Rheumatoid arthritis Treatment

  • Treatment

    Although very rare, rheumatoid arthritis can lead to complications that require prompt medical attention. Rheumatoid arthritis can lead to serious and even potentially life-threatening complications. Immune reactions can inflame a number of different tissues, and any sudden symptoms, such as chest or abdominal pain, warrant prompt medical attention. Rheumatoid arthritis can inflame the bones of the upper spine, which protects the delicate spinal cord. Any numbness, tingling, or electric shock sensations in the upper extremities that occur with neck movement also requires prompt medical attention.

    People with rheumatoid arthritis play a central role in the day-to-day management of their own disease. It is important for you to learn about this chronic disease and to take an active role in health care decisions and treatment. People may find that following an exercise plan, monitoring their own symptoms, and other such self care techniques allow them to gain a sense of control over their disease. Because rheumatoid arthritis varies so much from person to person, patients will always be more knowledgeable in the daily “personality” of his or her disease than even their doctor.

    Rest, stress reduction, flexibility, and self-awareness can help people cope with the physical and emotional effects of rheumatoid arthritis. Rheumatoid arthritis can affect all aspects of daily life, and can trigger anxiety and depression. Your health care provider will provide you with certain strategies to help you cope with the physical and emotional effects of this disease. Adequate rest is essential for dealing with fatigue. Stress reduction can eliminate this source of strain on the body, and may even decrease your perception of pain. A willingness to make lifestyle adjustments can also help you to adapt to the unpredictability of rheumatoid arthritis. In some cases, a daily journal can help pinpoint factors that worsen and improve symptoms.

    Gentle and appropriate exercise can help to maintain joint range of motion, muscle strength, and overall endurance. If you remain inactive, you are likely to lose even more mobility and strength. Moderate physical activity is strongly encouraged, because it is both physically and emotionally good for you. Exercise also has mood-elevating benefits, and may decrease pain. A doctor and a physical therapist can help tailor a safe and effective exercise program. Non-weight-bearing physical activities, such as swimming and bicycling, are often the best choices for people with rheumatoid arthritis.

    Supportive relationships can help you meet the challenges of rheumatoid arthritis. It is important to maintain your personal relationships, even if you feel down or depressed. Family and friends can often provide both physical and emotional assistance. Support groups can provide a forum for sharing information, experiences, and resources.

    A well-balanced and nutritious diet supports overall health. Maintaining a healthy weight will benefit your joints; especially if you have rheumatoid arthritis in your legs. Although there is no evidence that your diet, whether good or bad, plays a direct role in the activity of rheumatoid arthritis, a well-balanced and nutritious diet is essential for maintaining good health, and is always an excellent way that you can take care of yourself.

    Your doctor is the best source of information on the drug treatment choices available to you.

    Splints and braces help rest inflamed joints. Joints inflamed by rheumatoid arthritis are vulnerable to injury; however, injury can result from even routine motions of the joint. Resting the joints by immobilizing them with splints and braces can help protect these structures from accidental injury.

    Use of hot packs and cold packs can help alleviate symptoms. Hot packs and cold packs may help alleviate pain, muscle spasms, and inflammation. However, it is important to obtain guidelines about their correct use because these therapies can actually be harmful when used at the wrong time or for too long.

    Therapies such as hydrotherapy and massage can make your muscles feel relaxed, and can help you to maintain flexibility. Hydrotherapy — immersion in water, with or without exercise — can relax muscles, take weight off the joints, and help relieve pain. If you don't have access to a pool, gentle massage performed by a licensed professional can also be a safe and effective way of relaxing muscles and maintaining flexibility.

    Specialized shoes, specialized shoe inserts (orthotics), and neck collars can support and protect unstable joints. Specialized shoes and orthotic inserts, which must be made specifically for you, can help protect feet that have been affected by rheumatoid arthritis. Neck collars can help stabilize the upper spine and prevent spinal cord damage in people who have instability of the cervical spine.

    Crutches, canes, and assistive devices can make routine activities easier Figure 03. Crutches and canesmay help relieve stress on weight-bearing joints. Assistive devices, such as specialized utensils and hand rails, can also make daily life easier. An occupational therapist can recommend certain lifestyle adjustments and devices based on a your degree of disability.

    Click to enlarge: Assistive Devices

    Figure 03. Assistive Devices

    Surgery can help alleviate pain, correct deformities, and sometimes restore function in severely damaged joints. Surgery can provide several benefits if you have had advanced joint damage from rheumatoid arthritis. Different types of surgery are often recommended for different joints.

