Rheumatism — what to take?

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Symptoms

Symmetrical joint pain and swelling (hands, feet, wrists), morning stiffness over 1 hour, chronic fatigue, low-grade fever, weight loss. Extra-articular manifestations: rheumatoid nodules, vasculitis, interstitial lung disease, Sjögren's syndrome.

Diagnosis

Rheumatoid factor, anti-CCP, ESR, CRP, blood count, X-rays of hands/feet, joint ultrasound, MRI at onset. 2010 ACR/EULAR criteria.

Treatment

DMARDs (Rx) — essential, early:

• Methotrexate — first line, 15-25 mg/week.
• Sulfasalazine, leflunomide, hydroxychloroquine.
• Biologics: anti-TNF (adalimumab, etanercept), anti-IL6 (tocilizumab), anti-B (rituximab), JAK inhibitors.

Symptomatic:

• NSAIDs for pain.
• Short oral corticosteroid during flares (prednisone).
• Intra-articular injections.

Adjuvant supplements

• Omega-3 2-3 g/day — anti-inflammatory, reduces pain.
• Vitamin D3.
• Curcumin with piperine.
• GLA (evening primrose oil, borage).
• Folic acid (mandatory with methotrexate).
• Probiotics — immune modulation.

Associated comorbidities

Increased cardiovascular risk, osteoporosis, depression, infections, malignancies. Screening and prevention are essential.

Medical disclaimer: the information in this guide is for informational purposes only and does not replace advice from a doctor or pharmacist. For diagnosis and treatment, consult a healthcare professional.