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| Step Two: Key elements of treatment include
patient education and the use of one or more DMARDs. The ACR recommends DMARD
use within 3 months of diagnosis for all patients who have ongoing joint pain,
morning stiffness, or other signs of active rheumatoid arthritis (RA) despite treatment with nonsteroidal anti-inflammatory drugs (NSAIDs). The use of NSAIDs; local (injected directly into joints) or low-dose oral steroids; or physical or occupational therapy also may be considered. |
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Step Three: The ACR recommends that
patients with rheumatoid arthritis (RA) are regularly examined to see how much joint pain they
have, how long their morning stiffness lasts, how long their fatigue
lasts, and how many tender and swollen joints they have. Doctors also
may look for other signs of disease progression by checking for joint
motion or deformity as well as other joint problems, doing blood tests,
taking X-rays, and asking questions to measure how well treatment is
working. |
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Step Four: According to the ACR, when the highest dosage of one
DMARD does not work within 3 months, it should either be replaced by a new DMARD
or used in combination with a new DMARD. DMARD selection will depend on which
medicines a patient has already tried. Some patients will need to take more than
one DMARD to control their RA. For some patients, even a combination of DMARDs
will not prevent joint damage that ultimately requires surgery. For other patients,
one or more DMARDs will be effective. These patients will still need regular
checkups, as shown in Step 3, to assess their disease activity. The ACR also
suggests that rheumatologists be consulted when combination therapy is being
considered or whenever a primary care provider is unsure about any aspect of
RA diagnosis or treatment. |
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