Rheumatoid arthritis (RA) is a chronic inflammatory disorder that typically affects the small joints in the hands and feet. Like other autoimmune diseases, the body’s tissues are mistakenly attacked by their own immune system. In the case of RA, the joints in the body are attacked causing severe pain, joint damage or deformity. Unfortunately at this time, there is no cure for RA. However, there are a number of treatments that can help control and lessen the effects.
RA is the most common type of autoimmune arthritis, and with early diagnosis and treatment, joint pain and swelling can be controlled and lessen joint damage. Signs and symptoms of the disease include:
- joint pain in the feet, hands, and knees;
- swollen joints;
- tender joints;
- loss of joint function;
- stiff joints;
- joint redness;
- rheumatoid nodules ( firm lumps under the skin close to the joints affected);
- joint warmth;
- and joint deformity.
During the initial stages of the disease the doctor will usually prescribe medications that are known to have the fewest side effects. As the disease progresses, stronger medications may be required, but more potentially serious side effects can occur.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs (like Advil and Motrin) are used for pain relief as well as reducing inflammation. They can be purchased over-the-counter without a prescription, and they will help treat the pain, but will not slow down the progression of the disease.
When NSAIDs do not help, corticosteroids are effective at reducing inflammation and pain, plus they are helpful at slowing down joint damage. If the patient has a single inflamed joint the doctor may inject the steroid into the joint. Effective relief is usually felt rapidly and the effect can last from weeks to months, depending on the severity of symptoms.
Examples include prednisone (Lodotra) and methylprednisolone (Medrol). Corticosteroids are generally used for acute, short term flare ups – then the dosage is gradually reduced.
DMARDs (disease-modifying antirheumatic drugs)
These types of medications may slow down the progression of the disease, as well as prevent permanent damage to the joints and other tissues. The earlier the patient starts taking a DMARD after diagnosis with RA, the more effective it will be.
Unlike a corticosteroid injection, these types of medications take longer to notice reduction in pain. It could take four to six months, to see results, but it’s important to not stop taking the medication. Patients may have to try different types of DMARDs before finding the most suitable one for them. This medication is usually taken indefinitely.
Examples include leflunomide (Arava), methotrexate (Rheumatrex, Trexall), sulfasalazine (Azulfidine), minocycline (Dynacin, Minocin), and hydroxychloroquine (Plaquenil).
Because rheumatoid arthritis is an auto-immune disease, suppressing the immune system helps reduce the damage to good tissue. Examples include cyclosporine (Neoral, Sandimmune, Gengraf), azathioprine (Imuran, Azasan), and cyclophosphamide (Cytoxan).
Tumor necrosis factor-alpha inhibitors (TNF-alpha inhibitors) are used for the reduction of pain, morning stiffness and swollen or tender joints. Results are usually noticed within two weeks of starting treatment. Examples include (Enbrel), infliximab (Remicade) and adalimumab (Humira).
If the treatments listed above have not been effective enough, the doctor may consider surgery to repair damaged joints, allowing the patient to use that joint again. Surgery may also help correct deformities, or reduce pain. The following procedures may be considered:
- Arthroplasty – total replacement of the joint. The damaged parts are surgically removed and a prosthesis (artificial joint) made of metal and plastic is inserted.
- Tendon repair – if the tendons around the joint are loosened or ruptured, surgery may help restore them.
- Synovectomy – this involves the removal of the joint lining, if the synovium (lining around the joint) is inflamed and causing pain.
- Arthrodesis – if a joint replacement is not an option, the joint may be surgically fixed to promote a bone fusion; the joint is realigned or stabilized. Also called artificial ankylosis, syndesis.
When a flare-up occurs the patient should rest as much as possible — this is not a time to work through the pain as the exerting of very swollen and painful joints frequently results in worsening symptoms.
However, if the patient is not experiencing a flare-up, regular exercise will help their general health and mobility. If rheumatoid arthritis has caused muscles around the joints to become weak, exercise will help strengthen them. Exercises that do not strain the joints are best, such as swimming. Physical therapy can also help to improve mobility.
Rheumatoid arthritis can affect people of all ages and more than 200,000 cases are diagnosed each year. Anyone can get this disease, though it occurs more often in women. Rheumatoid arthritis often starts in middle age and is most common in older people. But children and young adults can also get it.
If you are experiencing any symptoms listed above, please visit your doctor. The sooner you can begin treatment, the sooner you can effectively treat your pain.