What Are Rheumatoid Arthritis Treatments
Despite significant advances in treatment over the past decades, rheumatoid arthritis continues to be an incurable disease. While there is no cure, the goal of disease remission is frequently attainable. Treatment of rheumatoid arthritis has two major components:
Living With Rheumatoid Arthritis
Rheumatoid arthritis is a lifelong disease. When its treated, it may go away for a little while, but it usually comes back. Its important to see your doctor as soon as symptoms begin. The earlier you start treatment, the better your outcome. Some of the damage from RA is irreversible, so finding the disease and treating it early is very important.
If left untreated, RA can cause other health problems. Your hands may become bent or twisted. Other joints can become deformed. Inflammation will affect your cartilage and bones. Lung and heart problems also can occur. Talk to your doctor if you notice any new symptoms or problems.
Rheumatoid Arthritis: Causes Symptoms Treatments And More
Rheumatoid arthritis is an inflammatory type of arthritis that can causes joint pain, swelling and damage. Learn what causes RA and how to treat it.
Rheumatoid arthritis causes joint inflammation and pain. It happens when the immune system doesnt work properly and attacks the lining of the joints . The disease commonly affects the hands, knees or ankles, and usually the same joint on both sides of the body. But sometimes, RA causes problems in other parts of the body as well, such as the eyes, heart and circulatory system and/or lungs. For unknown reasons, more women than men get RA, and it usually develops in middle age. Having a family member with RA increases the odds of developing RA.
In a healthy person, the immune system fights invaders, such as bacteria and viruses. With an autoimmune disease like RA, the immune system mistakes the bodys cells for foreign invaders and releases inflammatory chemicals that attack, in the case of RA, the synovium. Thats the tissue lining around a joint that produces a fluid to help the joint move smoothly. The inflamed synovium gets thicker and makes the joint area feel painful and tender, look red and swollen and moving the joint may be difficult.
Researchers arent sure why some people develop RA. They think that these individuals have certain genes that are activated by a trigger in the environment, like a virus or bacteria, or physical or emotional stress or some other external factor.
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Medical History And Physical Examination
After listening to your symptoms and discussing your general health and medical history, your doctor will examine your foot and ankle.
Skin. The location of callouses indicate areas of abnormal pressure on the foot. The most common location is on the ball of the foot . If the middle of the foot is involved, there may be a large prominence on the inside and bottom of the foot. This can cause callouses.
Foot shape. Your doctor will look for specific deformities, such as bunions, claw toes, and flat feet.
Flexibility. In the early stages of RA, the joints will typically still have movement. As arthritis progresses and there is a total loss of cartilage, the joints become very stiff. Whether there is motion within the joints will influence treatment options.
Tenderness to pressure. Although applying pressure to an already sensitive foot can be very uncomfortable, it is critical that your doctor identify the areas of the foot and ankle that are causing the pain. By applying gentle pressure at specific joints your doctor can determine which joints have symptoms and need treatment. The areas on the x-ray that look abnormal are not always the same ones that are causing the pain.
Skin And Mucous Membranes
Around 20% of people with rheumatoid arthritis will develop hardened bumps beneath the skin called rheumatoid nodules. They most often develop on the elbows, knees, or knuckles.
Several skin-related symptoms may develop in later-stage disease, including:
RA is associated with a few problems involving the heart and circulation, including:
- Pericarditis, inflammation of the membrane surrounding the heart
- Vasculitis, constriction of capillaries that may cut off circulation
- Increased risk of stroke and heart attack
Your healthcare provider can help you find ways to lower your risk of these possible complications.
The long-term complications of RA translate to reduced life expectancy. People with RA may live 10 to 15 years less than they otherwise would if they didn’t have the disease. Cardiovascular disease is leading cause of death in people with rheumatoid arthritis.
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What About Rheumatoid Arthritis And Pregnancy
In general, rheumatoid arthritis often improves during pregnancy. It is commonplace for the rheumatoid joint inflammation to decrease and be minimized during pregnancy. Unfortunately, this reduction of joint inflammation during pregnancy is not usually sustained after delivery.
- Do not use non-steroidal anti-inflammatory drugs, including ibuprofen , naproxen and others, during pregnancy. Women should not use methotrexate or cyclosporine during pregnancy. They must discontinue their use well in advance of conception due to potential risks to the fetus. Biologic medicines are avoided during pregnancy when possible.
- When rheumatoid arthritis is active during pregnancy, steroid medications such as prednisone and prednisolone are often used to quiet the joint inflammation. These medicines do not adversely affect the fetus.
What Treatment Options Are Available For Ra
There are medications that help manage RA symptoms and control inflammation, such as NSAIDs, corticosteroids, disease-modifying anti-rheumatic drugs, and biologics. However, there are non-medication treatment options as well. Non-pharmacologic treatment options include rest, exercise, physical and occupational therapies, dietary management, and, in some cases, surgery.
