Painful,
tender joints can make even the simplest activities difficult for those
with this inflammatory disease. Recently, pharmaceutical breakthroughs
have revolutionised RA treatment, enabling many to lead active and
productive lives again.u
In healthy joints, the surfaces of your bones and the cartilage that cushions them glide smoothly against one another, allowing for easy, pain-free movement. But for the 3 percent of the population with rheumatoid arthritis (RA), the cartilage becomes inflamed and breaks down, causing pain, stiffness and swelling. If the disease progresses, bones and ligaments can permanently wear away. The heart, lungs, muscles and skin can become damaged and there's an increased risk for blood or lymph cancers.
Unlike the simple joint wear and tear of its common cousin, osteo-arthritis, rheumatoid arthritis arises from an immune system gone awry, which mistakenly attacks healthy joint tissue. Nobody knows what trigger this, although scientists speculate it may be the result of an infection perhaps combined with genetic factors that make you susceptible to the disease. During a flare-up, white blood cells collect in your joints and mount an inflammatory attack, secreting substances called cytokines that join the battle. One form of cytokine is a destructive protein called tumour necrosis factor (TNF); another is interleukin-1. In response, cells in the besieged joint release defensive chemicals called prostaglandins, which cause the joint to become red, sore and swollen. This is the basic inflammatory process although there are different forms of RA, some milder than others.
LIKELY FIRST STEPS
Many new drugs have become available in recent years. The key is to find the right one for you. A simple pain reliever, such as aspirin or another nonsteroidal anti-inflammatory drug (NSAID), such as naproxen, ibuprofen or indomethacin, often provides prompt relief. NSAIDs are available as pills and also in pain-relieving creams. A newer class of NSAID called COX-2 inhibitors modulate inflammation-causing prostaglandins and may cause fewer side effects. COX-2s include celecoxib (Celebrex), rofexocib (Vioxx) and meloxicam (Mobic). NSAIDs may not be strong enough to control the inflammation; if so, you may need more potent drugs.
Although they may have serious side effects (see on shortly), some of the best drugs to control rheumatoid inflammation fast are powerful anti-inflammatory oral or intravenous corticosteroids.
One way to minimise the side effects of predinose, a commonly prescribed steroid, is to take it when your body naturally produces it--early in the morning, between 5 a.m. and 7 a.m. Steroids are also sometimes injected directly into joints for relief of flare-ups, but this practice should be minimised because it may ultimately damage joints.
Stronger disease-fighting drugs are often started quickly to protect joints and organs from long-term damage. These medicines are called DMARDs, or disease-modifying anti-rheumatic drugs.
The most commonly prescribed type is methotrexate (Ledertrexate, Methoblastin). Originally developed as a cancer drug, low doses of methotrexate ease pain and other symptoms by switching off underlying inflammation. Others include sulfasalazine (Salazopryin, Pyralin); injectable or oral gold; hydroxychloroquine (Plaquenil);
What is happening
In healthy joints, the surfaces of your bones and the cartilage that cushions them glide smoothly against one another, allowing for easy, pain-free movement. But for the 3 percent of the population with rheumatoid arthritis (RA), the cartilage becomes inflamed and breaks down, causing pain, stiffness and swelling. If the disease progresses, bones and ligaments can permanently wear away. The heart, lungs, muscles and skin can become damaged and there's an increased risk for blood or lymph cancers.
Unlike the simple joint wear and tear of its common cousin, osteo-arthritis, rheumatoid arthritis arises from an immune system gone awry, which mistakenly attacks healthy joint tissue. Nobody knows what trigger this, although scientists speculate it may be the result of an infection perhaps combined with genetic factors that make you susceptible to the disease. During a flare-up, white blood cells collect in your joints and mount an inflammatory attack, secreting substances called cytokines that join the battle. One form of cytokine is a destructive protein called tumour necrosis factor (TNF); another is interleukin-1. In response, cells in the besieged joint release defensive chemicals called prostaglandins, which cause the joint to become red, sore and swollen. This is the basic inflammatory process although there are different forms of RA, some milder than others.
