What Do I Do If I Think I Have Rheumatoid Arthritis
If youre experiencing joint pain and inflammation, its important that you discuss your symptoms with your doctor. Getting a diagnosis as soon as possible means that treatment can start quickly. Early treatment will help you to control the inflammation, manage pain more effectively and minimise the risk of long-term joint damage and disability.
If youre diagnosed with rheumatoid arthritis or suspected of having the condition, you may be referred to a medical specialist known as a rheumatologist for further investigations and medical treatment.
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.
Evening Primrose Oil Supplements
Some plant oils may reduce pain and stiffness associated with RA. Evening primrose oil contains an essential fatty acid called gamma-linolenic acid that may provide some relief.
A 2016 study found that taking evening primrose oil and fish oil may reduce inflammation and disease activity.
According to the National Center for Complementary and Integrative Health , however, more research is needed on the effectiveness of primrose oil.
Again, check with your doctor before taking evening primrose oil, as it may interact with some medications. Potential side effects include headache and an upset stomach.
Thunder god vine grows in China and Taiwan and is used in traditional Chinese medicine. Research has indicated that it may be effective for treating RA symptoms.
According to a 2015 study , thunder god vine was comparable to the standard RA drug methotrexate in relieving symptoms. The study found that taking both was even more effective.
A 2018 research review also suggested that thunder god vine supplements may help reduce inflammation. Still, more research is needed on long-term effects and safety.
Talk to your doctor and assess the benefits before trying thunder god vine, as it may have some serious side effects. These can include reduced bone mineral content, infertility, rashes, and hair loss.
Thunder god vine can also be poisonous if it isnt prepared correctly.
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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.
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?
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Complications Of Rheumatoid Arthritis
Because RA damages joints over time, it causes some disability. It can cause pain and movement problems. You may be less able to do your normal daily activities and tasks. This can also lead to problems such as depression and anxiety.
RA can also affect many nonjoint parts of the body, such as the lungs, heart, skin, nerves, muscles, blood vessels, and kidneys. These complications can lead to severe illness and even death.
How Diet Affects Ra
Although there is no demonstrable link between diet and RA, studies have shown that the type of inflammation experienced in RA could be modulated by certain foods. Increased inflammation has been attributed to processed foods or foods cooked at higher temperatures.
It is recommended to increase consumption of foods that are considered to be anti-inflammatory, such as fruits, veggies, and cold water fish . As a result, inflammatory symptoms may improve and possibly lead to fewer flare-ups.
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Types Of Medication That Treat Rheumatoid Arthritis
SeeRheumatologist’s Role in Patient Care
When prescribing a medication, a physician will take into account the patients age, disease activity, and other medical conditions, but each patient is unique. Figuring out which medication or combination of medications work best for an individual can be challenging and often requires a process of trial and error.
How Many Canadians Live With Rheumatoid Arthritis And How Many Are Newly Diagnosed Each Year
Approximately 374,000 Canadians aged 16 years and older live with diagnosed rheumatoid arthritis and 23,000 were newly diagnosed in 20162017. The prevalence and incidence of diagnosed rheumatoid arthritis generally increase with age and are higher among females compared to males .
Figure 1: Prevalence of diagnosed rheumatoid arthritis by sex and age group, Canada,Footnote a 20162017
- Footnote a
| 0.8 |
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Ra Pain: What Is The Best Pain Relief For Rheumatoid Arthritis
Rheumatoid arthritis is a chronic disease that can cause severe and debilitating symptoms for patients of many ages. Fortunately, there are several treatment options available today to help control the disease and reduce inflammation, which is the primary cause of pain.
One of the most important aspects of treatment is rheumatoid arthritis pain management. For patients who suffer from chronic pain or frequent flare-ups, knowing how to manage pain on an ongoing basis and as needed is an important part of improving quality of life.
