Rheumatoid arthritis (RA) is an autoimmune disease
that causes chronic inflammation of the joints1
RA IS A COMMON TYPE OF ARTHRITIS, AFFECTING OVER 1 MILLION PEOPLE IN THE UNITED STATES1
Signs and symptoms of RA include2:
- Pain, stiffness, and swelling in multiple joints
- The same symptoms on both sides of the body (such as both hands or both knees)
Inflammation causes the signs and symptoms of RA3
- The release of inflammatory chemicals causes joint swelling, increased joint fluid and inflammation of the synovial membrane4
Treatment should aim to relieve both the inflammation and pain associated with RA
SEVERAL TREATMENT OPTIONS ARE AVAILABLE FOR RA SYMPTOMS5,6
- First-line recommendations for early and established RA are patient dependent and include traditional disease-modifying antirheumatic drugs (DMARDs) and biologics5
- NSAIDs are commonly used for effective symptomatic relief in RA6
NSAIDS RELIEVE THE INFLAMMATION AND PAIN ASSOCIATED WITH RA6
- NSAIDs inhibit the cyclooxygenase (COX-1 and COX-2) enzymes from producing prostaglandins which are mediators of inflammation and pain6-8
- NSAIDs are also known to have an analgesic effect6
DRAG TO SEE HOW NSAIDs REDUCE INFLAMMATION & PAIN
For illustrative purposes only. The mechanism of action of NSAIDs is not completely understood.7
For patients with moderate or high RA disease activity who are starting DMARDs
ACR RECOMMENDS CONSIDERING LOW-DOSE GLUCOCORTICOIDS5*†
Short-term (<3 months) glucocorticoids should also be considered for RA flares.5*†
ACR=American College of Rheumatology.
*Low-dose is defined as ≤10 mg/day of prednisone or equivalent.5
†Glucocorticoids should be used at the lowest possible dose and for the shortest period possible.5
Glucocorticoids such as prednisone reduce a number of pro-inflammatory processes9
Prednisone has been shown to reduce production of lymphocytes, edema, fibrin deposition, capillary dilation, migration of leukocytes, and phagocytosis.9
Low-dose glucocorticoids are often added to DMARD therapy to improve response10,12-14‡
Adding low-dose prednisone to stable DMARD therapy produced higher response rates as determined by ACR20 in RA.10,11‡
Multiple studies revealed that low-dose glucocorticoids slowed radiographic progression of RA.12-14
‡ACR20 was defined as a 20% improvement in tender or swollen joint count and a 20% improvement in 3 out of 5 of the following: patient’s global assessment, physician’s global assessment, patient’s assessment of pain, degree of disability, and level of acute-phase reactant.11
- Arthritis Foundation. Rheumatoid arthritis. Arthritis Foundation website. https://www.arthritis.org/diseases/rheumatoid-arthritis. Accessed June 14, 2020.
- Centers for Disease Control and Prevention. Rheumatoid arthritis (RA). Centers for Disease Control and Prevention website. https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html. Accessed June 14, 2020.
- Derksen VFAM, Huizinga TWJ, van der Woude D. The role of autoantibodies in the pathophysiology of rheumatoid arthritis. Semin Immunopathol. 2017;39(4):437-446.
- Arthritis Foundation. Causes of inflammatory joint pain. Arthritis Foundation website. https://www.arthritis.org/health-wellness/healthy-living/managing-pain/understanding-pain/causes-of-inflammatory-joint-pain. Accessed June 14, 2020.
- Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2016;68(1):1-25.
- Crofford LJ. Use of NSAIDs in treating patients with arthritis. Arthritis Res Ther. 2013;15(suppl 3):S2.
- DUEXIS (ibuprofen and famotidine) [prescribing information] Horizon.
- Ricciotti E, FitzGerald GA. Prostaglandins and inflammation. Arterioscler Thromb Vasc Biol. 2011;31(5):986-1000.
- RAYOS (prednisone) delayed-release tablets [prescribing information] Horizon.
- Buttgereit F, Mehta D, Kirwan J, et al. Low dose prednisone chronotherapy for rheumatoid arthritis: a randomized clinical trial (CAPRA-2). Ann Rheum Dis. 2013;72(2):204-210.
- American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum. 2002;46(2):328-346.
- Kirwan JR. The effect of glucocorticoids on joint destruction in rheumatoid arthritis. N Engl J Med. 1995;333:142-146.
- Wassenberg S, Rau R, Steinfeld P, Zeidler H; for the Low-Dose Prednisolone Therapy Study Group. Very low-dose prednisolone in early rheumatoid arthritis retards radiographic progression over two years. Arthritis Rheum. 2005;52:3371-3380.
- van Everdingen AA, Jacobs JWG, van Reesema DRS, Bijlsma JWJ. Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-modifying properties, and side effects. Ann Intern Med. 2002;136:1-12.