Many patients receive an NSAID and at least one DMARD, sometimes with low-dose oral glucocorticoids . If disease remission is observed, regular NSAIDs or glucocorticoid treatment may no longer be needed. DMARDs help control arthritis but do not cure the disease. For that reason, if remission or optimal control is achieved with a DMARD, it is often continued as a maintenance dosage. Discontinuing a DMARD may reactivate disease or cause a "rebound flare", with no assurance that disease control will be reestablished upon resumption of the medication.
Herbal and acupuncture medicine can be very helpful in the treatment of articular and soft tissue rheumatological disorders. The following are basic patterns seen clinically. The treatment of pain in TCM is predicated basically on the saying "if there is free flow there is no pain." Therefore, formulas that restore flow are used. In general, therapies that can unblock flow and thus treat pain incorporate one or more of the following herbal categories (deficiency of Qi and Blood may also lead to obstruction).
Aspirin, (NSAIDs), and/or low dose steroids may be continued, although the possibility of increased toxicity with concomitant use of NSAIDs including salicylates has not been fully explored. (See PRECAUTIONS, Drug Interactions .) Steroids may be reduced gradually in patients who respond to methotrexate. Combined use of methotrexate with gold, penicillamine, hydroxychloroquine, sulfasalazine, or cytotoxic agents, has not been studied and may increase the incidence of adverse effects. Rest and physiotherapy as indicated should be continued.