Modern management of rheumatoid arthritis.

The management of rheumatoid arthritis can be challenging even to the most experienced and astute physician. The rheumatoid inflammatory process can be profound, ravaging, and unremitting, and the illness is notorious for its protean manifestations and capricious course. Moreover, the response to therapy is unpredictable, although it can be quite successful in many cases. Nevertheless, the intense pain, profound disability, progressive destructive arthropathy, and negative psychological milieu that haunt patients demand that something be done therapeutically. Rheumatoid arthritis responds best to a symphony of therapeutic modalities including drugs, rehabilitation, joint surgery, and attention to psychosocial issues. The foundation of any successful therapeutic venture is an educational program designed, however simply, to imbue the patient and family with an understanding of the disease and its course and treatment, and with realistic expectations. Drug therapy is often polypharmaceutical, employing analgesics, nonsteroidal anti-inflammatory agents, both local and systemic corticosteroids, and remission-inducing drugs. Pacing of lifestyle, physical and/or occupational therapy, vocational guidance, psychological and sexual counseling, and social intervention are as much a part of modern management in rheumatoid arthritis as are drugs. The extra-articular (systemic) manifestations are addressed in a variety of ways depending upon the type and severity of involvement. Although most patients can be treated by their primary care physician, some may require the expertise provided by a specialist. Finally, despite the lack of a cure for rheumatoid arthritis, most patients respond well to treatment and return to their desired activities of daily living.