Abstract
REST, PHYSIOTHERAPY, joint protection, patient education and counselling all play an important role alongside drug therapy and sur gery in the management of a chronic disorder such as theumatoid arthritis. Patients expect their physician to take the initiative in integrating the members of the multi-disciplinary team devoted to their care.
The physician will also instigate drug therapy. In early disease, an analgesic ('for pain') may supplement a non-steroidal anti-inflammatory drug ('for stiffness'). A variety of such drugs are available with various advantages and disadvantages.
For more severe, progressive disease a 'second-line' or disease-modifying drug may be prescribed. Typical examples are injectable gold, penicillamine, anti malarials, sulphasalazine and methotrexate. The pres cription of any of these represents a calculated risk: the benefits of treatment have to be balanced against the likely side-effects.
A variety of intra-articular treatments are also available for providing some localisation of response and sometimes obviating the need for surgery which should be the subject of close collaboration between the rheumatologists and orthopaedic surgeons.
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