Which treatments should be considered for acute presentations of rheumatoid arthritis (RA)?

Updated: Feb 07, 2020
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Acute presentations in patients with RA are generally because of an exacerbation of known disease or manifestations in other organ systems or other disease sequelae. Patients presenting with an initial onset of previously undiagnosed possible RA require symptomatic treatment with NSAIDs and rapid referral for definitive diagnosis and institution of DMARD therapy. A delay of as little as 2-3 months in initiating joint-sparing therapy results in significant irreversible joint damage measured radiographically at 5 years.

In patients with known disease, increased pain, edema, and dysfunction are characteristics of rheumatoid flare (exacerbation). Flares may be local or systemic in nature. Laboratory evaluation may reveal elevation in acute-phase reactants. Treatment consists of rest, NSAIDs, DMARDs, short courses of steroids (2-4 weeks), and, possibly, intra-articular steroid injections. Pain relief is important and may necessitate short-term use of narcotic analgesics.


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