Appendix: The List Of The Members Of The Quest
Argentina Sergio Toloza, Santiago Aguero, Sergio Orellana Barrera, Soledad Retamozo: Hospital San Juan Bautista, CatamarcaPaula Alba, Cruz Lascano, Alejandra Babini, Eduardo Albiero: Hospital of Cordoba, Cordoba
Canada Juris Lazovskis: Riverside Professional Center, Sydney, NS
Denmark Merete Lund Hetland, Louise Linde: Copenhagen Univ Hospital at Hvidovre, HvidovreKim Hørslev-Petersen: King Christian the Xth Hospital, GråstenTroels Mørk Hansen, Lene Surland Knudsen: Copenhagen Univ Hospital at Herlev, Herlev
Estonia Raili Müller, Reet Kuuse, Marika Tammaru, Riina Kallikorm: Tartu University Hospital, TartuTony Peets: East-Tallinn Central Hospital, TallinnIvo Valter: Center for Clinical and Basic Research, Tallinn
Finland Heidi Mäkinen: Jyväskylä Central Hospital, JyväskyläKai Immonen, Sinikka Forsberg, Jukka Lähteenmäki: North Karelia Central Hospital, JoensuuReijo Luukkainen: Satakunta Central Hospital, Rauma
France Laure Gossec, Maxime Dougados: University René Descartes, Hôpital Cochin, ParisJean Francis Maillefert: Dijon University Hospital, University of Burgundy, DijonBernard Combe: Hôpital Lapeyronie, MontpellierJean Sibilia: Hôpital Hautepierre, Strasbourg
Greece Alexandros A. Drosos, Sofia Exarchou: University of Ioannina, IoanninaHM Moutsopoulos, Afrodite Tsirogianni: School of Medicine, National University of Athens, AthensFotini N Skopouli, Maria Mavrommati: Euroclinic Hospital, Athens
Kosovo Sylejman Rexhepi, Mjellma Rexhepi: Rheumatology Department, Pristine
Rheumatoid Arthritis Drug Classes
There are two main ways RA drugs work. Some classes aim to reduce symptoms, such as and swelling. Others target the disease process itself. Neither of these approaches can cure RA and RA medication side effects depend on the specific RA drug. However, they can improve your quality of life and delay and decrease symptom flares.
Doctors follow expert practice guidelines when choosing medicines to treat RA. These guidelines often recommend early treatment because it offers the best chance of preventing joint destruction and disability. Classes of RA drugs include:
Your doctor will monitor your RA after you start treatment. This includes understanding how often you experience symptoms and how severe they are. Keeping a symptom diary can help you communicate this to your doctor. Some wellness tool apps for smart phones are available specifically for people with rheumatoid arthritis to track daily activities and symptoms. All of this information helps your doctor gauge how well your treatment is working. It may be necessary to change or add medications to get the best result.
What To Expect During The Infusion
A doctor or nurse will check your temperature, blood pressure, and pulse before you start. They’ll monitor these vital signs throughout your treatment.
You’ll feel a pinch when they put a needle into your arm, but the infusion itself shouldn’t hurt. You may get medicine before your treatment to relax you if you’re nervous. While the medicine goes in, you can read a book or watch a movie.
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Acr Guidelines On Treating Rheumatoid Arthritis
The American College of Rheumatology guidelines on treating rheumatoid arthritis recommend a treat-to-target approach, essentially recommending that clinical decisions be personalized to the patient case. Currently, even in individuals with low disease severity who have never taken a disease-modifying anti-rheumatic drug for RA, the recommendation is to prescribe DMARD monotherapy, preferably methotrexate.
As alternative or later-line options, the ACR guidelines recommend combining traditional DMARDs, tumor necrosis factor inhibitors, or non-TNF biologics. Last-line approaches target the utilization of different combinations of these mechanisms. No drug mechanisms are currently available that specifically use the m-TOR or AMPK pathways to target FLS.4
The public health and quality of life impact of RA supports the importance of discovery and development of new treatments. Fifteen million US adults report severe joint pain due to arthritis. Rheumatic conditions and arthritis are a leading cause of missed work with 2.5 times increased risk of falls and arthritis-related healthcare costs of $304 billion.5 Thus, a novel mechanism for treating RA would be valuable.
