What Is The Treatment For Rheumatoid Arthritis
While theres no cure for rheumatoid arthritis, there are many strategies to help manage the condition and its symptoms so you can continue to lead a healthy and active life. Its helpful to understand the nature of your condition and build good relationships with your doctor, rheumatologist and healthcare professionals.
A Warning About Supplements
A few RA studies show that certain supplements and natural remedies can help. But the research is still in its early stages, so the bottom line isnât clear yet.
NCCAM: “Rheumatoid Arthritis and Complementary and Alternative Medicine ” “The Use of Magnets for Pain” and “Thunder God Vine.”
Session 3: Joint Nutrition Society and Irish Nutrition and Dietetic Institute Symposium on “Nutrition and autoimmune disease” PUFA, inflammatory processes and rheumatoid arthritis.
Arthritis Today: “Supplement Guide.”
Who Should Diagnose And Treat Ra
A doctor or a team of doctors who specialize in care of RA patients should diagnose and treat RA. This is especially important because the signs and symptoms of RA are not specific and can look like signs and symptoms of other inflammatory joint diseases. Doctors who specialize in arthritis are called rheumatologists, and they can make the correct diagnosis. To find a provider near you, visit the database of rheumatologistsexternal icon on the American College of Rheumatology website.
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What Are The Symptoms Of Ra
Rheumatoid arthritis usually starts quite slowly and you may first notice:
- joints of your fingers, wrists or the balls of your feet become uncomfortable or tender
- swelling in your joints, which often comes and goes
- joints are affected symmetrically you will notice symptoms in the same joints on both sides of the body.
- feeling stiff when you wake up in the morning.
For some people, the disease develops very rapidly and there may be a sudden onset of pain and swelling in a lot of joints.
What Do I Need To Know About Ra Medicines And Pregnancy
- Men: Talk to your doctor about your RA and the medicines you take. Some medicines may keep your partner from getting pregnant. Talk to your doctor if you and your partner are discussing pregnancy.
- Women: Talk to your gynecologist about contraceptives. Tell him or her about your RA and what medicines you take. He or she will tell you what the best contraceptive for will be. Not all contraceptives are effective if you have RA and are taking certain medicines. You may not be able to breastfeed if you are taking certain RA medicines.
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How Does Rheumatoid Arthritis Affect How People See Themselves
Rheumatoid arthritis is relatively common in young women. The limitations it can cause come right at a time when most of their peers are in good health, and that can be hard to deal with.
Some women worry that they cant be a good mother or partner. Young women who have rheumatoid arthritis often wonder whether they should even have children. Having this disease doesnt mean that getting pregnant isnt an option. But its important to keep in mind that not all of the rheumatoid arthritis medication can be taken before and during pregnancy or while breastfeeding. You can talk to a rheumatologist or gynecologist about this early on. Men who are trying for a baby with their partner also need to stop taking certain rheumatoid arthritis medications for a while.
Some people are concerned about loss of status if they have to give up their job or take on a different position. The pain and loss of strength can also affect how you see yourself. It can be hard to show weakness or accept help, especially for men. Quite a few people even try ignoring the condition as much as possible because it doesnt fit in with how they view themselves. Theyd like to stay in control and continue living the life theyre used to as much as possible. This can be physically and emotionally draining, though. It can sometimes lead to depressive thoughts, frustration and aggression.
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Best Foods For Rheumatoid Arthritis
Making healthy food choices can help reduce inflammation from rheumatoid arthritis.
Diet wont cure rheumatoid arthritis , but the right food choices can help by controlling the inflammation that wreaks havoc in the body, delivering nutrients your body needs and helping you maintain a healthy weight. Thats important because excess weight adds to pressure on achy joints and can make certain RA meds less effective. Whats more, body fat produces proteins called cytokines that promote inflammation.
Studies show that a Mediterranean diet, with lots of fruits and vegetables, whole grains and healthy fats is a good choice for people with RA. Heres a look at some foods you should be eating.
Fatty fish. Salmon, tuna, sardines, herring and other cold-water fish are rich in omega -3 fatty acids, which may help control inflammation. Your body needs a healthy balance of omega-3 and omega-6 fatty acids. Researchers have found that a greater ratio of omega-6s to omega-3s is associated with an increase in chronic inflammatory diseases like RA. So its important to reduce omega-6s which may provoke inflammation and are found in meats, certain oils and in fried and processed foods that contain those oils and increase omega-3s.
You can also view past webinars about good nutrition for arthritis, here.
