of patients with rheumatoid arthritis is taking corticosteroid hormonal drugs (hereinafter referred to as corticosteroids).
These include:
Methylprednisolone (Medrol, Depo-Medrol, Metypred);
Triamcinolol (triamsinolol, polcortolone, kenalog, kenacort);
Betamethasone (celeston, flosterone, diprospan);
Corticosteroids are very popular in the West, where they are prescribed to almost all RA patients. But in our country, doctors are divided into two opposing camps: some advocate taking hormones, while others vehemently reject this technique, calling it extremely dangerous. Accordingly, patients who want to keep abreast of all the news from the world of medicine read interviews with American and Russian rheumatologists and become confused: who to believe? Let's try to figure it out.
Taking corticosteroids causes a rapid improvement in well-being in patients with RA: pain goes away, stiffness of movement and chills in the morning disappear. Of course, this cannot but please the person, and he automatically assigns the status of “professional” to the attending physician. The pills helped - the doctor is good, they didn’t help - the doctor is bad, everything is clear here. And in the West, feelings of gratitude to a doctor are usually expressed in monetary terms. That is why there are many more “good” doctors there than “bad” ones.
In our country, with free medical insurance, a doctor will think twice before prescribing hormones to his patient. Because time will pass, and this same doctor will most likely have to deal with the consequences of such therapy.
Why is taking corticosteroids so dangerous? These are stress hormones that have a powerful negative effect on all organs. While a person takes them, he feels great, but as soon as he stops, the disease becomes more active with triple force. If earlier the joints hurt so much that it could be tolerated, now they hurt unbearably, and nothing helps.
So is it possible to keep the patient on hormones constantly? This is absolutely impossible, because, firstly, over time they will bring less and less effect, and secondly, the negative impact on internal organs will accumulate and add up until it leads to a serious failure.
Here are just some of the likely consequences:
Itsenko-Cushing syndrome - terrible swelling and hypertension as a result of too slow removal of sodium and fluid from the body;
Decreased protective properties of the body, frequent colds;
Moon-shaped oval face;
Convulsive seizures and psychoses;
Insomnia and uncontrollable excitement of the nervous system.
Terrible list, isn't it? Usually, if at least one serious side effect occurs, corticosteroids are immediately discontinued, but then the worst thing begins - the body protests against the withdrawal. This is expressed in a wave-like increase in the inflammatory process in the articular and periarticular tissues and severe pain that cannot be relieved by anything. They try to cancel hormones gradually to avoid such shock consequences.
But how can you drink them if it threatens such terrible consequences, you ask. Indeed, at some stage corticosteroids will definitely stop bringing relief and will begin to harm the patient. But there are situations when you have to choose the lesser of several evils. Sometimes the patient is already worse than ever, and only hormones can alleviate his condition. We are talking about patients with Still's syndrome, Felty's syndrome, polymyalgia rheumatica and other severe complications.
A reasonable and far-sighted specialist will prescribe hormones only to a patient whose rheumatoid arthritis is at a very high stage of activity, the ESR is off the charts, the level of C-reactive protein in the blood is prohibitive, and the inflammatory process is not controlled by NSAIDs.
The conclusion is as follows: corticosteroids should be prescribed to a patient with rheumatoid arthritis if the expected benefit of treatment outweighs the likely harm.
Such techniques include drainage of the thoracic lymphatic duct, lymphocytophoresis, plasmaphoresis and irradiation of lymphoid tissue. Each of the listed procedures is quite effective, but has a number of disadvantages. Let's look at them in detail.
This procedure requires sophisticated medical equipment. Using a drainage apparatus, the doctor penetrates the patient’s thoracic lymphatic duct, pumps out all the lymph from there, places it in a special centrifuge, which rotates and separates the contents into pure lymph and cellular decay products, microbial waste and other “garbage.” The completely purified lymph is pumped back into the thoracic duct.
A couple of weeks after this procedure, the patient begins to feel much better, but this effect lasts only for a month. Then the cleansed lymph is again filled with harmful impurities, because the disease has not disappeared anywhere. This is why thoracic duct drainage is almost never used in the modern practice of treating rheumatoid arthritis. The procedure is complex and expensive, but its effect lasts for a too modest period of time.
This procedure is also very expensive and is performed using high-tech medical equipment in large medical centers. The doctor, as it were, “cuts” into the patient’s circulating bloodstream so that the blood passes through a special centrifuge, and there monocytes and lymphocytes are removed from it. During the four hours during which lymphocytophoresis is performed, it is possible to remove approximately 12,120 lymphocytes from the patient’s bloodstream.