- Anti-inflammatories, such as NSAIDs (including COX-2 inhibitors), to ease pain.
- Steroids, such as prednisone, to control more serious cases of inflammation.
- Early treat ment with a DMARD drug, such as methotrexate, to slow the disease's progression.
- Biologic response modifiers, such as Enbrel or Remicade, alternatively or in combination with other drugs, to halt the disease's progression.
- Lifestyle measures such as low-impact exercise or water aerobics, as well as plenty of rest.
QUESTIONS TO ASK
- What type of rheumatoid arthritis do I have-mild or severe? Are my symptoms likely to keep getting worse?
- How long will I need to stay on medications?
- Will changing my diet help?
- Can I get pregnant while being treated?
- Are all my symptoms related to my illness or are some a side effect of the medications I'm taking?
- Will I need to undergo joint replacement surgery?
Treatments
The most important aspect of rheumatoid arthritis treatment is stopping the joint inflammation. The past decade has been dramatic stopping the joint inflammation. The past decade has seen dramatic changes: new medications can now halt the inflammation and hence the progression of disease. Self-help measures are also important and selected surgical and nonsurgical treatments may be helpful for advanced disease. Because there are so many options to choose from, you should talk to your doctor about which ones may be right for you. While none is a cure, some may offer long-term relief.
Traditionally, the least aggressive medicines, such as aspirin, were used first. If they didn't work, progressively stronger medications--with more severe side effects--were tired. Now doctors start with aggressive therapies to quell inflammation and halt the disease at an early stage before damage is severe. Such treatment may be particularly beneficial for those with more serious disease. Just remember, you will have 'good days' and 'bad days' and even long periods when the condition seems to quieten down altogether.
The most important aspect of rheumatoid arthritis treatment is stopping the joint inflammation. The past decade has been dramatic stopping the joint inflammation. The past decade has seen dramatic changes: new medications can now halt the inflammation and hence the progression of disease. Self-help measures are also important and selected surgical and nonsurgical treatments may be helpful for advanced disease. Because there are so many options to choose from, you should talk to your doctor about which ones may be right for you. While none is a cure, some may offer long-term relief.
Traditionally, the least aggressive medicines, such as aspirin, were used first. If they didn't work, progressively stronger medications--with more severe side effects--were tired. Now doctors start with aggressive therapies to quell inflammation and halt the disease at an early stage before damage is severe. Such treatment may be particularly beneficial for those with more serious disease. Just remember, you will have 'good days' and 'bad days' and even long periods when the condition seems to quieten down altogether.
Treatment Options
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Pain relievers NSAIDs for quick relief.
------------------------------------------------------------------------------------------------------------------------------------------
Corticosteroids For severe flare-ups/recurrences
-------------------------------------------------------------------------------------------------------------------------------------------
DMARDS Methotrexate and others, for inflammation.
-------------------------------------------------------------------------------------------------------------------------------------------
Biologic response modifiers Forestall progressive joint deterioration.
--------------------------------------------------------------------------------------------------------------------------------------------
Immunosuppressants Oral, intravenous or by injection.
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Paraffin baths Particularly good for hand pain.
----------------------------------------------------------------------------------------------------------------------------------------------
Exercise/spa therapy Walking, tai chi, water therapy.
NATURAL METHODS
-----------------------------------------------------------------------------------------------------------------------------------------------
Supplements For inflammation and pain.
PROCEDURES
---------------------------------------------------------------------------------------------------------------------------------------------
Prosorba therapy Blood filtration if drugs don't work.
---------------------------------------------------------------------------------------------------------------------------------------------
Surgery Joint replacement if major deterioration.
