...less medical jargon in a 'Quick Glance' format!
Rheumatoid Arthritisis an inflammatory form of arthritis that causes joint pain and damage. It attacks the lining of your joints causing swelling that can result in aching and throbbing and eventually deformity. Sometimes the symptoms make even the simplest activities — such as opening a jar or taking a walk — difficult to manage.
This form of arthritis is two to three times more common in women than in men and generally occurs between the ages of 40 and 60. But rheumatoid arthritis can also affect young children and older adults.
There's no cure. With proper treatment, a strategy for joint protection and changes in lifestyle, you can live a long, productive life with rheumatoid arthritis.
Signs and symptoms of rheumatoid arthritis may include:
Joints that are tender to the touch
Red and puffy hands
Firm bumps of tissue under the skin on your arms
Morning stiffness that lasts at least 30 minutes
.....Symptoms appear in smaller joints first
Rheumatoid arthritis usually causes problems in several joints at the same time. Early rheumatoid arthritis tends to affect your smaller joints first — the joints in your wrists, hands, ankles and feet. As the disease progresses, your shoulders, elbows, knees, hips, jaw and neck can also become involved.
.....Symptoms of a rheumatoid arthritis flare
Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity — called flare-ups or flares — alternate with periods of relative remission, during which the swelling, pain, difficulty sleeping, and weakness fade or disappear.
Rheumatoid arthritis occurs when white blood cells — whose usual job is to attack unwanted invaders, such as bacteria and viruses — move from your bloodstream into the membranes that surround your joints. The blood cells appear to play a role in causing the synovium to become inflamed. The inflammation causes the release of proteins that, over months or years, cause the synovium to thicken. The proteins can also damage the cartilage, bone, tendons and ligaments near your joint. Gradually, the joint loses its shape and alignment. Eventually, it may be destroyed.
Doctors don't know what causes this process that leads to rheumatoid arthritis. It's likely that rheumatoid arthritis occurs as a result of a complex combination of factors, including your genes, your lifestyle choices, such as smoking, and things in your environment, such as viruses.
There is no cure for rheumatoid arthritis. Treatment for rheumatoid arthritis aims to reduce inflammation in your joints in order to relieve pain and prevent or slow joint damage. Early and aggressive rheumatoid arthritis treatments may slow joint damage and help reduce the risk of disability. Treatment typically involves medications, though surgery may be necessary in cases of severe joint damage.
. . . Medications
Rheumatoid arthritis medications can relieve pain and slow or halt the progression of joint damage. What medications you can consider will depend on the severity of your rheumatoid arthritis. Options include:
NSAIDs Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve). Stronger versions of these NSAIDs and others are available by prescription. NSAIDs have risks of side effects that increase when used at high dosages for long-term treatment. Side effects may include ringing in your ears, gastric ulcers, heart problems, stomach bleeding, and liver and kidney damage. Consuming alcohol or taking corticosteroids while using NSAIDs also increases your risk of gastrointestinal bleeding.
Steroids Corticosteroid medications, such as prednisone and methylprednisolone (Medrol), reduce inflammation and pain, and slow joint damage. In the short term, corticosteroids can make you feel dramatically better. But when used for many months or years, they may become less effective and cause serious side effects. Side effects may include easy bruising, thinning of bones, cataracts, weight gain, a round face and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.
Disease-modifying antirheumatic drugs (DMARDs) Doctors prescribe DMARDs to limit the amount of joint damage that occurs in rheumatoid arthritis. These drugs are typically used in the early stages of rheumatoid arthritis in an effort to slow the disease and save the joints and other tissues from permanent damage. You may need to take DMARDs for weeks or months before you notice any benefit. For that reason, they may be combined with other medications that give you more immediate relief from signs and symptoms, such as NSAIDs or corticosteroids. Common DMARDs include hydroxychloroquine (Plaquenil), the gold compound auranofin (Ridaura), sulfasalazine (Azulfidine), minocycline (Dynacin, Minocin) and methotrexate (Rheumatrex).
Immunosuppressants These medications act to tame your immune system, which is out of control in rheumatoid arthritis. In addition, some of these drugs attack and eliminate cells that are associated with the disease. Some of the commonly used immunosuppressants include leflunomide (Arava), azathioprine (Imuran), cyclosporine (Neoral, Sandimmune) and cyclophosphamide (Cytoxan). These medications can have potentially serious side effects such as increased susceptibility to infection.
