Heres Why The Disease Progresses What To Expect And How To Stop It
Rheumatoid arthritis is a chronic condition for which there is no cure. But even though the disease is progressive, newer disease-modifying drugs may actually be able to slow or even halt it getting worse. We have many effective treatments for RA that help control the symptoms of joint pain and stiffness, but also prevent progression of the disease and the development of permanent damage, says Lindsay Lally, MD, a rheumatologist at Hospital for Special Surgery in New York City.
Early treatment for RA is key, because whatever joint damage has already occurred cant be reversed. Find out how to recognize the symptoms at each stage of RA, and what can be done to treat it.
Effects On Your Daily Life
- See a doctor or other relevant healthcare professional if youre unable to do everyday tasks due to joint or muscle pain.
- If youve lifted something heavy and hurt your back, for example, take some painkillers, apply some heat and try to stay active. If the pain doesnt ease after a couple of weeks or so, see a doctor.
Its important to see a doctor if you get any new symptoms or if you have any trouble with drugs youre taking.
If you have an appointment with a doctor, to help make sure you get the most out of it, you could take a list of questions with you and tick them off as they are discussed.
You could also keep a symptoms diary with details of how youre feeling in between appointments. Some people find that taking a friend or relative with them to an appointment can provide support and ensure that all important points are discussed.
Does Regenerative Medicine Help Rheumatoid Arthritis
The potential benefits of regenerative medicine procedures for persons with rheumatoid arthritis, regardless of the stage of the condition, include alleviation of pain and other symptoms and reduction of the level of inflammation. Ongoing research in the field of regenerative medicine shows promise even for patients in the advanced stages of RA.
If the condition is diagnosed soon enough, it is possible for patients with rheumatoid arthritis to live a normal, healthy life. The potential benefits of leading an active lifestyle for patients with rheumatoid arthritis include the ability to better manage the course of the disease, slow down its progression and increase life expectancy. However, it is essential to consult specialists on rheumatoid arthritis early on, as well as ask regenerative medicine specialists for an opinion.
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Biologic Therapy In Rapidly Progressing Patients
All of the commercially available biologic agents have been evaluated in patients with RA of differing disease durations. Currently, there are three TNF- inhibitors approved for use in RA: infliximab, etanercept and adalimumab, which act by different mechanisms to bind on and inhibit the activity of TNF-. While there are no head-to-head comparisons of the agents to date, all have proven effective in relieving the symptoms of RA and slowing or halting radiographic disease progression, with 5070% of patients showing clinically significant improvement . Importantly, all three anti-TNF- agents when combined with MTX have been shown to be very effective in preventing radiological damage . These studies of anti-TNF- therapy plus MTX, compared with the effects with MTX alone, have shown that although MTX is relatively effective at relieving clinical symptoms, it has little or no effect on underlying radiological progression. Anti-TNF- plus MTX combination therapy, however, completely prevented and in some cases actually slightly reversed the radiological progression of RA. These studies also confirmed that MTX plus biologic combination therapy is more effective than biologic monotherapy in inhibiting the progression of joint damage and improving the signs and symptoms of inflammation in RA patients.
Infliximab rapidly normalizes CRP levels in RA . Reproduced with permission from John Wiley & Sons, Inc.
Risk Factors For Ra Development
Preventive strategies that target risk factor modification would ideally be based on a sound understanding of the modifiable exposures that influence the development of RA. There are numerous factors that have been associated with increased risk for RA. Some of these risk factors are presented in . Several of the strongest risk factors are certain genetic factors including the presence of HLA alleles containing the shared epitope, female sex, family history of RA, and exposure to cigarette smoke . In particular, smoking is the strongest known environmental risk factor, especially for ACPA positive RA, and is thought to explain up to 35% of ACPA positive RA. There are also emerging understanding of other factors that may influence RA risk including the protective effect of factors such as alcohol use and intake of certain fatty acids . Furthermore, as mentioned above, there is growing evidence suggesting that certain infections and/or inflammatory processes such as periodontal disease and infections with Porphyromonas gingivials may be triggers for RA.
