What Is Rheumatoid Arthritis Again
Let’s refresh: Rheumatoid arthritis is an autoimmune disease, which means the immune system turns its sights on healthy tissue in the body, causing inflammation.
This form of arthritis targets the synovial membrane, the tissue that lines joints. Typically, this lining is thin and delicate, and it produces a clear fluid that allows the joint to move freely. But when the membrane becomes inflamed, the fluid gets thick and begins builds up, putting painful pressure on the surrounding nerves. When that happens, pain, stiffness, and even redness can occur. That inflammation literally heats up the joint, making it feel warm.
But RA isn’t only a disease of the joints. It’s a systemic illness that can impact your heart, lungs, eyes, and more. Which is exactly why prompt treatment is so important.
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Rheumatoid arthritis is a condition that can cause pain, swelling and stiffness in joints.
It is what is known as an auto-immune condition. This means that the immune system, which is the bodys natural self-defence system, gets confused and starts to attack your bodys healthy tissues. In rheumatoid arthritis, the main way it does this is with inflammation in your joints.
Rheumatoid arthritis affects around 400,000 adults aged 16 and over in the UK. It can affect anyone of any age. It can get worse quickly, so early diagnosis and intensive treatment are important. The sooner you start treatment, the more effective its likely to be.
To understand how rheumatoid arthritis develops, it helps to understand how a normal joint works.
The Importance Of Seeking Early Treatment
About 80 to 85 percent of those who develop RA experience joint damage, and the majority of this damage occurs within the first two years of onset, according to the Johns Hopkins Arthritis Center. Today, many experts recommend early, aggressive treatment to protect vulnerable joints.
Remission is increasingly possible thanks to new therapies, many of which can be used alone or in combination with one another. Your doctor will work with you to develop a treatment plan that addresses your individual needs. Your RA treatment plan may include:
Even if it takes some time to find the right treatment for you, its important to stick with it. Though you may find symptom relief fairly quickly, finding the right medication for prolonged care can take longer, Pisetsky explains. Usually, several months can elapse before it is clear if a treatment is working or not and whether its time to try something new.
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Treatment For Rheumatoid Arthritis
Despite the natural remedies for rheumatoid arthritis, some people do need additional medication or treatment to treat the condition.
Years ago, aspirin was a mainstay of therapy for rheumatoid arthritis. The problem is it doesnt modify the disease, says Dr. Rosian. It helps with the inflammation, but it doesnt slow the progression. And it gives people lots of bruising and bleeding at the doses that you need to take it.
However, people living with rheumatoid arthritis have more options today. There are more disease-modifying treatments for rheumatoid arthritis now than there ever have been, says Dr. Rosian. Common treatments include anti-inflammatory meds and prednisone, as well as more directed treatments, like immunosuppressive medicines and new families of biologics and oral biologics and injectable medications, she adds.
Its a different disease than it used to be 20, 30 years ago, notes Dr. Rosian. There are so many good medications that slow down the disease. I like to use the phrase remission on meds. People dont develop joint erosions. People dont look like they ever have rheumatoid arthritis if we can detect it and we treat them early.
How Does A Normal Joint Work
A joint is where two bones meet. Most of our joints are designed to allow the bones to move in certain directions and within certain limits.
For example, the knee is the largest joint in the body and one of the most complicated. It must be strong enough to take our weight and must lock into position, so we can stand upright.
It also has to act as a hinge, so we can walk, and needs to twist and turn when we run or play sports.
The end of each bone is covered with cartilage that has a very smooth, slippery surface. The cartilage allows the ends of the bones to move against each other, almost without rubbing.
The joint is held in place by the synovium, which contains thick fluid to protect the bones and joint.
The synovium has a tough outer layer that holds the joint in place and stops the bones moving too far.
Strong cords called tendons anchor the muscles to the bones.
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How To Tell If A Flare
How can you tell when a flare-up is on its way?
At first, the beginning of a flare-up is similar to the crummy feeling you get when you have a fever or infection.
On top of that, you may notice redness and swelling in the joints and severe morning stiffness.
In general, flare-ups can be unpredictable and often happen after stressful events. In fact, the trigger event can be physical or emotional .
Is There A Permanent Cure For Rheumatoid Arthritis
Rheumatoid arthritis is a chronic inflammatory disease that affects many joints, mainly the small joints of the hands and feet. It is a lifelong condition without a cure.
RA occurs when the immune system malfunctions and attacks healthy tissues. Untreated or severe RA can cause inflammation that also affects the organs. When RA attacks the joints, its target is the synovium . Over time, chronic inflammation can lead to bone erosion and joint deformity.
There is no permanent cure for RA. However, healthcare providers have many options for treating RA symptoms and getting the disease into remission. Remission is a time in which a person experiences few or no signs of the disease.
Keep reading to learn about how RA is treated, the latest research, and how remission in RA occurs.