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Identify Chronic Pain Vs New Pain
It is important to understand that there is a big difference between chronic pain and short-term pain.
Chronic pain affects patients for a very long period of time. In most cases, chronic pain will not go away without the assistance of a professional doctor.
In former times, chronic pain would sometimes last for an entire lifetime.
In todays world, there are many solutions for chronic pain that can address the source of the pain or at least reduce the symptoms.
In contrast, short-term pain ends after a finite period of time.
If something hurts today, it may not hurt a week later.
The pains associated with RA can vary by day, but this pain is usually very long-term.
Without taking action to address your RA pain, symptoms will start to get worse.
If you experience joint pain for a significant amount of time, it is important to consider the possibility that you could have RA.
Cognitive Mood And Emotional Disturbances
A 2019 research review pointed to RA causing disruptions to the chemicals and neurotransmitters in the brain. All of these together can lead to emotional and mood disturbances, as well as trouble concentrating and other cognitive issues.
People with RA are about 70 percent more likely to develop gastrointestinal problems than people without the condition, according to the Arthritis Foundation. These problems are likely due to a number of things, including:
- medications youre taking to treat RA
- other conditions you have alongside RA
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Difficulty With Daily Tasks
The combination of joint pain, stiffness, and fatigue can make it difficult to carry on daily activities, and the loss of function can be extremely frustrating. Especially when the hands are affected, its hard to hold a toothbrush, do up buttons or a zipper, open a water bottle, type on a keyboard, says Dr. Bykerk. It can even be difficult to hold a grocery bag or a child. Not being able to function normally and deal with daily life understandably sends many people to the doctor to find out whats wrong.
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Amplification In The Synovium
Once the generalized abnormal immune response has become established which may take several years before any symptoms occur plasma cells derived from B lymphocytes produce rheumatoid factors and ACPA of the IgG and IgM classes in large quantities. These activate macrophages through Fc receptor and complement binding, which is part of the intense inflammation in RA. Binding of an autoreactive antibody to the Fc receptors is mediated through the antibody’s N-glycans, which are altered to promote inflammation in people with RA.
This contributes to local inflammation in a joint, specifically the synovium with edema, vasodilation and entry of activated T-cells, mainly CD4 in microscopically nodular aggregates and CD8 in microscopically diffuse infiltrates. Synovial macrophages and dendritic cells function as antigen-presenting cells by expressing MHC class II molecules, which establishes the immune reaction in the tissue.
The Signs And Symptoms Of Ra
Luckily, the signs and symptoms of early onset RA ARE heavily documented. Experts agree that the most common initial symptoms are as follows:
- You begin to experience a general feeling of pain or stiffness in your joints.
- Your joints begin to swell or turn red on a regular basis even when youre not engaged in heavily physical activities.
- These symptoms extend to four or more of your joints, including those in your hands and fingers.
- Your symptoms are symmetrical meaning that they equally affect both the left and right sides of your body.
- You experience a general sense of stiffness in your entire body when you wake up in the morning that often lasts for a half hour or more.
- Any of the above physical symptoms last for longer than six months in a row.
If you begin to experience any of these initial signs, you should absolutely consult your doctor to schedule a physical examination. Dont continue to ignore your body. Its trying to tell you something is wrong. Outside of the symptoms directly associated with RA, there are a number of indirect signs to be on the lookout for, too. These include, but are not limited to, ones like:
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Quality Assessment Of The Articles
The Cochrane tool was used to assess quality of the RCT articles included in this systematic review by determining the risk of bias . This validated tool consists of the following eight categories: random sequence generation, allocation concealment, blinding of participants, assessor blinding, reporting drop out or withdrawal, intention to treat, selective outcome reporting, and other potential bias. Each category was scored as H, high ROB, U, uncertain ROB, or L, low ROB. Three independent reviewers performed the quality assessment, and disagreement on scores was resolved through discussion.
Medication For Rheumatoid Arthritis
Some of the medications you may take include:
- pain relievers , such as paracetamol, for temporary pain relief
- non-steroidal anti-inflammatory medications , such as ibuprofen, to control inflammation and provide pain relief
- corticosteroids, such as prednisolone, to quickly control or reduce inflammation
- disease-modifying anti-rheumatic drugs , such as methotrexate, to control your overactive immune system
- biological and biosimilar medicines , such as infliximab these are biological disease-modifying drugs that work to control your immune system, but in a much more targeted way.
Depending on your particular symptoms, and how much pain and inflammation you have, you may take one medication or a combination of different medications.
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Where Can People Get Additional Information On Rheumatoid Arthritis
From the 2015 national meeting of the American College of Rheumatology:
- There are many new biologic treatments for rheumatoid arthritis on the near horizon. Many of these are being studied with and without simultaneous methotrexate. Some block chemical messengers and some block specific cell types of inflammation.
