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Rheumatoid Arthritis Treatment

Rheumatoid arthritis (RA) is a chronic autoimmune disease in which the body’s immune system attacks the lining of the joints, causing pain, inflammation and swelling. Bone erosion and joint deformity can result over time if the disease is not treated. In RA, the immune system can also attack other parts of the body, leading to problems with the heart, respiratory system, nerves and eyes. The cause of rheumatoid arthritis is poorly understood. There is a strong genetic component, which is thought to contribute to 50 to 60% of the overall risk of developing the disease.

The 2017-18 National Health Survey (NHS) conducted by the Australian Bureau of Statistics reported approximately 456,000 Australians with rheumatoid arthritis. This equates to approximately 1.9% of the Australian population. RA accounted for 13% of all arthritic conditions in 2017-18.

Rheumatoid arthritis is most commonly reported in people over the age of 75, but the initial onset of the disease usually takes place between the ages of 35 and 64. It occurs more frequently in women, with an overall incidence of 2.3% of the female Australian population compared to 1.5% of the male Australian population.

There is no cure for rheumatoid arthritis. Instead, rheumatoid arthritis treatment in Australia focuses on stopping inflammation (putting the disease into ‘remission’), relieving symptoms and preventing future joint and organ damage. Medications are primarily used to treat the condition, however physical therapy and surgery can also be employed.

The range and efficacy of medications available to treat RA have improved dramatically over the past 20 years. The most commonly used medications are as follows:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – over the counter (e.g. ibuprofen) or prescription (e.g. meloxicam) to relieve pain and reduce inflammation;
  • Steroids (e.g. prednisolone) – to reduce inflammation, pain and slow joint damage; and
  • Disease-modifying antirheumatic drugs (DMARDs, e.g. methotrexate, leflunomide) – to slow the progression of the disease and save the joints and parts of the body from permanent damage.

Biological DMARDs are a form of advanced rheumatoid arthritis treatment in Australia. Due to their high cost (usually subsidised via Medicare’s Pharmaceutical Benefits Scheme), they are generally reserved for use when other forms of treatment have failed or are poorly tolerated.

Biological DMARDs (sometimes referred to as “immunotherapy”) act directly on the parts of the immune system that are responsible for triggering inflammation. They have been shown to stop or slow the disease process, reducing the joint destruction and disability associated with RA. The biological agents most commonly used for rheumatoid arthritis treatment in Australia include:

  • Actemra® (tocilizumab);
  • Orencia® (abatacept);
  • Remicade® (infliximab);
  • Mabthera® (rituximab); and
  • Simponi® (golimumab).

Many of these biological DMARDs must be given directly into the bloodstream by intravenous infusion, administered by a nurse specifically trained in their use. Many people attend a major hospital to have such doses administered, with 40% of all hospitalisations associated with RA being purely for the administration of medication.

In many cases, it is possible for these infusions to be administered in your own home by one of our highly trained nurses. Contact one of our friendly team members to see if home infusions with View Health – chemo@home might be suitable for you.

 

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