    Total joint replacement is the most common type of surgery recommended for rheumatoid arthritis in the hips, knees, and shoulders. Replacement of the damaged joint with an artificial joint made of plastic and metal can markedly alleviate pain and restore function Figure 04.

    Other types of surgery are recommended for the hands, feet, and wrists. Reconstructive surgery is often recommended for the hands. This surgery can realign the hand, relieve pain, and improve function. Surgery is often used to prevent or treat tendon damage.

    Arthrodesis, surgical fusion of the bones to permanently prevent motion, is often recommended for the joints of the ankles and feet.

    Carpal tunnel surgery can relieve pressure on a nerve that travels through the wrist.

    Synovectomy, surgical removal of the inflamed lining of the joint (synovium), can temporarily relieve pain in specific joints; however, the synovium usually grows back over time.

    Click to enlarge: Hip replacement surgery (animation and audio)

    Figure 04. Hip replacement surgery (animation and audio)

    At this time, most alternative practices have no proven benefit for helping rheumatoid arthritis. Because rheumatoid arthritis fluctuates from flares to remission, you can easily be convinced that a particular alternative treatment is working. These therapies must be put to the same scientific testing that FDA approved drugs have been put through before they are deemed effective. It is important to remember that the fluctuation of pain and inflammation is characteristic of the disease, and may not be attributed to any one therapy.

    Although the promises of alternative practices may sound attractive, these practices are not a substitute for the medical treatment of rheumatoid arthritis. The safety and effectiveness of taking some herbs is unknown, and these therapies can be financially draining and potentially harmful. When considering alternative medicine, it's important to research specific practices, to use good common sense, and to consult with a doctor first.

    Omega-3 fatty acids, zinc, and vitamin E may alleviate symptoms in some people. Taking omega-3 fatty acids (found in certain plant and fish oils) may improve symptoms in people with rheumatoid arthritis by working in similar ways to NSAIDs.

    If you notice that your rheumatoid arthritis consistently flares when you eat a certain food, eliminating that food is a probably a good idea. However, it is important to eat a balanced diet to maintain proper nutrition. Speak with your health professional before making any significant changes in what you eat, such as eliminating an entire food group.

    Certain alternative practices, such as yoga and meditation, can help alleviate stress and manage pain. Your emotional status and outlook play a large role in the overall management of rheumatoid arthritis. Safe, alternative practices that have relaxing, soothing, and revitalizing effects can help alleviate stress and manage pain.

    Rheumatoid arthritis varies widely in its severity. The severity and the length of time you suffer from rheumatoid arthritis can be strikingly different from person to person. You may have minor joint pain that quickly resolves, whereas another person may develop severe joint damage and disability. Unfortunately, there is no certain way to predict how severe or prolonged rheumatoid arthritis will be in each person. Thus an aggressive treatment regimen is crafted for each individual and changes are made over time, depending upon your response and disease characteristics.

    Although it is impossible to predict the course of rheumatoid arthritis, certain factors seem to play a role in the severity and duration of the disease. Early and aggressive treatment of rheumatoid arthritis usually means a better prognosis. However, the presence of rheumatoid factor, particularly at high levels, is associated with more severe joint damage and complications in other organs and tissues. If you have inflammation in more than 20 joints, you are more likely to have severe joint damage. Other factors that seem to indicate likelihood for severe joint damage are serious inflammation that persists for more than one year, being over the age of 60 years at the time of diagnosis, or having x-rays that show evidence of bone damage.

    The joint damage of rheumatoid arthritis progresses most rapidly in the first years of disease, and gradually subsides over time. Within two years of diagnosis, about 70% of people have some signs of joint damage on x-rays. Loss of physical function is also most severe in the first few years of disease, a loss which tends to progress over time. About 15% of people with rheumatoid arthritis are fortunate to have symptoms that lead to only minor loss of function. However, over time, most untreated patients develop some degree of joint damage and loss of function.

    Most cases of rheumatoid arthritis are characterized by a pattern of painful flare ups (relapses) and less painful periods (remissions), where the disease does not seem to be a major problem. If remission is going to occur, it is most likely to occur in the first year of disease.

    Regular medical visits are essential if you have rheumatoid arthritis. Regular medical visits to your primary care doctor or your rheumatologist are essential for monitoring the success and side effects of treatment, and for assessing and maintaining optimal overall health. Your doctor may have to periodically adjust your treatment plan.

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