Treatment Of Rheumatoid Arthritis
Treatment of rheumatoid arthritis continues to improve, which can give many people relief from symptoms, improving their quality of life. Doctors may use the following options to treat RA:
- Routine monitoring and ongoing care.
- Complementary therapies.
Your doctor may recommend a combination of treatments, which may change over time based on your symptoms and the severity of your disease. No matter which treatment plan your doctor recommends, the goals are to help:
- Relieve pain.
- Prevent, slow, or stop joint and organ damage.
- Improve your ability to participate in daily activities.
Rheumatoid arthritis may start causing joint damage during the first year or two that a person has the disease, so early diagnosis and treatment are very important.
The Erythrocyte Sedimentation Rate
The ESR measures the degree of inflammation in the joints. Blood is taken and placed in a small, thin tube, and the distance the red cells settle in one hour is measured. The more rapidly the red cells settle the more inflammation in the joints. One of the aims of treatment is to reduce the ESR to normal levels.
Prepare For The Journey Of Arthritis
Many people who are newly-diagnosed want the quick fix or cure for arthritis. For most people with arthritis, however, there is no cure. There have been significant advances in treatment options over the years, but finding the right course of treatment can be a journey. It is not uncommon to start one course of treatment and have to change several times before you find what works best.
Also, it is important to realize that what brings relief to one person may be totally ineffective for you. There are many things to try, including exercise, so try to be patient as you go through the process of finding what works for you. Even after you have been treated for a period of time, its very important that you talk to your healthcare provider about new or persistent symptoms. It may be time to change your treatment if your response is no longer satisfactory.
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Diagnosis Of Rheumatoid Arthritis
- Ordering laboratory tests.
- Ordering imaging studies, such as x-rays or ultrasound.
It can be difficult to diagnose rheumatoid arthritis when it is in the early stages because:
- The disease develops over time, and only a few symptoms may be present in the early stages.
- There is no single test for the disease.
- Symptoms differ from person to person.
- Symptoms can be similar to those of other types of arthritis and joint conditions.
As a result, doctors use a variety of tools to diagnose the disease and to rule out other conditions.
What Is Involved In Reviewing Your Medical History And Your Current Symptoms
When reviewing your medical history, your healthcare provider may ask the following questions:
Have you had any illnesses or injuries that may explain the pain?
Is there a family history of arthritis or other rheumatic diseases?
What medication are you currently taking?
Your healthcare provider may also ask:
What symptoms are you having? For example, pain, stiffness, difficulty with movement, or swelling.
About your pain:
Rheumatoid arthritis is a difficult disease for healthcare providers to diagnose, especially in its early stages, because the signs and symptoms are similar to those of many other conditions. So far, healthcare providers dont have a single test that definitively diagnoses RA, so they rely a physical exam, family medical history, several blood tests, and imaging such as X-rays.
Rheumatoid arthritis differs from osteoarthritis in that it is an autoimmune disorder. That means the immune system mistakenly attacks its own cells and tissues, primarily, in RA, the cells and tissues of the joints.
Most autoimmune diseases are hard to diagnose, but getting it right is important because it helps determine the appropriate course of treatment.
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The Diagnostic Criteria For Rheumatoid Arthritis
The diagnosis of rheumatoid arthritis cant be established with just one test. Instead, rheumatologists rely on a combination of your medical history, a physical exam, laboratory tests, and sometimes imaging tests to pinpoint the disease.
They also try to rule out the possibility of other conditions that may resemble RA, such as lupus, psoriatic arthritis, gout, or osteoarthritis. This is called a differential diagnosis.
To begin the diagnostic process, a rheumatologist will take your medical history, which includes asking questions about your current symptoms particularly pain, swelling, and stiffness and their location, duration, and severity.
Theyll also ask about your familys medical history as it pertains to RA and other autoimmune conditions. Conditions like RA can be more common in families with RA or other immune system-related health problems. For example, research recently published in the journal Arthritis Care & Research found that people who have a first-degree relative with RA are more than twice as likely as the general population to develop RA. A family history of lupus, scleroderma, thyroid disease, or inflammatory bowel disease also substantially increased the risk of RA.
Your rheumatologist will also perform a physical examination, testing each of your joints for things like swelling, tenderness, and limited range of motion. The location of affected joints is important to diagnosis.
How Is Seronegative Rheumatoid Arthritis Diagnosed
Some patients still have RA but do not test positive for either anti-CCPs or RF they have seronegative RA.
Annals of the Rheumatic Diseases
Your doctor may also conduct a synovial biopsy, which involves removing a small piece of the tissue lining one of your joints.
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When To See A Healthcare Provider
Anyone experiencing symptoms of joint swelling, pain or tenderness, particularly worse in the morning, and/or fatigue for several weeks, should be evaluated by a healthcare provider.
