Early diagnosis and treatment of rheumatoid arthritis is key

July 28, 2010

Treatment for Rheumatoid Arthritis

What is rheumatoid arthritis?

Arthritis means "inflammation of the joints." The inflammation can affect any part of a joint, including the lining, bones, cartilage, and supporting tissues. Common symptoms of arthritis include pain, stiffness, and swelling of the joint. Although degenerative or osteoarthritis (OA) is the most common, rheumatoid arthritis (RA) affects 2.1 million Americans and is harder to live with. Joint damage can happen soon after the disease begins.

Rheumatoid arthritis (RA) is a chronic, or long-term, type of arthritis. The cause is unknown. The disease starts when the body's immune system attacks the body itself. It can affect people of any age but often starts between the ages of 20 and 60 and is three times more common in women. The disease can cause pain in any joint but usually occurs in the same joints on both sides of the body. The wrist, hands, elbows, shoulders, knees, and ankles are the joints most often affected.

It is hard to know how RA will progress, but it usually has three stages. Inflammation of the joint lining causes pain, warmth, stiffness, redness, and swelling. The joint lining thickens, and inflamed cells release chemicals that damage the cartilage and bone. This can affect the shape and movement of the joint.

RA can affect your entire body. Symptoms may vary. Many people with RA feel tired. Sometimes they have trouble with daily activities and have a low fever and depression. For some, the disease may be mild to moderate with periods of worsening symptoms (called flares) and times when they feel good. For others it may be more severe. In a few cases, the RA will get better on its own.

It's important to get a diagnosis as early as possible. Work with your doctor and start on treatment to control inflammation, relieve pain, prevent or control joint damage, and improve your ability to do everyday things. Your doctor will use a combination of tests, an exam, and medical history to make a diagnosis.

What medicines are used for RA?

There are many types of medicines your doctor may prescribe to help ease your symptoms, keep the disease from getting worse, and reduce joint damage. It's important to understand which medicines control pain and which ones help prevent joint damage. Most treatment plans will include both types.

  • Disease-modifying antirheumatic drugs (DMARDs) — Your doctor may suggest that you start treatment with DMARDs within a few months of diagnosis. DMARDs can often slow down the RA by interrupting the immune process that causes inflammation and joint destruction. However, they may take up to six months to work. DMARDs have improved life for many people with RA. These RA drugs are often used along with medicines to reduce pain or inflammation, but you may not need the other medicines. Because DMARDs target the immune system, they also make it harder to fight infections. This means you need to watch for early signs of infection. In some cases, you may need regular blood tests to make sure the drug is not hurting blood cells or organs such as your liver, lungs, or kidneys.
  • Analgesics — These are pain relievers such as acetaminophen.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) — These medicines, such as ibuprofen or naproxen, are often given to relieve pain and inflammation. They do not slow progression of RA.
  • Steroids — Steroids such as prednisone reduce inflammation. Your doctor may inject the steroid directly into a joint for severe pain. It can also be taken in pill form.

What else can you do?

Rheumatoid arthritis starts when the body's immune system attacks the body itself.

Getting the right diagnosis and treatment from your doctor is very important. Equally important are the things you can do to limit the impact of RA on your life.

Exercise
Moderate activity on a regular basis helps give you more energy, strengthen muscles and bones, increase flexibility, and improve your sense of well-being. Keeping joints flexible is very important when you have RA because stiff joints can keep you from doing things like buttoning a shirt or starting the car. Talk to your doctor about the types of exercises that can help you.

Balance activity and rest
Staying active helps you manage stress and depression. It also helps you sleep better and makes it less painful to move your joints. But you don't want to push yourself too hard and end up having a flare and hurting your joints. So how do you know how much is too much and find balance in your life? The best answer is to listen to your body. Work a few rest periods into your day. This is very important if you are experiencing a flare because you could damage your joints.

Control stress
All people have stress in their lives — both good and bad. And both kinds can cause a flare of your RA. People who are optimistic and feel in control of their lives tend to do better than people with a less positive attitude toward their disease. It is important to be able to face stressful situations with confidence. Following are steps to help in stress management.

Identify the things in your life that add stress. Keep a stress diary, noting the time and your physical and emotional response. Look for patterns.

Get rid of the negative. You will never be able to get rid of all the negative stress from your life but using your stress diary you may be able to recognize some stressful patterns, times of day or routine situations. By looking at ways to ease these stressful situations you can make changes. This could be as simple as saying "no" when people ask you to do things. It may be hard to find that you can't do everything, but you will get sense of freedom.

Find ways to deal with stress by using positive activities. Try to be flexible when you have to deal with change. It will help if you focus on solving problems rather than worrying about them, find support systems, and have a safety valve such as journaling to use when you need to let off steam.

Relaxation and rest
These tips can help you relax and sleep better, too.

  • Breathe deeply for 5 to 15 minutes throughout the day.
  • Use progressive relaxation. Lie on your back, then tense and relax your muscles starting with your feet and moving up toward your neck and face.
  • Try guided imagery. You can use a tape or your imagination to take you to a happy, relaxing place.
  • Ask your doctor or other healthcare professional for help with other methods of relaxation.
  • Get into a nightly routine that includes things that relax you.
  • Take a warm bath before bed to relax your muscles.
  • Choose a good comfortable mattress and good quality sheets and blankets.
  • Avoid alcohol, tobacco, big meals, and beverages and foods with caffeine when it's close to bedtime.

For prevention and management information and to find out about treatment options and alternative therapies sign in to MyHumana and visit Humana's Bone and Joint Condition Center under the Health & Wellness section. There is a complete guide to bone and joint conditions available only to Humana members. Additional information can be found at: rheumatoidarthritis.com or The Arthritis Foundation www.arthritis.org

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