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What Causes Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disease. This means that your immune system which usually fights infection attacks the cells that line your joints by mistake, making them swollen, stiff and painful.
Over time, this can damage the joint itself, the cartilage and nearby bone.
It’s not clear what triggers this problem with the immune system, although you are at an increased risk if you are a woman, you have a family history of rheumatoid arthritis, or you smoke.
Read more about the causes of rheumatoid arthritis.
Rheumatoid Factor And Anti
Specific blood tests can help to diagnosis rheumatoid arthritis, but are not accurate in every person. About half of all people with rheumatoid arthritis have a positive rheumatoid factor present in their blood when the disease starts, but about one in every 20 people without rheumatoid arthritis also tests positive for this.
Another antibody test known as anti-CCP is also available. People who test positive for anti-CCP are very likely to develop rheumatoid arthritis, but not everybody found to have rheumatoid arthritis has this antibody.
Those who test positive for both rheumatoid factor and anti-CCP may be more likely to have severe rheumatoid arthritis requiring higher levels of treatment.
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Treating Rheumatoid Arthritis: The Sooner The Better
Treating rheumatoid arthritis early is critical for staving off its progression. Rheumatoid, if left untreated, can destroy the joints very quickly, Dr. DeLorenzo points out. Also, the chronic inflammation from the immune system can cause other issues, like heart disease or lung disease.
If you are experiencing arthritic symptoms, Dr. DeLorenzo says to visit your primary care doctor first, to see if they can give you a definite diagnosis. From there, if your doctor thinks you have rheumatoid arthritis, you will be sent to a rheumatologist, who will recommend:
- Regular exercise
- Taking anti-inflammatory medications
You will likely also be put on disease-modifying antirheumatic drugs to halt the progression of the disease.
What Is It Like To Live With Rheumatoid Arthritis
If youre fighting Rheumatoid Arthritis, you can live an active, normal life, but you may need to practice self-care to minimize your pain and symptoms. Here are a few ways that those suffering from RA manage it:
Physical Activity. Regular exercise is vital. Staying strong and keeping muscles active is a great way to reduce pain. Suggested activities include low-impact aerobics, dance, Pilates, yoga and other exercises that strengthen muscles and promote flexibility. Patients should see a doctor or physical therapist for recommended activities based on their abilities and then lessen the intensity if any joint damage has already occurred.
Diet. Eating foods that help keep inflammation low can be greatly beneficial to those suffering from RA. Most of these items fall into the traditional Mediterranean diet menu of fish, olive oil, fruits and vegetables. Foods to avoid include anything processed like packaged cookies and crackers, and fast foods.
Temperature Therapies. Some Rheumatoid Arthritis patients find relief using heating pads and hot baths to soothe stiff joints and muscles. Alternately, for a rapid reduction of inflammation to numb sharp pain, ice packs can be utilized.
Community. Connecting with others who suffer from Rheumatoid Arthritis and/or discussing the ailment with supportive friends and family members may help to mentally navigate the condition.
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Prevention Of Initial Onset Of Ia In Subjects Who Have Developed Ra
Moving even further back into the evolution of RA, subjects who have developed abnormalities of RA-specific autoantibodies in absence of overt IA as defined by physical examination findings of synovitis may be targeted for disease prevention. This time period of RA development is particularly attractive to target because, as discussed above, abnormalities of these biomarkers are highly predictive of the future onset of RA and therefore in clinical trials they can be used to inform subjects of their specific risks for developing RA, as well as give some indication as to the expected timing of onset of clinically apparent RA factors which are highly important in designing the duration of a clinical trial, powering the study, and recruiting subjects. In addition, immune modulation during this period of RA development may be particularly amenable to alteration because more permanent changes in inflammation such as changes in fibroblasts that render them more persistently activated may not yet have occurred.