What Other Risk Factors May Increase Your Likelihood Of Experiencing Ra
* Gender: Women are much more likely to suffer from this autoimmune disorder.* Weight: Overweight individuals are more prone to developing RA.* Smoking: If you smoke, you are more likely to develop RA, and if you develop it, your symptoms may be more pronounced than those who do not smoke.* Age: RA is more likely to hit you in middle age * Environment: Certain environmental exposures have been found to elevate your risk of RA, including exposure to asbestos and silica.
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How Can Rheumatoid Arthritis Be Managed
The specific causes of rheumatoid arthritis are unknown, but there are a number of factors associated with an increased risk of developing the disease including family history, smoking, increased age and occupational exposures.Footnote 4Footnote 5 While there is no cure for rheumatoid arthritis, there are treatment options which aim to alleviate joint symptoms and improve function. Individuals often work with a rheumatologist to develop a treatment plan to prevent further joint damage. Medication is often prescribed as a first line of therapy and is key to controlling disease and preventing damage. Other ways to manage include physical therapy, occupational therapy and education.Footnote 6 Individuals with rheumatoid arthritis who are diagnosed and treated early are less likely to experience long-term joint damage and functional impairments.
Treatments For Rheumatoid Arthritis
Theres no cure, but the progression can be slowed. The main goals are slowed progression, pain relief, and optimal joint mobility. Some treatment options include:
- Anti-rheumatic drugs. These drugs help reduce the inflammation in your body. These can be used alone or with other therapies.
- Joint preserving exercises. Tolerable activity helps rheumatoid arthritis-ridden joints move more smoothly. Your plan-of-care may include a physical or occupational therapist. You may benefit from a low-impact exercise program, such as pool aerobics.
- Pain management. Pain is one of the biggest problems related to arthritis. Your doctor may prescribe you pain or anti-inflammatory medications to improve your quality of life.
- Surgery.7 If your arthritis has progressed and conventional methods havent worked, your doctor may recommend surgery. This can range from tendon release, a joint resurfacing, a joint replacement, or nerve surgery to manage pain.
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Can I Cut Back On My Ra Medications If I Feel Ok
If pain and stiffness start to fade, you may wonder if you can change your medications.
RA is a long-term condition, and medicine keeps your symptoms under control. But with guidance from their doctor, some people may be able to lower the amount of medication they take.
When was your last flare?
Studies show that people who stop their RA medicine are likely to have a flare of symptoms 4 to 8 weeks later. If your disease stays active, you’re more likely to get permanent joint damage.
Your doctor will want to know how long it’s been since you had any problems. Theyâll also do some tests. If everything looks good, your doctor may slowly lower the dose of your medications, usually starting with NSAIDs.
You want to keep a constant and effective level of your RA drugs in your system, so if you are able to cut back on your medicine, it would be a slow change. It helps if you take your medicine at the same time every day.
Do you have any trouble with side effects from your meds?
If so, tell your doctor about them. They may be able to adjust your medicine. For example, many drugs used to treat RA can cause an upset stomach. To help, your doctor may suggest that take it at a different time or with food. They may also recommend medication to ease nausea and help with stomach acid.
Do you use reminders to help you take medicine on time?
Rheumatoid Arthritis Pain Management
While the overall goal of rheumatoid arthritis therapy is to prevent disease progression and further joint damage, pain management is a necessary daily practice for patients, in order to maximize their quality of life. Chronic pain can adversely affect a patients ability to work, participate in physical and social activities, and can generally interrupt day-to-day life.
Despite medications and aggressive forms of treatment, many rheumatoid arthritis patients experience ongoing pain and stiffness. The reality is, it may never completely go away. But there are specific things patients can do to manage pain and limit its impact on their lives.
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What Causes Rheumatoid Arthritis
The exact cause of rheumatoid arthritis is unknown. However, it is believed to be caused by a combination the following factors:
- Genetics
- The environment
- Hormones
Normally, the immune system protects the body from disease. In people who have rheumatoid arthritis, somethingpossibly infections, cigarette smoking, and physical or emotional stress, among other causestriggers the immune system to attack the joints .
