All about rheumatoid arthritis

Arava (leflunomide) is a recently approved DMARD for treating active RA, and it reduces the signs and symptoms of RA in about 40-50 per cent of patients. Side effects include diarrhoea, elevated liver enzymes, alopecia (hair loss), rash and bone marrow toxicity.

Corticosteroids such as prednisone and methylprednisolone have both anti-inflammatory and immunosuppressive properties. Since they can effect dramatic improvements in a very short time, doctors often use them while waiting for DMARDs to kick in. They may be an option if your RA doesn't respond to NSAIDs and DMARDs. These medications also have serious side effects, especially at high doses, including osteoporosis, mood shifts, fragile easily bruised skin, fluid retention and weight gain, muscle weakness, onset or worsening of diabetes, cataracts and increased risk of infection.

Biological alternatives
Two new biologic response modifiers to be used under specialist supervision include enbrel or etanercept - a genetically engineered protein that helps reduce the symptoms of severe RA in adult patients who have not responded well to other treatments.

Remicade has been approved for use in combination with methotrexate to treat RA patients who have had inadequate response to methotrexate alone. This drug, which improves signs and symptoms in about 50 per cent of patients, must be given intravenously. Patients usually receive eight infusions the first year and six thereafter. Potential side effects include upper respiratory tract infections, headache, nausea, sinusitis, rash and cough.

Surgical options
Surgery may be an option if you have severe joint damage. In the right circumstance it can help reduce pain, improve the affected joint's function and appearance, and enhance your ability to perform daily activities. However, it is not the right course of action for everyone. The most common type of surgery is joint replacement. One thing to consider is that the artificial joints can wear out, necessitating additional surgery.

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