Bos and colleagues published the results of such a trial in 2010 wherein they treated 83 anti-CCP positive subjects with arthralgias but no IA based on examination by 2 rheumatologists with 2 doses of IM 100 mg dexamethasone versus placebo. Dexamethasone reduced autoantibody titers ; however, it did not delay the progression to clinically apparent IA suggesting that another agent, or more sustained therapy would be necessary to prevent the development of RA.
What Can You Do About The Side Effects
Some of methotrexate’s side effects occur because it interferes with the effect that has in the body. The risk of these side effects can be lowered by also taking low-dose folic acid once a week. Studies have shown that this helped more than half of the people who had side effects to continue their treatment with methotrexate.
It is also possible to inject the medication under the skin or into a muscle instead: When the medication is given in this way, side effects such as nausea, diarrhea and inflammations of the membranes lining the mouth are less common.
Because of the increased risk of infections, pneumonia is more likely to develop. In very rare cases the medications can cause other serious side effects too, such as liver damage or changes in blood cell count. In order to detect these kinds of serious side effects earlier, blood and urine samples are tested regularly during the treatment. It’s generally always important to talk to a doctor if side effects occur.
When deciding which medication to use, it’s also important to take other medical conditions into account. For instance, in very rare cases hydroxychloroquine can damage the retina so it isn’t suitable for people who have a retinal disease. Because sulfasalazine can lead to allergic skin reactions, it shouldn’t be used in people who have certain allergies.
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How Effective Are Drugs Like Methotrexate
Research has shown that conventional disease-modifying drugs can prevent damage to joints and relieve symptoms. In research on medication for rheumatoid arthritis, a treatment is considered to work if it reduces swelling in the joints and at least three of the following improvements occur:
- Pain relief
- Better overall rating of general health
An analysis of methotrexate studies that lasted one year found the following:
- Symptoms were reduced by at least a half in 23 out of 100 people who took methotrexate.
- Symptoms were reduced by the same amount in 8 out of 100 people who took a placebo for comparison.
So treatment with methotrexate helped 15 out of 100 people to feel significantly better. Symptoms like morning stiffness also improved in a lot more people who took a conventional disease-modifying drug.
There hasn’t yet been any good-quality research looking into whether one particular conventional disease-modifying drug is more effective than any of the others.
Stopping Medication Can Trigger Relapse
One reason you may have a remission relapse is simple: you stop taking your medications. When an RA patient achieves remission, some doctors will taper treatment, either by decreasing the dose of medication or increasing the time between treatments. In other cases, a doctor might decide a patient can attempt to go without any medication at all. The purpose of reducing or eliminating a patients medication is to minimize the risk of side effects that accompany todays powerful medications.;
However, someone who had been in remission can have their symptoms return, explains rheumatologist Theodore Fields, MD, clinical director of the Early Arthritis Initiative in the Inflammatory Arthritis Center at New York Citys Hospital for Special Surgery. I have some patients who have been off medication for a couple of years and stayed in remission, says Dr. Fields. But thats true for only a small number of patients, hes quick to add.;
Little is known about which RA patients in remission might be able to go drug-free, although some evidence hints that those who received early and aggressive treatment for the disease might be the best. However, patients who have mild symptoms, but arent in total remission, are not candidates for the cold turkey approach, stresses Dr. Field. The risk of relapse and a worsening of symptoms is too great.;
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Your Range Of Motion Changes
Commonly, people will say their fingers dont straighten anymore or they cant bend or straighten them all the way, Dr. Wallace says. Their fingers dont necessarily hurt more, but they don’t work like they used to work.” Any range of motion or function changes like these can indicate rheumatoid arthritis progression, even without accompanying pain or tenderness.