Joint Surgery For Treating Rheumatoid Arthritis: A Last Resort
Joint surgery is only conducted after careful consideration, and can help reduce pain, improve joint function, and improve your quality of life.
A surgeon may operate to:
- Clean out inflammation-causing bone and cartilage fragments from the joint, fix tears in soft tissues around joints, or repair damaged cartilage and ligaments
- Remove some or all of the inflamed joint lining
- Fuse a joint so that it no longer bends and is properly aligned and stabilized
- Replace a joint , particularly of the ankles, shoulders, wrists, and elbows, with an artificial one made of plastic, ceramic, or metal
- Remove only a certain section of a damaged and deformed knee joint
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Classes Of Drugs For Treating Ra
DMARDs: DMARDs, like methotrexate, work by altering the underlying processes of RA, particularly those responsible for inflammation. While they are not painkillers, they can reduce pain, swelling, and stiffness by slowing down RAs effects.
Biologics: Other types of DMARDs, called biologics, target specific molecules responsible for inflammation. These drugs work much quicker than standard DMARDs.
NSAIDs: NSAIDs work by targeting an enzyme called cyclooxygenase . They prevent COX from making prostaglandins, which are hormones involved in inflammation.
Analgesics: Analgesics can relieve RA pain because they change the way the brain and body sense and respond to pain.
Corticosteroids: Corticosteroid drugs can relieve pain and inflammation quickly by mimicking the effects of cortisol, a hormone naturally found in the body.
DMARDs and biologics are not used for managing pain, stiffness, and swelling associated with RA flare-ups .
Healthcare providers will instead recommend NSAIDs, analgesics, and corticosteroids for this purpose. These drugs are effective at quickly improving joint pain, stiffness, and other RA symptoms. They are considered short-term treatments because of the dangers and risks associated with their long-term use.
Rheumatoid Arthritis Healthcare Provider Discussion Guide
Get our printable guide for your next healthcare provider’s appointment to help you ask the right questions.
Current Treatment Guidelines Decisions And Concerns
The American College of Rheumatology has come up with guidelines on how to treat RA in general as well as early RA. There are four domains to evaluate:
Each category is assigned a point score if the total score is six or more points, a diagnosis for RA is confirmed.
In a comprehensive scheme for treatment, the ACR guidelines address six major topics, which include the use of:
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Side Effects And Risks Of Nsaids
Like all medications, NSAIDs come with a risk for side effects and other risks.
Side effects are more common if you are taking high doses for long periods, are older, or have serious health conditions. OTC NSAIDs will have fewer side effects compared to stronger prescription NSAIDs.
Possible side effects of NSAIDs include:
- Gastrointestinal: Stomach aches, nausea, diarrhea, etc.
- Stomach ulcers: Can bleed and lead to anemia
- Liver or kidney problems
- Heart and circulation problems including heart failure, heart attack, and stroke
The FDA advisory panel has deemed Celebrex as safe as other NSAIDs when it comes to its cardiovascular risks. The panel also recommended changing the labeling to reflect that it still poses a threat to heart health. Research on celecoxib shows it has a lower risk for GI problems, including bleeding and ulcers, compared to other NSAIDs.
If you experience severe side effects from NSAIDs, stop using the medication and let your healthcare provider know.
Some kinds of NSAIDs interact negatively with other medications. This means they can affect how other medicines work and can increase the risk for side effects.
Medications that might interact with an NSAID include:
Dont Take Too Much
You should call 911 if you or someone else experience serious signs of an overdose, including seizures, breathing troubles, or loss of consciousness.
Who Shouldnt Take NSAIDs
Physical And Occupational Therapy For Rheumatoid Arthritis
An occupational therapist can teach you how to modify your home and workplace and better navigate your surroundings to effectively reduce strain on your joints and prevent further aggravation of the inflammation during your day-to-day activities. Additionally, they can teach you how to perform regular tasks in different ways to better protect your joints.
They’ll teach you joint protection techniques, such as how to maintain proper body position and posture, body mechanics for specific daily functions, and how to distribute pressure to minimize stress on individual joints.
Occupational and physical therapists can also teach you about the hand exercises that are best for you.