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What Foods Are Good For Rheumatoid Arthritis
It is important to maintain a healthy diet if you have rheumatoid arthritis to help reduce your risk of developing serious symptoms. This includes:
- eating lots of fruits, vegetables and wholegrain cereal food, such as brown rice or oats
- eating foods that contain fish oil
- avoiding fatty, sugary or very salty foods
- not drinking alcohol often
- maintaining a healthy body weight
How Is Rheumatoid Arthritis Treated
There is no cure for rheumatoid arthritis. But there are treatment options your doctor can prescribe to help manage your pain and stop further damage to your joints. Your doctor may recommend a combination of medicines, including:
- Pain relief medicines, such as paracetamol.
- Omega-3 supplements. This is a type of fat naturally found in foods such as certain fish that you can take as a food supplement to help with pain and stiffness.
- Non-steroidal anti-inflammatory drugs or cyclo-oxygenase-2 selective inhibitors. These are pain relief medicines that your doctor might prescribe when paracetamol and supplements do not relieve your pain and stiffness.
- Disease modifying antirheumatic drugs , such as methotrexate. These are a group of medicines that reduce your symptoms and the damage to your joints, including medicines known as biologic DMARDS .
- Corticosteroids, such as prednisolone. These are medicines that can help manage your pain and stiffness during flare ups. Corticosteroids are available as tablets, or it might be injected by your doctor into a joint to reduce pain.
Other complementary treatments such as massage, acupuncture or transcutaneous electrical nerve stimulation can help reduce your pain. But they will not reduce the damage to your joints and should not replace your prescribed medications.
Tripterygium wilfordii is a Chinese herb that is not recommended to treat rheumatoid arthritis as it can have dangerous side effects.
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Can Ra Go Into Remission
RA remission means your disease is no longer active. For some people, that means they no longer experience RA symptoms, and for others, it could mean symptom-free periods with an occasional, mild flare-up.
Remission should be a long-term goal for you and your healthcare provider, and it is possible to experience it. But because there is no specific definition of “remission,” it is hard to know exactly how many people with RA experience it.
For example, a 2017 review of RA remission studies published in Therapeutic Advances in Musculoskeletal Disease found that remission rates ranged from 5% to around 45% based on the criteria used to define remission.
That review also shares that people with RA who maintain remission for six or more months have achieved sustained remission. The authors note sustained remission is linked to improved outcomes in function, patient-reported outcomes, and survival.
Your healthcare provider will use measures to determine if you are in remission based on the American College of Rheumatology criteria. These include:
- Less than 15 minutes of stiffness in the morning
- Little or no joint pain, tenderness, or swelling
- Blood tests that show low levels of inflammation
The Risks Of Untreated Rheumatoid Arthritis
Left untreated, RA can lead to a host of health problems, so its essential to find and stick with a treatment plan that works.
Staying on top of your rheumatoid arthritis treatment can be difficult, but untreated or undertreated RA can lead to dangerous consequences and have a large impact on your health and overall quality of life.
Without proper treatment, RA can cause long-term damage to joints and serious damage to your whole body with persistent pain and possible disability, says David Pisetsky, MD, PhD, a rheumatologist and professor of medicine and immunology at Duke University School of Medicine in Durham, North Carolina. Over time, theres a high risk of joint deformity and lost function.
On the flip side, the right treatment plan can go a long way toward preventing long-term damage and preserving joint function: With current treatment options, most people can have good control of symptoms and reduce RA progression, Dr. Pisetsky says. Many can even experience remission.
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How Is Rheumatoid Arthritis Managed
You can manage rheumatoid arthritis by taking medicines as prescribed to treat pain and joint inflammation. You can also help reduce symptoms by exercising and maintaining a healthy weight. Aim to do 30 minutes of moderate exercise most days of the week. This can be at one time or broken up into shorter sessions.
You may also need to make changes at home to help you manage daily tasks like cleaning or gardening. An occupational therapist can help you make adjustments if pain or joint stiffness makes certain tasks hard to complete. They can recommend tools to reduce strain on your joints, such as long-handled dustpans so you dont need to bend over, or book holders to reduce the strain on your hands and wrists.
You might find that rheumatoid arthritis makes you frustrated and upset. Rheumatoid arthritis can cause poor sleep, which can also make you feel down. Discus your feelings with friends and family and explain to them what they can do to support you. This may help you feel better and reassured that help is available, if needed. If you are struggling with a low mood or not managing to sleep, your doctor will be able to support you and work with you to build a plan to help.