Most people with active rheumatoid arthritis have a limited range of motion in the joints most affected by the disease, Dr. Wallace says. For many people, this includes the joints in their hands, which makes it hard to do everyday things, like drink coffee. A lot of people with active rheumatoid arthritis have problems with things like holding coffee cups, gripping steering wheels, chopping vegetables, things that require a tight grip, she says. This is often worse in the morning and gets worse when a person is experiencing a flare.
Depending on your situation, your doctor may recommend using supportive devices, like finger splints, to correct mild deformities. In situations where you have scar tissue or your joint function is severely limited, surgery may be necessary to regain proper functioning, according to Merck Manual.
What Does It Mean To Be In Remission From Rheumatoid Arthritis
If you or someone you love has rheumatoid arthritis, youve probably thought about remission from rheumatoid arthritis more than once. As you likely know, rheumatoid arthritis is a very serious illness, and it can often be debilitating. So the concept of achieving remission can feel like a beacon of hope.
Today more than 1.3 million Americans are living with rheumatoid arthritis, and about 75 percent of them are women, according to the American College of Rheumatology. Rheumatoid arthritis is the most common form of autoimmune arthritis and causes pain, stiffness, and swelling in the joints of the hands, feet, and wrists.
As a quick refresher: Autoimmune diseases like rheumatoid arthritis arise when the bodys immune systemwhich typically keeps you healthy and defends against diseasestops working properly and mistakenly attacks healthy cells in your body, according to the U.S. National Library of Medicine. But with new advances in treatment options, it is possible to stop or slow the progression of rheumatoid arthritis with the right treatment. In some cases, people are even able to achieve a state of remission where the joints arent seeing further damage and the disease doesnt interfere with day-to-day living. Heres what you need to know about achieving rheumatoid arthritis remission.
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How Rheumatoid Arthritis Is Treated
There is no cure for rheumatoid arthritis, but early diagnosis and appropriate treatment enables many people with rheumatoid arthritis to have periods of months or even years between flares and to be able to lead full lives and continue regular employment.
The main treatment options include:
- medication that is taken in the long-term to relieve symptoms and slow the progress of the condition
- supportive treatments, such as physiotherapy;and occupational therapy, to help keep you mobile and find ways around any problems you have with daily activities
- surgery to correct any joint problems that develop;
Read more about treating rheumatoid arthritis.
Neck Joints Are Not Spared Ra Joint Pain And Damage
- The Neck Someone with RA can also experience inflammation and pain in the neck. This can cause stiffness, weakness, and loss of motion. If not treated, severe inflammation in the neck can lead to instability of the cervical spine.
- The Throat Although rare, the cricoarytenoid joint near the windpipe may also swell from the disease, affecting breathing.
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New To Ra Treat It Please
- Reactions 0 reactions
You think you might have rheumatoid disease , but youre not sure. Youre reluctant to bring it up with your doctor. Youre afraid shell think youre imagining it, or exaggerating, or being a know-it-all because you googledor all of the above. Or maybe youre afraid youre right and you do have it. What then?
Or maybe you recently received a diagnosis of RD, but youre unsure about howor even ifyou should treat it. Youve heard or read about the sobering side-effects of many RD drugs, and youre worried about taking them. Given how serious some of them are, who wouldnt be a little scared?
Ill put this in the most respectful, yet urgent way I can: please stop hesitating. If you arent sure and havent pursued a diagnosis, please dont wait any longer. See your doctor. And if you do have RD, then please treat it.
Rheumatoid disease is deadly serious. Its not your garden-variety, older-persons arthritis . The main difference between the two? RD can affect your entire body, not just;your joints.
RD is a systemic autoimmune disease. It causes the bodys immune system to attack, damage, and destroy its own tissues as if they were foreign invaders, like viruses or bacteria. No one really knows what causes RD, but scientists suspect genetics, environment, and other factors, including smoking, may trigger it.
RD inflammation causes other symptoms, as well: low-grade fevers, fatigue, and a flu-like malaise that is often simply overwhelming.