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Compression Of Medical Images
Medical imaging techniques produce very large amounts of data, especially from CT, MRI and PET modalities. As a result, storage and communications of electronic image data are prohibitive without the use of compression. image compression is used by the standard for storage and transmission of medical images. The cost and feasibility of accessing large image data sets over low or various bandwidths are further addressed by use of another DICOM standard, called , to enable efficient streaming of the compressed image data.
Trends In The Use Of Dmards
The use of methotrexate for the treatment of RA did not begin until the 1990s in many countries . In a survey from the USA, RA patients were taking methotrexate on 0.6% of visits in 19801981, 4.9% of visits in 1985, 9.1% of visits in 19891991, and 27.3% of visits in 19931999. In patients with early RA in the Wichita, Kansas database, the use of methotrexate increased from 6% in patients who were diagnosed in the 1970s versus 45% in the 1990s, calculated as percentage of person-time in follow-up . In many countries, the use of methotrexate appears have increased to more than 50% of patients only during the 2000s .
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The Significance Of Inflammation
The cytokine milieu in rheumatoid arthritis influences a multitude of physiological processes. These include promoting the influx of immune effector cells into the joint synovium, and activation of osteoclasts, chondrocytes and fibroblasts.3 There is a positive feedback loop that reinforces the inflammatory process. Unabated, this process results in joint pain and destruction, ultimately causing deformity and disability.
Chronic inflammation also contributes to an increased risk of myocardial infarction, stroke and death. A Canadian population-based prospective cohort study reported an absolute increase in cardiovascular events of 5.7 per 1000 person-years in patients with rheumatoid arthritis compared to those without.4 The use of disease-modifying antirheumatic drugs to attenuate the inflammatory process has been shown to prevent joint erosions and reduce pain, cardiovascular morbidity and mortality.3,5
Methotrexate Alone Or In Combination With Other Medications For Rheumatoid Arthritis
Researchers in the Cochrane Collaboration conducted a review of the effects of methotrexate either taken alone or with other disease-modifying anti-rheumatic drugs for people with rheumatoid arthritis. After searching for all relevant studies up to January 19, 2016, they found 158 studies with over 37,000 people. These studies were published between 1985 and 2016 and were between 12 weeks and 2 years in duration. Their findings are summarised below:
In people with rheumatoid arthritis, compared to taking methotrexate alone:
-The combination of methotrexate + sulfasalazine + hydroxychloroquine and methotrexate + most biologic DMARDs improves disease activity. Other treatment combinations may improve disease activity in people who do not respond to methotrexate alone.
-The combinations of methotrexate + several biologic DMARDs reduces joint damage slightly over one year in patients who have not taken methotrexate before.
-The combinations of methotrexate + azathioprine, methotrexate + cyclosporine and methotrexate + tocilizumab probably increases the chance of stopping the medication due to a side effect.
What is rheumatoid arthritis and what is methotrexate and other disease-modifying anti-rheumatic drugs?
What happens to people with rheumatoid arthritis who take methotrexate combined with other disease-modifying anti-rheumatic drugs?
A) People who have not taken methotrexate before:
X-rays of the joints:
Stopping the medication due to a side effect
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Hand Therapies For Rheumatoid Arthritis
When rheumatoid arthritis affects your hands and wrists, a variety of treatment options are available to help relieve pain, offer better mobility and prevent joint deformity.
With its 29 joints and intricate network of muscles, ligaments and tendons to support them, the human hand is capable of exacting tasks such as performing surgery or playing the violin. But with arthritis, even the simplest of tasks can become difficult or painful. For rheumatoid arthritis of the hands, treatment includes good medical management, along with occupational therapy interventions for some. This could mean using splinting and adaptive aids to reduce deforming stresses on the joints of the hands and maintain mobility. Finally, if joint damage has occurred, surgery may be an option.
Assistive Devices and Occupational Therapy
In many cases, strengthening and stretching exercises, as prescribed by an occupational or physical therapist can also help relieve symptoms and improve function. In a 2016 study published in Arthritis Care & Research, 242 people with hand RA were randomly assigned to continue their regular treatment, while 246 were assigned to a program of exercises designed to improve a variety of hand and wrist movements. Researchers found improvements in grip strength at 4 months predicted improved hand function at 12 months.
