Rheumatoid Arthritis (10)
What Is Inflammation?
When you think of arthritis, you think of inflammation. Inflammation is a process in which the body's white blood cells and chemicals help protect us from infection and foreign substances such as bacteria and viruses.
In some diseases, however, the body's defense system (immune system) triggers an inflammatory response when there are no foreign substances to fight off. In these diseases, called autoimmune diseases, the body's normally protective immune system causes damage to its own tissues. The body responds as if normal tissues are infected or somehow abnormal.
What Diseases Are Associated With Inflammation?
Some, but not all types of arthritis, are the result of misdirected inflammation. Arthritis is a general term that describes inflammation in joints. Some types of arthritis associated with inflammation include:
- Rheumatoid arthritis
- Psoriatic arthritis
- Gouty arthritis
- Systemic lupus erythematosus
The most common form of arthritis called osteoarthritis (also known as degenerative arthritis) is a bit of a misnomer. It is not believed that inflammation plays a major role in osteoarthritis. Other painful conditions of the joints and musculoskeletal system that are not associated with inflammation include fibromyalgia, muscular low back pain, and muscular neck pain.
What Are the Symptoms of Inflammation?
The symptoms of inflammation include:
- Swollen joint that's tender and warm to the touch
- Joint pain
- Joint stiffness
- Loss of joint function
- Often, only a few of these symptoms are present.
Inflammation may also be associated with general "flu"-like symptoms including:
- Fatigue/loss of energy
- Loss of appetite
- Muscle stiffness
What Causes the Symptoms of Inflammation?
When inflammation occurs, chemicals from the body are released into the blood or affected tissues. This release of chemicals increases the blood flow to the area of injury or infection and may result in redness and warmth. Some of the chemicals cause a leak of fluid into the tissues, resulting in swelling. This process may stimulate nerves and cause pain.
What Are the Results of Joint Inflammation?
Increased blood flow and release of these chemicals attract white blood cells to the sites of inflammation. The increased number of cells and inflammatory substances within the joint can cause irritation, wearing down of cartilage (cushions at the end of bones), and swelling of the joint lining (synovium).
How Are Inflammatory Diseases Diagnosed?
Diagnosis of inflammatory diseases consists of all or some of the following:
- Complete medical history and physical exam.
- The location of painful joints.
- Presence of joint stiffness in the morning.
- Evaluation of other symptoms.
- Results of X-rays, blood tests, and other studies.
Can Inflammation Affect Internal Organs?
Yes. Inflammation can affect organs as part of an autoimmune disorder. The type of symptoms depends on which organs are affected. For example:
- Inflammation of the heart (myocarditis) may cause vague chest pain or fluid retention.
- Inflammation of the small tubes that transport air to the lungs (bronchiolitis) may cause shortness of breath.
- Inflammation of the kidneys (nephritis) may cause high blood pressure or kidney failure.
- Inflammation of the eye (iritis or uveitis) may cause pain or decreased vision.
- Inflammation of the muscles (polymyositis) may cause achiness or weakness.
- Inflammation of the blood vessels (vasculitis) may cause rash, headaches, or internal organ damage.
Pain may not be a main symptom since many organs do not have pain-sensitive nerves. Treatment of organ inflammation is directed at the cause of inflammation whenever possible.
How Are Inflammatory Joint Diseases Treated?
There are a number of treatment options for inflammatory joint diseases including medications, rest, exercise, and surgery to correct joint damage. The type of treatment prescribed will depend on several factors including the type of disease, the person's age, type of medications he or she is taking, overall health, medical history, and severity of symptoms.
The goals of treatment are to:
- Avoid or modify activities that aggravate pain
- Relieve pain through pain medications and anti-inflammatory drugs
- Maintain joint movement and muscle strength through physical therapy and exercise
- Decrease stress on the joints by using braces, splints, or canes as needed
What Drugs Are Used to Treat Inflammatory Diseases?
There are many drugs available to decrease joint pain, swelling, and/or inflammation and hopefully prevent or minimize the progression of the inflammatory disease. These medications include:
- Anti-inflammatory pain reliever drugs (NSAIDs -- such as aspirin, ibuprofen, or Celebrex).
- Corticosteroids (such as prednisone).
- Other medications* include chemotherapy drugs, disease modifying treatments, biologic therapy, or narcotic pain relievers.