A rheumatologist is a specialist who diagnoses and treats RA and other autoimmune illnesses. While primarily targeting the joints, RA can lead to inflammation elsewhere in the body, including of the heart or lungs, so untreated disease can lead to serious complications and long-term disability.
Why You Have Arthritis
There are over 100 different types ofarthritis that can develop as you get older or following an injury. The many types of arthritis target your joints, causing pain, inflammation, and stiffness and limiting your joints flexibility.
The two most common types of arthritis that affect many adults in the United States include osteoarthritis and rheumatoid arthritis.
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Take This Test: Do You Have Rheumatoid Arthritis
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Take this test: Do you have Rheumatoid Arthritis?
Lots of people have joint pain or other joint problems. Most of the time, there are not due to rheumatoid arthritis .
There is no single test to diagnose RA. The diagnosis is made from a combination of clinical symptoms and findings, supported by various blood tests .
However, you can try this arthritis screen to determine the likelihood of having the disease by this series of questions which may act as a rheumatoid arthritis test.
What Are The Complications Of Ra
Rheumatoid arthritis has many physical and social consequences and can lower quality of life. It can cause pain, disability, and premature death.
- Premature heart disease. People with RA are also at a higher risk for developing other chronic diseases such as heart disease and diabetes. To prevent people with RA from developing heart disease, treatment of RA also focuses on reducing heart disease risk factors. For example, doctors will advise patients with RA to stop smoking and lose weight.
- Obesity. People with RA who are obese have an increased risk of developing heart disease risk factors such as high blood pressure and high cholesterol. Being obese also increases risk of developing chronic conditions such as heart disease and diabetes. Finally, people with RA who are obese experience fewer benefits from their medical treatment compared with those with RA who are not obese.
- Employment. RA can make work difficult. Adults with RA are less likely to be employed than those who do not have RA. As the disease gets worse, many people with RA find they cannot do as much as they used to. Work loss among people with RA is highest among people whose jobs are physically demanding. Work loss is lower among those in jobs with few physical demands, or in jobs where they have influence over the job pace and activities.
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How Your Doctor Can Tell If You Have Rheumatoid Arthritis
After testing is finished, your doctor will decide if you have RA. But before that, they will need to rule out other conditions that can mimic RA. It is important to rule out these other diagnoses because they often require a different treatment strategy. These conditions include:5
- Osteoarthritis, a type of arthritis in which the protective tissue at the ends of bones begin to break down
- Psoriatic arthritis, a type of inflammatory arthritis that is often associated with psoriasis
- Polymalagia rheumatica, a disorder that causes inflamed muscles around the shoulders and hips
- Infectious arthritis, an infection in the joint
In order to rule out these other diagnoses, your doctor will use a set of RA criteria established by scientific study and real-world practice. Here are the signs, symptoms, and test results your doctor will look for:2
- At least 2 joints impacted by inflammatory arthritis, including the shoulders, elbows, hips, knees, and ankles
- Smaller joints affected by inflammatory arthritis
- A positive result on a rheumatoid factor or CCP antibody test
- Higher CRP or sed rate levels
- Symptoms for 6 weeks or longer
Keep in mind that you may not meet all of these criteria, but your doctor could still diagnose you with RA.2
Theyll Order Imaging Tests
Rheumatoid arthritis impacts the lining of joints, which leads to damage of joint tissue. Your doctor may order X-rays to check for joint damage caused by RA . Sometimes, doctors order CT scans, ultrasounds or even MRIs as well. X-rays in early stages may not show the changes, caused by RA, Dr. Khan says. Ultrasound and MRI give far more information about the joint lining and whether or not the tissues around the joints are inflamed.
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Measures To Reduce Bone Loss
Inflammatory conditions such as rheumatoid arthritis can cause bone loss, which can lead to osteoporosis. The use of prednisone further increases the risk of bone loss, especially in postmenopausal women.
You can do the following to help minimize the bone loss associated with steroid therapy:
- Use the lowest possible dose of glucocorticoids for the shortest possible time, when possible, to minimize bone loss.
- Get an adequate amount of calcium and vitamin D, either in the diet or by taking supplements.
- Use medications that can reduce bone loss, including that which is caused by glucocorticoids.
- Control rheumatoid arthritis itself with appropriate medications prescribed by your doctor.
What Conditions May Be Confused With Ra
People with this condition often feel pain all over, in all their muscles and joints, and have multiple tender points when examined. They will also often have a degree of early morning stiffness. Poor unrestorative sleep is often present, with associated fatigue and low mood, and often there are associated symptoms of headaches and irritable bowels and bladder. Investigations tend to be normal. It is important to distinguish this condition from rheumatoid arthritis as their management is very different, although sometimes both conditions are present.
This condition causes pain and stiffness of the shoulders and thighs and tends to occur in people over 65 years of age. It is more common in females. Sometimes elderly people with RA present with similar symptoms. PMR is treated by a course of steroid tablets where the dosage is gradually reduced over months and can generally be stopped after about 18 months 2 years. In people with RA presenting with PMR type symptoms, the correct diagnosis of RA usually becomes apparent when the patient is unable to reduce the steroid dosage below 10mg.
