Although it may sound like an unconventional idea, treating rheumatoid arthritis (RA) is similar to winning a civil war: It requires strategic planning, intelligence, and state-of-the-art fighting power.  The story of RA treatment is separated into two parts.  The first is like traditional civil war weapons and the second part is like the 21st century Star Wars assassins, message interruption, and anti-missile warfare.  When the inflammatory process advances, chemical mediators released from immune cells can damage cartilage, bones, and ligaments, causing joints to become deformed and functionally impaired.

Over the years, many studies have demonstrated that methotrexate (MTX), hydroxycholoroquine (Plaquenil) leflunomide (Arava) and sulfasalazine (Azulfidine) are effective in the treatment of RA.  These drugs affect the activity of RA to a greater extent than non-steroidal anti-inflammatory drugs (NSAIDs).  These drugs appear to modify the immune system in a way that helps slowdown the inflammatory process.  Therefore, this group of drugs is called disease-modified anti-rheumatic drugs (DMARDs).

The strategic plan in treating RA has changed from a conventional treatment of using NSAIDs and corticosteroids to control symptoms, to a more disease-modifying process by adding DMARDs to the preceding to alter the inflammatory process and prevent joint damage.  This is one of the milestones in the treatment of RA.  Since the mid-1980s, MTX has become the more popular treatment for RA because of its effectiveness and ability to work more rapidly than other DMARDs.  Not only is MTX used to treat RA, but it can also be used to treat some forms of cancer.  However, the dose, side effects and administration are quite different when treating arthritis versus cancer.   The combination of MTX with other DMARDs is even more effective than MTX alone.

Since DMARDs often take weeks to months to work, trying them requires patience, commitment, and time.  Once symptoms have subsided, a patient may have to stay on DMARDs for a long period of time, though the prescribed dosage may decrease.  While side effects can result from the use of DMARDs, frequent laboratory monitoring will largely keep side effects from occurring.

Despite the powerfulness of DMARDs, only fifty to sixty percent of patients adequately respond to treatment.  Even though the progression of joint damage may slow, the results are still unsatisfactory.  DMARDs may temporarily win battles, but cannot win the war.  In the past decade, scientists have worked extremely hard to further understand the immune system and to develop new weapons to win this civil war.  Stay tuned for the Star Wars-like weaponry advancements.