Gender, heredity, and genes largely determine a person’s risk of developing rheumatoid arthritis. For example, women are about three times more likely than men to develop rheumatoid arthritis.
Talk To Your Doctor About Ra Treatments
When taking meds, you should discuss a few things with your rheumatologist. For starters, tell your doctor if youre planning to start a family shortly . With some of these medications, you want to be off it for about three months before trying to get pregnant, or trying to get your partner pregnant, says Dr. Blank.
On the other hand, the DMARDs sulfasalazine and hydroxychloroquine are considered safe for pregnancy, so if youre planning to get pregnant, your doctor may start you on one of those. Theoretically, you can be on some TNF inhibitor biologic drugs until your third trimester, says Dr. Sharmeen. But the only one thats safe is Cimzia, she says.
You also want to talk about your lifestyle. For example, if you drink alcohol your doctor will avoid a drug that affects your liver enzymes. And tell your physician if you tend to get a lot of recurrent infections, upper respiratory infections, or are around young children who may pass along infectionsyour doctor may choose a less immunosuppressant drug if your situation makes you more vulnerable to infections. These are all important things for your doctor to know to find the right for you, says Dr. Sharmeen.
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What Will The Future Hold
Is blockade of TNF- the complete answer to treatment of rheumatoid arthritis? In terms of toxicity, anti-TNF- agents fortunately have only produced side effects in line with their mode of action infections are increased, and latent tuberculosis can be activated . It is, however, possible to screen and minimise the reactivation of tuberculosis with prophylaxis. Other problems include inducing antibodies against the drugs themselves and also switching to autoantibody production as is seen with Th2 cells. A greater problem is the need for ongoing therapy, which entails giving protein long term to patients, although it can now be a fully human monoclonal protein. Over time a finite loss of response occurs. Both a primary and a secondary non-response have been proposed for this complex mechanism. This is a particular problem in patients currently approved for therapy by the National Institute of Health and Clinical Excellence, as these patients have long duration of disease with much damage and a greater failure rate with tumour necrosis factor blockers. Induction of remission with TNF- blocker and maintenance with a disease modifying antirheumatic drug is a potentially attractive approach for the future, especially if it avoids long term therapy with biological agents. For the foreseeable future, a large number of patients will have tried and failed anti-TNF- therapy owing to a mixture of inefficacy or toxicity.
Additional educational resources
Information for patients
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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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.
Drugs For Rheumatoid Arthritis
As part of rheumatoid arthritis treatment, your doctor will probably prescribe a nonsteroidal anti-inflammatory drug . These medications reduce pain and inflammation but donât slow RA. So if you have moderate to severe RA, youâll probably also need to take other drugs to prevent further joint damage.
Many come as pills or tablets. Over-the-counter NSAIDs include ibuprofen and naproxen. Most people with RA need a prescription version, like celecoxib , as they offer a higher dose with longer-lasting results and require fewer doses throughout the day.
Prescription NSAIDs carry a warning about the higher risk of heart attack and stroke. NSAIDs can also raise blood pressure and can cause stomach irritation, ulcers, and bleeding.
You and your doctor can weigh the benefits of NSAIDs against the potential risks. You may have to try a few to find the one thatâs right for you.
DMARDs
This stands for disease-modifying antirheumatic drugs. They curb your immune system to help slow RA or keep it from getting worse.
Doctors usually first prescribe methotrexate to treat rheumatoid arthritis. If that alone doesnât calm the inflammation, they may try or add a different type of DMARD such as hydroxychloroquine , leflunomide , sulfasalazine , or tofacitinib .
You can take DMARDs as a pill, but some people get methotrexate as a shot. It may take a few weeks or months for them to start to work, and longer to get the full effect.
Biologics
Combination therapy
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Dr Tollestrup Specializes In Pain
If you have rheumatoid arthritis thats progressed into constant pain and reduced movement, surgery may be your next step. Talk to your doctor about it. If your plan-of-care requires surgery, Dr. Tollestrup would like to help. Let us answer your questions at 702-505-8781, or start the intake process with our New Patient Form.
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