The Role Of Blood Tests
Blood tests dont provide a simple yes-or-no answer to whether you have RA. But they can help your doctor steer toward a diagnosis. Blood tests narrow down options and suggest how your disease might progress.
After you receive a diagnosis of RA, continued blood tests will monitor the side effects of drugs used in treatment. They can also help track the progression of the disorder.
How Is Ra Diagnosed
RA is diagnosed by reviewing symptoms, conducting a physical examination, and doing X-rays and lab tests. Its best to diagnose RA earlywithin 6 months of the onset of symptomsso that people with the disease can begin treatment to slow or stop disease progression . Diagnosis and effective treatments, particularly treatment to suppress or control inflammation, can help reduce the damaging effects of RA.
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The C Reactive Protein
The CRP also measures the degree of inflammation in the joints. The CRP is a protein produced in the liver when there is inflammation anywhere in the body. Special techniques have to be used to measure the CRP. The more inflammation in the joints, the higher the CRP. The CRP is a more sensitive measure of inflammation than the ESR. This is because, in the normal situation, there is very little if any CRP in the blood.
How Is Rheumatoid Arthritis Treated
The goals of rheumatoid arthritis treatment are to:
- Control a patient’s signs and symptoms.
- Prevent joint damage.
- Maintain the patients quality of life and ability to function.
Joint damage generally occurs within the first two years of diagnosis, so it is important to diagnose and treat rheumatoid arthritis in the window of opportunity to prevent long-term consequences.
Treatments for rheumatoid arthritis include medications, rest, exercise, physical therapy/occupational therapy, and surgery to correct damage to the joint.
The type of treatment will depend on several factors, including the person’s age, overall health, medical history, and the severity of the arthritis.
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What Imaging Techniques May Be Used To Diagnose Arthritis
Imaging techniques may give your healthcare provider a clearer picture of what is happening to your joint. Imaging techniques may include the following:
X-ray. X-rays may show joint changes and bone damage found in some types of arthritis. Other imaging tests may also be done.
Ultrasound. Ultrasound uses sound waves to see the quality of synovial tissue, tendons, ligaments, and bones.
Magnetic resonance imaging . MRI images are more detailed than X-rays. They may show damage to joints, including muscles, ligaments, and cartilage.
Arthroscopy. This procedure uses a thin tube containing a light and camera to look inside the joint. The arthroscope is inserted into the joint through a small incision. Images of the inside of the joint are projected onto a screen. It is used to evaluate any degenerative and/or arthritic changes in the joint to detect bone diseases and tumors to determine the cause of bone pain and inflammation, and to treat certain conditions.
Rheumatoid Factor And Anti
One blood test measures levels of rheumatoid factors in the blood. Rheumatoid factors are proteins that the immune system produces when it attacks health tissue.
About half of all people with rheumatoid arthritis have high levels of rheumatoid factors in their blood when the disease starts, but about 1 in 20 people without rheumatoid arthritis also test positive.
A related blood test known as anti-cyclic citrullinated peptide test is also available. Anti-CCPs are antibodies also produced by the immune system.
People who test positive for anti-CCP are very likely to develop rheumatoid arthritis, but not everybody with 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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What Are The Signs And Symptoms Of Ra
With RA, there are times when symptoms get worse, known as flares, and times when symptoms get better, known as remission.
Signs and symptoms of RA include:
- Pain or aching in more than one joint
- Stiffness in more than one joint
- Tenderness and swelling in more than one joint
- The same symptoms on both sides of the body
- Weight loss
Diagnosis Involves A Process Of Elimination
To diagnose you with psoriatic arthritis, healthcare providers use your medical history, a physical examination, and X-rays or other imaging studies.
If its not adequately treated, it may lead to permanent joint damage and disability.
Psoriatic arthritis can be well managed with certain medications. But treatments for other types of arthritis arent effective against psoriatic arthritis. That makes getting an accurate diagnosis extremely important.
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What Causes Arthritis Of The Knee
Experts have identified some genes that might cause arthritis, including arthritis of the knee. They predict that there are more genes not yet discovered. You could have a gene linked to arthritis without knowing it and a virus or injury could trigger arthritis of the knee.
Though the cause is unknown, some risk factors increase the possibility of arthritis of the knee. Risk factors of osteoarthritis, specifically, include:
- Age. Osteoarthritis happens to older adults more often than younger adults and children.
- Bone anomalies. Youre at a higher risk for osteoarthritis if your bones or joints are naturally crooked.
- Gout. Gout, also a type of inflammatory arthritis, might lead to osteoarthritis.
- Injuries. Knee injuries can cause arthritis of the knee.
- Stress. A lot of stress on your knees from jogging, playing sports or working an active job can lead to osteoarthritis of the knee.
- Weight. Extra weight puts more pressure on your knees.