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What Are The Early Signs Of Rheumatoid Arthritis
Early signs of rheumatoid arthritis include tenderness or pain in small joints like those in your fingers or toes. Or you might notice pain in a larger joint like your knee or shoulder. These early signs of RA are like an alarm clock set to vibrate. It might not always been enough to get your attention. But the early signs are important because the sooner youre diagnosed with RA, the sooner your treatment can begin. And prompt treatment may mean you are less likely to have permanent, painful joint damage.
Causes Of Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune condition, which means it is caused by the bodys immune system attacking itself. However, it is not yet known what triggers this.
Normally, your immune system makes antibodies that attack bacteria and viruses, helping fight infection. But if you have rheumatoid arthritis, your immune system mistakenly sends antibodies to the lining of your joints, where they attack the tissue surrounding the joint.
This causes the thin layer of cells covering your joints to become sore and inflamed.
This inflammation in turn causes chemicals to be released that thicken the synovium and damage nearby:
- National Rheumatoid Arthritis Society : Possible causes and risk factors
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Questions For Your Doctor
- How do I know if my joint pain is caused by rheumatoid arthritis?
- Does RA run in families?
- What medicines would work best for me, and what are the side effects?
- Is there anything I can do to prevent flare-ups of RA?
- What are the pros and cons of surgery to treat RA?
- Does RA affect my life expectancy?
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.
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Symptoms Affecting The Joints
Rheumatoid arthritis is primarily a condition that affects the joints. It can cause problems in any joint in the body, although the small joints in the hands and feet are often the first to be affected.
Rheumatoid arthritis typically affects the joints symmetrically , but this is not always the case.
The main symptoms of rheumatoid arthritis affecting the joints are outlined below.
Can Supplements Help Improve Rheumatoid Arthritis Symptoms
Its important to discuss supplements with your doctor before starting them, because many herbal supplements are not rigorously studied by the FDA and may potentially interfere with other prescription medications. That said, numerous dietary supplements have been proposed for RA treatment, and research suggests that some of them appear promising.
Fish oil, for instance, contains high levels of omega-3 fatty acids, and studies have suggested that this substance may help relieve tender joints and morning stiffness, reducing the need for anti-inflammatory drugs. But fish oil should be used with caution because it can interact with blood pressure medication.
A review published January 2017 in the journal Nutrients found that marine oil supplements can help reduce pain in patients with RA.
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Does Rheumatoid Arthritis Cause Fatigue
Everyones experience of rheumatoid arthritis is a little different. But many people with RA say that fatigue is among the worst symptoms of the disease.
Living with chronic pain can be exhausting. And fatigue can make it more difficult to manage your pain. Its important to pay attention to your body and take breaks before you get too tired.
What are rheumatoid arthritis flare symptoms?
The symptoms of a rheumatoid arthritis flare arent much different from the symptoms of rheumatoid arthritis. But people with RA have ups and downs. A flare is a time when you have significant symptoms after feeling better for a while. With treatment, youll likely have periods of time when you feel better. Then, stress, changes in weather, certain foods or infections trigger a period of increased disease activity.
Although you cant prevent flares altogether, there are steps you can take to help you manage them. It might help to write your symptoms down every day in a journal, along with whats going on in your life. Share this journal with your rheumatologist, who may help you identify triggers. Then you can work to manage those triggers.
Starting And Raising A Family
If you are taking medicines for rheumatoid arthritis, let your healthcare team know if you want to start a family or if you are worried about becoming pregnant while on medication.
Some medications, such as methotrexate, leflunomide and biological treatments, should not be taken by men or women while they are trying for a baby. The doctors and nurses will work with you to ensure your rheumatoid arthritis is controlled while you are trying to get pregnant.
Babies and young children are physically and mentally demanding for any parent, but particularly so if you have rheumatoid arthritis. If you are struggling to cope, it may help to talk to other people in the same situation as you. You may also be able to get additional support from your health visitor or occupational therapist to help you manage your young family.
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Forgetting To Protect Your Joints
Joint protection is an important part of any treatment program for RA. The goal is to reduce pain, prevent deformity, stabilize the joints, and reduce stress on the joints. This is accomplished through the use of splints, braces, or assistive devices exercise proper body mechanics pacing your activities and modifying your environment if necessary. Failure to protect your joints can make RA worse.
Managing The Pain Of Rheumatoid Arthritis
Understanding the causes of pain in RA can go a long way to helping you to find the best ways to manage your pain.