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What Is Rheumatoid Arthritis Why Is Ra So Painful
Being an autoimmune disease, RA involves the body attacking itself, specifically the cartilage that protects our joints. Once that cartilage is gone, the body does not grow it again, leaving our bones free to rub against each other with every movement and causing swelling, pain, and inflammation. The nerves within and surrounding our joints are often affected by the lack of protection as well, adding to the patients suffering.
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Types Of Medication That Treat Rheumatoid Arthritis
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.
Nutritional Supplements And Dietary Changes
There’s no strong evidence to suggest that specific dietary changes can improve rheumatoid arthritis, although some people with rheumatoid arthritis feel their symptoms get worse after they have eaten certain foods.
If you think this may be the case for you, it may be useful to try avoiding problematic foods for a few weeks to see if your symptoms improve.
But it’s important to ensure your overall diet is still healthy and balanced. A Mediterranean-style diet, which is based on vegetables, fruits, legumes, nuts, beans, cereals, grains, fish and unsaturated fats such as olive oil, is recommended.
There’s also little evidence supporting the use of supplements in rheumatoid arthritis, although some can be useful in preventing side effects of medicines you may be taking.
There’s some evidence to suggest that taking fish oil supplements may help reduce joint pain and stiffness caused by rheumatoid arthritis.
- National Rheumatoid Arthritis Society : diet and rheumatoid arthritis
Page last reviewed: 28 August 2019 Next review due: 28 August 2022
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How Is Rheumatoid Arthritis Treated
Treatment of rheumatoid arthritis can give you relief from symptoms, improving your quality of life. Doctors may use the following options to treat RA:
- Medications to relieve pain and swelling, and to slow joint damage.
- Surgery, such as joint replacement surgery.
- Ongoing care to see how your medications are working and to change your treatment as needed.
The goals of treatment are to help:
- Relieve pain.
- Prevent, slow, or stop joint and organ damage.
- Help you take part in daily activities.
What Are The Symptoms Of Rheumatoid Arthritis
The main symptoms of RA are joint pain, swelling, and stiffness. Usually, symptoms develop gradually over several weeks, but in some people, symptoms develop rapidly.
The small joints of the hand and feet are usually the first to become affected. Stiffness is usually worse first thing in the morning or after periods of inactivity and may make movement difficult. RA usually affects the joints on both sides of the body equally.
The pain is typically described as throbbing and aching. Joint stiffness is usually worse in the morning but still tends to persist, unlike stiffness caused by osteoarthritis which tends to wear off after about 30 minutes. Because the tissue inside the joints is affected, joints may look swollen and feel hot and tender to the touch. Some people develop firm swellings under the skin, called nodules, around affected joints.Joint and bone destruction can occur over time if the disease process is not well-controlled.
Patients may also lack energy and have experience fevers, sweating, a poor appetite, and weight loss. Other symptoms may occur depending on what other parts of the body are affected, for example, dry eyes, or heart or lung problems.
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Found This Study Interesting Get Involved
If you are diagnosed with rheumatoid arthritis, or another rheumatic or musculoskeletal condition, we encourage you to participate in future studies by joining CreakyJoints patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and .
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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The Importance Of Early Diagnosis Of Ra
Identification of RA at initial presentation and treatment at earlier stage can affect disease course, prevent the development of joint erosions or retard progression of erosive disease . Early diagnosis and treatment may affect disease outcomes even to a remission state . Recognizing early RA from non-RA at the onset of disease is not straightforward but there is limitation in the use of the American College of Rheumatology revised criteria for early diagnosis. Since due to inadequate clinical or laboratory evidences at onset of arthritis, this criteria is not sensitive enough to identify early RA .
In a study of Frech cohort, only 50.9% of RA satisfied 1987 ACR revised criteria for diagnosis of RA in 1 year . However, in the absence of treatment inflammation will lead to articular damages and bone erosion particularly within the first two years of disease onset . Regarding the current concept of “window of opportunity”, early diagnosis of RA is essential for initiation of treatment, otherwise, disease will progress to more severe forms requiring more aggressive therapy .