- The significant benefit of treating lipid/cholesterol profiles in patients with rheumatoid arthritis to improve long-term risks of stroke and heart attack was emphasized.
- Diets higher in fish, grains, and vegetables decrease the risk of developing RA. The Western diet, defined as including more processed meats, increases the risk. It is not certain whether this is because of a direct anti-inflammatory effect of the fish, grains, and vegetables or because of changes in the natural bacteria in the gut.
For more information about rheumatoid arthritis as well as living with RA and for support groups, please consider the following:
- National Institute of arthritis https://www.niams.nih.gov/health-topics/rheumatoid-arthritis
- National Arthritis and Musculoskeletal and Skin Diseases Clearinghouse
The Number Of Swollen Painful Joints You Have Is An Indicator Of Disease Severity
The more joints that are painful and swollen, the more severe the disease may be, says Dr. Cush. Joint pain and swelling are characteristic signs and symptoms of rheumatoid arthritis. Rheumatologists consider this a very important way to measure disease severity.
Your doctor should examine joints in your hands, feet, shoulders, hips, elbows, and other spots to see how many are causing problems. Symmetrical symptoms, such as having the same swollen joints on both sides of the body, are also hallmark symptoms of rheumatoid arthritis, Cush says.
Dr. Domingues adds that the traditional morning stiffness and joint swelling that are characteristic symptoms of RA should be discussed with a rheumatologist as soon as possible. Those are signs of active rheumatoid arthritis, and when it presents like that, it gives doctors an opportunity to be aggressive in early treatment or to switch to another class of drugs if symptoms are worsening.
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Joint Swelling And Pain
When the disease is active, affected joints become red, swollen, painful, and feel warm to the touch.
In the early stages of RA, smaller joints in the hands, wrists, and feet tend to be affected first. Over time, larger joints in the knees, shoulders, hips, and elbows may become affected.
What differentiates RA from other types of arthritis is that RA symptoms attack symmetrically. This means that if your left wrist is inflamed, your right wrist likely will be inflamed as well.
Determine If The Pain Is Ra
Common characteristics to look out for when trying to identify rheumatoid arthritis pain symptoms:
1. Pains associated with RA are usually chronic, or long-lasting.
2. RA pain is usually symmetrical, meaning that it equally affects both sides of a persons body.
3. Pain occurring near joints and severe pain after strenuous activity are strong signs of RA.
4. RA pain is usually experienced simultaneously at several locations throughout the body.
5. Severe swelling can often occur in areas that are affected by RA.
If your pain matches the characteristics of at least three of the items listed above, you should make an appointment with a doctor.
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Stomach Pain Or Indigestion
RA and medicines used to treat it are linked to mouth and stomach ulcers, stomach bleeding, acid reflux, diarrhea, and constipation. Painful diverticulitis and colitis are also possible if you have RA.
RA drugs like NSAIDs often cause ulcers or an upset stomach.
Belly pain is sometimes a sign of a rare RA complication called rheumatoid vasculitis — when inflammation spreads to your blood vessels. Weight loss and lack of appetite are other symptoms. Vasculitis is serious, so see a doctor right away. Learn more about vasculitis symptoms and types.
Other Body Parts Ra Can Affect
- Bones. The chemicals that cause inflammation can also take a bite out of your bones. It often affects your hips and spine. Sometimes, itâs a byproduct of years of treating RA with steroids.
- Liver and kidneys. Itâs rare for RA to affect these organs. But the drugs that treat it can. Nonsteroidal anti-inflammatory drugs can be bad for both. Cyclosporine may cause kidney disease. Methotrexate can damage your liver.
- Immune system. The medications you take can slow it down. This makes you more likely to get infections.
- Mucous membranes. You might be more likely to get a condition called Sjogrenâs syndrome that dries out moist places in your body like your eyes, your mouth, and inside your nose.
- Muscles. When inflammation stops you from moving your joints, the attached muscles can get weak. Or you could get a condition called myositis that weakens them. The medications you take for RA can also be to blame.
- Nerves. RA causes symptoms that range from numbness and tingling to paralysis. It can result from joint damage that RA causes, the disease process itself, or medications that treat it.
- Blood vessels. RA can cause inflammation of your blood vessels. It can show up as spots on the skin or can cause ulcers in more severe cases.
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Biologic Response Modifiers And Ra
Biologic response modifiers: These agents act like substances produced normally in the body and block other natural substances that are part of the immune response. They block the process that leads to inflammation and damage of the joints. These are targeted treatments that are directed at specific processes in the immune system that are involved in the disease development and progression. Prior to taking biologic response modifiers, patients typically receive screening tests for hepatitis B, hepatitis C, and tuberculosis . Live forms of vaccinations are not generally administered while persons are taking biologic medications.
While biologic medications are often combined with traditional DMARDs in the treatment of rheumatoid arthritis, they are generally not used with other biologic medications because of the unacceptable risk for serious infections.