Pain is an extremely personal experience. While this review will try to explain some of the simple mechanisms of pain and the current treatments for pain in rheumatoid arthritis patients, such an overview represents a view based on an understanding of the evidence-based literature on current RA therapies and an individual rheumatologists experience it cannot fully explain every individual patients pain problems. All pain that is present for a reasonable length of time, no matter what the underlying cause, can be associated with poor sleep patterns and depressed mood. The stress associated with RA-related job loss or relationship problems all impact on how we cope with pain. Pain involves not only the nerves at the site of pain but the nerve pathways leading to the brain and special pain pathways within the brain itself. Very simply, pain is a complex phenomenon.
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Common Signs Of Rheumatoid Arthritis:
- Joint painis the main sign of rheumatoid arthritis. Ultimately, the knees, hands, ankles, wrists, and feet are the most affected.
- Joint swellingthat lasts for six weeks or more.
- Joint inflammation, tenderness, heat, and redness.
- Morning stiffnessthat lasts for at least 30 minutes
- Trouble walking, climbing stairs, bending over, and moving normally.
- Loss of appetite
Not surprisingly, symptoms are worse when inflammation levels are high. As a result, the only way to manage rheumatoid arthritis is to reduce inflammation.
In the long run, most RA patients have flare-ups where symptoms suddenly get worse. After a while, inflammation can be controlled, but its only a matter of time before it returns.
What Causes Rheumatoid Arthritis Symptoms
Overall, the loss of joint cartilage due to inflammation is responsible for a lot of RAs symptoms. As a result of cartilage loss, the space between the joints shrinks. In the end, the surrounding tissues may begin to rub together and swell.
With a healthy joint, the synovial fluid provides lubrication. In contrast, a joint with inflammation has thicker synovial fluid and more friction.
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Other Immunomodulatory And Cytotoxic Agents
Some additional immunomodulatory drugs are used in RA including azathioprine , and cyclosporin A . Rarely cyclophosphamide and d-Penicillamine are used. Because the potential of high toxicity, these agents are typically utilized for life-threatening extra-articular manifestations of RA such as systemic vasculitis or with severe articular disease that is refractory to other therapy.
Azathioprine has some activity in rheumatoid arthritis but may take 8-12 weeks to see an effect. It is a purine analog that can cause bone marrow suppression and lowering of blood cell counts particularly in patients with renal insufficiency or when used concomitantly with allopurinol or ACE inhibitors. Increased risk of secondary malignancy due to azathioprine is controversial. Screening for levels of the enzyme thiopurine methyltransferase is recommended before initiating therapy with azathioprine. Certain individuals have deficiencies in this enzyme that metabolizes azathioprine with a concomitantly increased risk of toxicitiy for the medication. Side effects include nausea, and alopecia. Blood tests to monitor blood counts and liver function tests are necessary for patients on azathioprine.
Getting Tough On Ra From The Start
Most doctors begin hard-hitting treatment as soon as rheumatoid arthritis is diagnosed. Research shows that even in the first months after diagnosis, joint damage can occur if the disease is not treated aggressively, says Paul Howard, MD, a rheumatologist at Arthritis Health in Scottsdale, Ariz.
Doctors once took more of wait-and-see approach prescribing nonsteroidal anti-inflammatory drugs early in the disease process before moving onto stronger drugs. Today, they are likely to begin treating right away with traditional disease-modifying drugs such as methotrexate , azathioprine and leflunomide . If the disease is not controlled quickly, the next step is the addition of a biologic agent, says Dr. Howard, who often prescribes a biologic in three months in those cases.
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How To Get A Good Fit
Most people wear shoes that are too small for their feet. So how do you get a good fit?
Look for a shoe thatâs wide enough. That means your foot doesnât fall off the side of the sole or push the material out of shape. Check the width of the heel as well. If itâs too wide, your heel might slip out when you walk.
The shoe shouldn’t push on any of your toes, including those that are out of shape because of foot problems . And there should be enough room over the top of your foot to make it easy to get in and out of the shoe. You can adjust this in many lace-up shoes, as long as they have three or more sets of holes for laces.
In general, there should be about a half-inch of space between your longest toe and the end of the shoe. If you have a bunion or claw toe, the shoe should be as long as you’d need if all your toes were straight. This helps ensure a correct fit for width and the flex of the foot in the shoe.
Finally, try on any pair of shoes before you buy it. Even if you know your correct size in one brand of shoe, it may not be the same in a different brand or even a different model of the same brand. Try on both shoes, since your feet may not be the same size or width.
If youâre still having trouble getting the right fit, a foot doctor called a podiatrist can help.