TAKING CONTROL
SALMON AND OTHER OILY FISH are rich in omega-3 fatty acids that have anti-inflammatory properties and may help to relieve symptoms of rheumatoid arthritis. Eat fish twice a week or try fish oil capsules.
MedicationsMEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Pain relievers NSAIDs for quick relief.
------------------------------------------------------------------------------------------------------------------------------------------
Corticosteroids For severe flare-ups/recurrences
-------------------------------------------------------------------------------------------------------------------------------------------
DMARDS Methotrexate and others, for inflammation.
-------------------------------------------------------------------------------------------------------------------------------------------
Biologic response modifiers Forestall progressive joint deterioration.
--------------------------------------------------------------------------------------------------------------------------------------------
Immunosuppressants Oral, intravenous or by injection.
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Paraffin baths Particularly good for hand pain.
----------------------------------------------------------------------------------------------------------------------------------------------
Exercise/spa therapy Walking, tai chi, water therapy.
NATURAL METHODS
-----------------------------------------------------------------------------------------------------------------------------------------------
Supplements For inflammation and pain.
PROCEDURES
---------------------------------------------------------------------------------------------------------------------------------------------
Prosorba therapy Blood filtration if drugs don't work.
---------------------------------------------------------------------------------------------------------------------------------------------
Surgery Joint replacement if major deterioration.
TAKING CONTROL
- Assemble a medical team. A rheumatologist (a physician who specialises in arthritis) may be particularly valuable in tailoring a state-of-the-art treatment program that's right for you. You also need a GP to monitor you overall health, a physiotherapist to help to keep your joints flexible and an occupational therapist to offer tips on making the most of your life at home or at work
- Be careful about drug combos. Don't take prednisone and an NSAID together--this can increase your risk of developing a stomach ulcer.
- Start treatment early. A study in the journal of Rheumatalogy found that those people with early rheumatoid arthritis who delayed treatment by nine months continued to feel worse (even three years later) than those who began therapy promptly. Early treatment is key to reducing damage and the need for more costly treatments, including surgery.
- If you smoke, quit. Studies show that smoking can make symptoms worse. If you undergo joint replacement surgery, smoking can prolong your recovery.
SALMON AND OTHER OILY FISH are rich in omega-3 fatty acids that have anti-inflammatory properties and may help to relieve symptoms of rheumatoid arthritis. Eat fish twice a week or try fish oil capsules.
Many new drugs have become available in recent years. The key is to find the right one for you. A simple pain reliever, such as aspirin or another nonsteroidal anti-inflammatory drug (NSAID), such as naproxen, ibuprofen or indomethacin, often provides prompt relief. NSAIDs are available as pills and also in pain-relieving creams. A newer class of NSAID called COX-2 inhibitors modulate inflammation-causing prostaglandins and may cause fewer side effects. COX-2s include celecoxib (Celebrex), rofexocib (Vioxx) and meloxicam (Mobic). NSAIDs may not be strong enough to control the inflammation; if so, you may need more potent drugs.
Although they may have serious side effects (see on shortly), some of the best drugs to control rheumatoid inflammation fast are powerful anti-inflammatory oral or intravenous corticosteroids.
One way to minimise the side effects of predinose, a commonly prescribed steroid, is to take it when your body naturally produces it--early in the morning, between 5 a.m. and 7 a.m. Steroids are also sometimes injected directly into joints for relief of flare-ups, but this practice should be minimised because it may ultimately damage joints.
Stronger disease-fighting drugs are often started quickly to protect joints and organs from long-term damage. These medicines are called DMARDs, or disease-modifying anti-rheumatic drugs.
The most commonly prescribed type is methotrexate (Ledertrexate, Methoblastin). Originally developed as a cancer drug, low doses of methotrexate ease pain and other symptoms by switching off underlying inflammation. Others include sulfasalazine (Salazopryin, Pyralin); injectable or oral gold; hydroxychloroquine (Plaquenil);
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