Other Therapies For Ra
Taking your medication is just one thing you can do to help you feel your best. Consider assembling a team of medical specialists from a variety of fields, like psychiatry, sleep medicine, physical or occupational therapy, or nutrition, who can support you wherever you may need it. Areas they can help with:
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Tumor Necrosis Factor Inhibitors
Tumor necrosis factor alpha is a pro-inflammatory cytokine produced by macrophages and lymphocytes. It is found in large quantities in the rheumatoid joint and is produced locally in the joint by synovial macrophages and lymphocytes infiltrating the joint synovium. TNF is one of the critical cytokines that mediate joint damage and destruction due to its activities on many cells in the joint as well as effects on other organs and body systems. TNF antagonists were the first of the biological DMARDS to be approved for the treatment of RA. These drugs began to enter the market for rheumatoid arthritis in 1999 and are now considered a part the ACR recommendations for treatment of RA. There are currently five TNF inhibitors FDA approved for the treatment of RA etanercept , infliximab , adalimumab , certolizumab pegol , and golimumab . Etanercept is a soluble TNF receptor-Fc immunoglobulin fusion construct infliximab, adalimumab, and golimumab are monoclonal antibodies and certolizumab pegol is an anti-TNF antigen binding domain-polyethylene glycol construct. While differing in structure, the efficacy and safety of the drugs is similar across the class in reducing the signs and symptoms of RA, as well as in slowing or halting radiographic damage, when used either as monotherapy or in combination with methotrexate.
Adopt Healthier Lifestyle Habits
It’s very important to maintain a healthy lifestyle. Eat a good diet, consider anti-inflammatory foods, and exercise regularly . Talk with your primary doctor and/or rheumatologist about alternative treatments for rheumatoid arthritis, such as acupuncture or relaxation therapy. Reducing your to reduce your rheumatoid arthritis pain is also an important, and many times undervalued, treatment option.
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It’s not that a healthy lifestyle will cure rheumatoid arthritis rather, a healthy lifestyle will help you get through each day better and help you better deal with the effects of RA.
It is helpful to keep a medical diary noting medications that work, drug side effects, severity of symptoms, flare-ups, and remissions.
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Ra Treatment: What Is The Safest Treatment For Rheumatoid Arthritis
Rheumatoid arthritis has no cure, but doctors recommend that patients adhere to suggested treatments early in diagnosis to decrease the severity of symptoms. There are a variety of treatment methods used to control symptoms and stop joint damage, including medications, surgery, and daily routine and lifestyle changes. Communication with a doctor or rheumatologist is necessary for choosing the most effective treatments. Your physician will ensure that treatments are safe and the medications are prescribed correctly based on each unique situation.
Treating RA will not cure the disease, but certain treatments can significantly reduce the pain and prevent permanent damage to the body. Depending on the severity of your symptoms, the goals of treatment will be to gain tight control of RA, meaning the diseases activity is kept steadily at a low level. Keeping RA in tight control can prevent long-term joint damage.
These goals primarily focus on:
- Reducing inflammation
- Preventing further or permanent damage
- Improving the quality of life
- Reducing daily and long-term side effects
Following a strict treatment regimen could bring RA into remission. Remission means that the level of disease activity has decreased in the body. It is never an indication that symptoms will not return, but following remission, many patients can go for long periods of time without experiencing symptoms.
Make Healthy Lifestyle Choices
Maintaining a healthy lifestyle will help your physical and mental well being. Doing gentle, regular exercises can help keep your joints flexible, strengthen your bones, help you maintain a healthy weight, relieve emotional stress and create a feeling of general well being. Eat a well-balanced diet with a high intake of whole grains, vegetables, fruits, legumes, nuts, fish and olive oil. There is no specific diet for people with RA and no specific foods to avoid.
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Ways To Improve Prognosis
Despite the unpredictability of rheumatoid arthritis progression, patients can ensure a positive outlook by doing the following:
- Maintaining a healthy lifestyle including diet
- Quit smoking and other poor lifestyle habits like drugs and alcohol
- exercising regularly including walking, cycling, and swimming
- Engaging in physical and occupational therapy to help adapt daily routines to any mobility challenges
- Adhering to a personalized medical treatment plan which can include taking DMARDs and other medications
All of these methods are aimed at improving or maintaining the patients quality of life, managing disease symptoms, reducing pain, and very importantly, establishing a positive outlook for the patient.
In some cases, doctors may recommend surgery to completely replace joints or to rebuild them. This can alleviate pain and improve mobility in some cases. While surgery is a viable option, the rates of surgical joint replacements in rheumatoid arthritis patients are declining. This is largely due to the massive improvements in other treatment options, and early detection rates in modern times.
What Happens In Ra
With continuous swelling and inflammation of your joints, the joint capsule remains stretched and can no longer hold the joint in its proper position. As a result, the joint may become unstable and this can lead to joint damage. The joints affected and the extent to which this happens varies a great deal from person to person. RA usually affects the small joints in your hands and feet, but it can affect many joints including your ankles, elbows, wrists, hips, knees, neck and shoulders. The pain, stiffness, fatigue and whole-body symptoms of rheumatoid arthritis can be disabling and can lead to difficulty with daily activities. Effective treatment by a rheumatologist can prevent joint damage and reduce other symptoms of RA.
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Meditation Is A Seriously Powerful And Underused Treatment
Most autoimmune disorders react negatively to stress so learning how to manage your day-to-day stress is huge, Dr. Levitan says. In fact, one of the first prescriptions he gives his patients is to download a meditation app and start using it regularly. Personal time and positive self-talk are also important stress reducers, he adds.