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Because damage to the joints occurs early in the course of rheumatoid arthritis (RA), early diagnosis and treatment is crucial for halting progression of the disease and preserving functional ability. Although RA is a life-long illness for which currently there is no known cure, early and aggressive treatment can help to slow down the disease progression and prevent disability.

In general, there are four major categories of drugs that are used for the management of patients with RA:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids
• Disease-modifying antirheumatic drugs (DMARDs)
• Selective costimulation modulators

Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually used for the management of pain, inflammation, and stiffness in patients with early-stage rheumatoid arthritis (RA). Because NSAIDs do not alter the course of the disease, they are usually used together with another class of drugs known as disease-modifying antirheumatic drugs (DMARDs) which are the only medications that are known to slow down the progression of RA. Patients with early-stage RA may be started on NSAIDs for a short period of time to control pain, inflammation, and stiffness. As soon as the diagnosis of RA is established, a DMARD is usually added for long-term therapy. Long-term use of NSAIDs (with or without DMARDs) poses a risk of gastrointestinal perforation and bleeding so patients must be carefully monitored to prevent this potentially serious side-effect of NSAID therapy.

Examples of medications that belong to the NSAID category of drugs include:

• Aspirin (e.g., Bayer)
• Acetaminophen (e.g., Tylenol)
• Ibuprofen (e.g., Motrin)
• Naproxen (e.g., Aleve)
• Cox-2 inhibitors (e.g., Celebrex)
• Diclofenac (e.g., Voltaren)
• Indomethacin (e.g., Indocin)
• Ketoprofen (e.g., Orudis)

Corticosteroids

Corticosteroids, such as prednisone , are highly potent anti-inflammatory agents that are useful for controlling the chronic inflammation that is responsible for causing joint damage in patients with rheumatoid arthritis (RA). In general, corticosteroids are used together with disease-modifying antirheumatic drugs (DMARDs)in a type of treatment known as "bridging therapy". Because corticosteroids work much more quickly than DMARDs, they are often used to "bridge" the time interval from when DMARDs are started until their maximum efficacy can be realized (usually several weeks or months). Corticosteroids (e.g., prednisone) may be given orally or injected directly into an arthritic joint. Due to their potentially serious side-effects, corticosteroids are used at the lowest effective doses and treatment is usually of short duration.

Potentially serious side-effects of corticosteroids (especially with long-term use) include:

• Osteoporosis - brittle bones
• Muscle atrophy and weakness
• Cataracts
• Hypertension
• Diabetes
• Increased susceptibility to infections

The American Academy of Rheumatology recommends that patients who are being treated with corticosteroids should also take calcium (1.0-1.5 grams/day) and vitamin D (400-800 IU/daily) to prevent osteoporosis and reduce the risk of vertebral fractures.

Disease-Modifying Antirheumatic Drugs

In recent years, disease-modifying antirheumatic drugs (DMARDs) have become the mainstay of drug therapy for rheumatoid arthritis (RA) because currently this is the only class of medications that has been shown to halt the progression of the disease and reduce the risk of long-term disability. Most experts are in agreement that because joint damage occurs early in the disease process, patients with RA should be started on DMARDs within 3 months of the onset of symptoms of the disease. Outcome of RA may be improved by early treatment with DMARDs.