TNF-alpha inhibitors TNF-alpha is a cytokine, or cell protein, that acts as an inflammatory agent in rheumatoid arthritis. TNF inhibitors target or block this cytokine and can help reduce pain, morning stiffness, and tender or swollen joints — usually within one or two weeks after treatment begins. There is evidence that TNF inhibitors may stop progression of disease. These medications often are taken with methotrexate. TNF inhibitors approved for treatment are etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira). Potential side effects include injection site irritation (adalimumab and etanercept), worsening congestive heart failure (infliximab), blood disorders, lymphoma, demyelinating diseases, and increased risk of infection. If you have an active infection, don't take these medications.
Anakinra (Kineret) Anakinra is similar to a naturally occurring chemical in your body — interleukin-1 receptor antagonist (IL-1Ra) — that stops a certain chemical signal from causing inflammation. You might consider anakinra if you have a moderate to severe case and haven't been helped by conventional DMARD therapy. Anakinra is given as a daily self-administered injection under the skin, and is sometimes combined with methotrexate. Potential side effects include injection site reactions, decreased white blood cell counts, headache and an increase in upper respiratory infections. There may be a slightly higher rate of respiratory infections in people who have asthma or chronic obstructive pulmonary disease. If you have an active infection, don't use anakinra.
Abatacept (Orencia) Abatacept reduces the inflammation and joint damage caused by rheumatoid arthritis by inactivating T cells — a type of white blood cell. People who haven't been helped by TNF-alpha inhibitors might consider abatacept, which is administered monthly through a vein in your arm. Side effects may include headache, nausea and mild infections, such as upper respiratory tract infections. Serious infections, such as pneumonia, can occur.
Rituximab (Rituxan) Rituximab reduces the number of B cells in your body. B cells are involved in inflammation. People who haven't found relief using TNF inhibitors might consider using rituximab, which is usually given along with methotrexate. Rituximab is administered as an infusion into a vein in your arm. Side effects include flu-like signs and symptoms, such as fever, chills and nausea. Some people experience extreme reactions to the infusion, such as difficulty breathing and heart problems.
. . . Surgery
If medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and correct deformities. The surgery may involve one or more of the following procedures:
• Total joint replacement During joint replacement surgery, your surgeon removes the damaged parts of your joint and inserts a metal and plastic prosthesis.
• Tendon repair Inflammation and joint damage may cause tendons around your joint to loosen or tighten. Your surgeon may be able to repair the tendons around your joint.
• Removal of the joint lining If the lining around your joint is inflamed and causing pain, your surgeon may recommend removing the lining of the joint.
Surgery carries a risk of bleeding, infection and pain. Discuss the benefits and risks with your doctor.
Rheumatoid Arthritis Treatment . . . What you can do
You can take steps to care for your self. These self-care measures, when used along with your rheumatoid arthritis medications, can help you cope with your signs and symptoms. Consider trying to:
Exercise regularly. Gentle exercise can help strengthen the muscles around your joints, and it can help fight fatigue you might feel. Check with your doctor before you start exercising. If you're just getting started, begin by taking a walk. Try swimming or gentle water aerobics. Public pools and health clubs in your area may offer classes. Avoid exercising tender, injured or severely inflamed joints. If you feel new joint pain, stop. New pain that lasts more than two hours after you exercise probably means you've overdone it. If pain persists for more than a few days, call your doctor.
Eat a healthy diet. A healthy diet emphasizing fruit, vegetables and whole grains can help you control your weight and maintain your overall health. However, there's no special diet that can be used to treat rheumatoid arthritis. It hasn't been proved that eating any particular food will make your joint pain or inflammation better or worse.
Protect your joints. Find different ways to approach everyday tasks in order to take stress off your painful joints. For instance, if your fingers are sore, pick up an object using your forearms. Lean into a glass door to force it open, rather than pushing on the door with sore arms.
Use assistive devices. Assistive devices can make it easier to go about your day without stressing your painful joints. For instance, using specially designed gripping and grabbing tools may make it easier to work in the kitchen if you have pain in your fingers. Try a cane to help you get around. Your doctor or occupational therapist may have ideas about what sorts of assistive devices may be helpful to you. Catalogs and medical supply stores may also be places to look for ideas.
Apply heat. Heat can help ease your pain and relax tense, painful muscles. One of the easiest and most effective ways to apply heat is to take a hot shower or bath for 15 minutes. Other options include using a hot pack or an electric heat pad set on its lowest setting. If your skin has poor sensation or if you have poor circulation, don't use heat treatments.
Apply cold. Cold may dull the sensation of pain. Cold also has a numbing effect and decreases muscle spasms. Don't use cold treatments if you have poor circulation or numbness. Techniques may include using cold packs, soaking the affected joints in cold water and ice massage.
Relax. Find ways to cope with pain by reducing stress in your life. Techniques such as hypnosis, guided imagery, deep breathing and muscle relaxation can all be used to control pain.