Joint pain on waking, stiffness that lasts more than 30 minutes, swollen joints… It may be a rheumatoid arthritis (RP). This inflammatory disease affects nearly 300,000 people in France, three-quarters of whom are women. If this is your case, consult your doctor as soon as possible. “This disease of the synovial membrane, attacked by the patient’s immune system, is a therapeutic emergency”, insists Dr. Laurent Grange, rheumatologist at the Grenoble University Hospital.
Stop joint destruction…
“By starting an effective treatment quickly, it is possible to avoid or stop the destruction of the joints and to live almost normally with the disease, explains our specialist. Once diagnosed, the goal is to achieve remission or at least low disease activity within six months. The reference treatment is methotrexate, a molecule used in low doses for its immunomodulatory action (which regulates immune reactions). While it takes effect, symptomatic treatments, such as cortisone and analgesics, are prescribed to fight against inflammation and pain. After a period of three or four months, if it does not work, we move on to biotherapies, alone or in combination. »
…thanks to inflammation-blocking treatments
Biotherapies act in a very targeted way by blocking one of the mechanisms at the origin of inflammation. There are many: TNF alpha (Remicade®, Enbrel®, Humira®, Simponi® or Cimzia®), interleukin 6 (RoActemra®). Another category: T (Orencia®) or B (Mabthera®) lymphocytes.
The objective of these powerful drugs: to stop the inflammatory cascade which inexorably leads to the destruction of the joints. They are chosen according to the profile of the patient, his disease, the side effects and the result obtained. The therapeutic arsenal being important, there is necessarily an effective molecule or combination. Next expected drug, tofacitinib, which blocks the inflammatory cascade at another level. It will be available in tablets, a considerable advantage for patients… European authorities are still awaiting details on its side effects before authorizing it.
Good follow-up is essential
At the start of treatment, patients are followed every one to three months, then every six months. “Today, we do custom-made,” explains Dr. Grange. The doses are spaced out or reduced, or even increased, depending on the case. Local treatments, infiltrations, preventive surgery, rehabilitation sessions… are offered according to the reaction of each patient, according to the results of blood tests, X-rays, ultrasounds… Consultations and regular examinations make it possible to detect the awakening of inflammation before the onset of pain. It is not because we are not suffering that the disease does not evolve. “Complete assessments also make it possible to detect undesirable effects, especially linked to the reduction of immune defenses under the effect of drugs. So to prevent possible complications, especially infections and skin cancer.
Know your disease to live better with it
Polyarthritis benefits from comprehensive care in which therapeutic education occupies an important place. “She has clearly improved the support for patients,” underlines Dr. Grange. In practice, it helps them to know their disease, to adapt their way of life and to use the treatments well. It also teaches them to monitor the appearance of side effects, namely to react in the event of an abnormal reaction. This support brings together professionals (doctors, nurses, pharmacists, physiotherapists, etc.) and patient-experts, who have received specific training. “If the medical team speaks to us, the patient-experts understand us”, say the patients.
Finally, the therapeutic education sessions are an opportunity to meet other patients, to discuss the difficulties of daily life, the administrative constraints and the various aids… A good way to remain active while sparing yourself to fight against fatigue.