Why is this needed, and what does it give? Lymphocytes, or cells of the immune system, are companions of the inflammatory process. This is why a rheumatologist is never happy when he sees an elevated level of lymphocytes in your blood test results. If at least some of these cells are removed from the bloodstream, the health of the RA patient will immediately improve. True, this effect, as in the previous case, will last only about a month. This is why lymphocytophoresis is used extremely rarely.
The plasmaphoresis procedure lasts about six hours, during which plasma containing harmful components is removed from a large volume of the patient’s blood: inflammatory mediators, aggressive immune cells, rheumatoid factor, bacterial waste. “Bad” plasma is replaced with donor plasma or albumin. In just one procedure, it is possible to remove 40 ml of plasma from the body for each kg of the patient’s weight. Plasmophoresis is carried out in courses of 15-20 procedures, treatment takes about one and a half months.
Why such suffering? Plasmophoresis greatly reduces ESR and ROE, reduces the amount of immunoglobulins in the blood, and the patient begins to feel much better. True, negative consequences are also possible: swelling, decreased hemoglobin, potassium deficiency. The side effects are quite manageable; the benefits of the procedure outweigh the risks.
The main disadvantages of plasmaphoresis are its high cost and short duration of the therapeutic effect. The positive result lasts for several months, and then the course has to be repeated. However, plasmaphoresis is often resorted to, especially in cases of sudden acute development of rheumatoid arthritis and in cases where the choice of drugs for basic therapy is delayed. It is plasmaphoresis that allows the attending physician to gain time and prevent a fatal deterioration of the patient’s condition.
The technique of irradiation of lymphoid tissue was first used in 1980, and has been actively used since then. Its essence is to subject the patient’s lymph nodes, spleen and thymus gland to targeted irradiation. In one session the patient receives from 150 to 220 rads, in total for a course of treatment - 4000 rads. In almost all cases, treatment is effective and allows you to reduce the dose of corticosteroids and NSAIDs, or even stop them altogether. The effect lasts for a long time - 1-2 years.
Like any treatment that involves radiation, irradiation of lymphoid tissue has side effects. Some patients experience general weakness, nausea, and a decrease in the level of leukocytes in the blood. However, this procedure is successfully used to treat rheumatoid arthritis, both in our country and in the West.
The condition of a patient with rheumatoid arthritis in the active stage can be alleviated with the help of hormonal injections into the joint capsule, laser therapy, cryotherapy, special ointments and creams. Let's look at the advantages and disadvantages of each method.
The essence of the technique is the injection of hormonal drugs from the group of corticosteroids (we discussed them above) into the joint cavity. This could be prednisolone, celeston, hydrocortisone, depo-medrol, diprospan, flosterone or kenalog. After the procedure, a quick and pronounced positive effect is observed: inflammation subsides, pain decreases or even disappears completely.
Corticosteroid injections are an “ambulance” for sore joints. The injection of hormones directly into the joint is done when the patient’s health is absolutely deplorable, and no other measures, including taking NSAIDs and movalis, help relieve pain and reduce inflammation. Usually after the injection the patient feels well for a month, but in severe cases the procedure must be repeated every 10 days. More often it is impossible, otherwise corticosteroids will begin to have a harmful effect on the body as a whole.
In addition, doctors strongly discourage hormonal injections into the same joint more than eight times. This can cause destructive changes in the cartilage, ligaments and muscles around the joint. It turns out that the patient will have to pay an exorbitantly high price for a temporary improvement in well-being.
Laser beams have a beneficial effect on the human body suffering from rheumatoid arthritis at any stage of activity. If an exacerbation of the disease is currently observed, the patient’s elbow bends are irradiated with a laser. In this way, they improve the quality of blood and also ensure a more complete blood supply to organs and tissues. It is believed that laser beams also normalize the immune status of RA patients. This technique is successfully used both independently and in combination with basic therapy, which we wrote about above.
When the period of exacerbation of the disease has passed, there is no acute inflammatory process in the patient’s body, the body temperature is not elevated, and the joint area can be irradiated directly with the laser. In the first weeks after the procedures, there may be a temporary deterioration in well-being and increased pain. However, then 80% of patients experience improvement, which lasts for several months.
The course of treatment usually consists of 15-20 procedures, and they are carried out at intervals of one day. Laser irradiation will do little to help patients in the last stages of rheumatoid arthritis - paralyzed, with crooked joints. However, in the initial stages and during periods of remission, such an effect is very effective and simply useful.
There are several important contraindications to laser irradiation:
The presence of any tumors in the body, including benign ones;
Blood diseases, such as poor clotting;