*Some of these medications are traditionally used to treat other conditions such as cancer and inflammatory bowel disease or to prevent organ rejection after transplants. However, when "chemotherapy" types of medications are used to treat inflammatory diseases, the doses are significantly lower and the risks of side effects tend to be considerably less than when prescribed in higher doses for cancer.
When you are prescribed any drug, it is important to meet with your doctor regularly so he or she can check its effectiveness and detect the development of any side effects.
SOURCE: Arthritis Foundation
(ĐTĐ) - The potential risks smoking and drinking pose to people with rheumatoid arthritis. You already know that smoking is bad for you and that it's unhealthy to drink too much alcohol.
But do you know how tobacco and alcohol relate to rheumatoid arthritis -- your odds of developing RA, or, if you already have RA, your odds of making it worse?
Here's what the research shows.
RA, Smoking, and Your Genes
Smoking may make people more likely to get RA. And, depending on their genes, it may make their RA worse. On top of that, smoking mixed with RA can lead to even greater problems, like heart disease.
"Very clear studies indicate that tobacco is highly associated [with] and probably causal in rheumatoid arthritis and is causal in the worst form of the disease," says Susan Goodman, MD, an assistant attending rheumatologist and internist at the Hospital for Special Surgery and assistant professor of medicine at Weill Cornell Medical College.
Your genes may also matter. A Swedish study, published in December 2010, shows that the odds of developing RA was related not just to how much a person smokes, but also to their genetic makeup. People with a certain gene variation, called HLA-DRB1, who smoke are much more likely to get rheumatoid arthritis than someone who doesn't smoke -- and to have severe RA.
"It turns out that people who smoke who bear this genetic factor are much more likely to develop rheumatoid arthritis and do develop more severe disease," Goodman says.
Health Problems From Smoking and RA
Smoking can also make dealing with the disease more difficult.
"In a lot of the studies on the course of rheumatoid arthritis, patients who smoke do less well, and they're less likely to achieve remission," Goodman says. "They're more likely to have a worse outcome. Smoking gives them a worse prognosis."
Smoking can increase painful rheumatoid nodules, which form in the joints, she says. It can also lead to heart disease, which -- even on its own -- is a big problem in people with RA. And smoking makes it worse.
"In the last 10 years, there have been studies that show the leading cause of death in patients with RA is cardiovascular disease," says Walter Moore, MD, senior associate dean for graduate medical education and veteran affairs at Georgia Health Sciences University and chief of rheumatology at Charlie Norwood Department of Veterans Affairs Medical Center. “And smoking itself is clearly associated as a risk factor for cardiovascular disease.”
Stroke is another concern for RA patients.
"RA is an illness like diabetes. In and of itself, it's a risk factor for heart attack and stroke," says Andrew Ruthberg, MD, an assistant professor of medicine and an attending physician at Rush University Medical Center and director of Rush Rheumatoid Arthritis Clinic. "And those two things conspire to raise your risk for those other problems to a higher level."
The bottom line: Quit. But Goodman says she doesn't always address that first.
When patients come into her office for treatment, Goodman first focuses on getting their pain under control. After that, she then turns to their bad habits -- like smoking.
"Certainly, everyone should quit smoking," Goodman says. “And we try to help the patient do that.”
Ruthberg takes a harder stance.
"I don't smoke myself," he says, "and I don't much like smoking. My father died of lung cancer, so it doesn't take much for me to discourage anyone who smokes from smoking. But I usually talk about other health risks associated with smoking, like heart attacks and strokes."
Do Alcohol and RA Medications Mix?
The lines between rheumatoid arthritis and drinking are blurrier. Alcohol doesn't promote or help cause RA like smoking does. But mixing alcohol and medications can lead to liver problems.
Some studies have found that drinking in moderation may help lower the chance and the symptoms of rheumatoid arthritis. A study published online in Rheumatology in July 2010 found that drinking alcohol more than 10 days a month decreases "both risk and severity" of the disease. The study was based on information collected from patients about their drinking habits, which doesn’t prove drinking alcohol counters RA or its effects.
"We don't spend very much time encouraging people to drink alcohol," Moore says, "and all things being considered, we are using drugs that have hepatotoxicity [are toxic to the liver] as part of the patients' regimens."
The drug he's talking about is methotrexate, a common RA medication. Mixing alcohol and RA medications like methotrexate, in particular, is risky. Plus, he says he'd like to see more information, like how much alcohol and what kinds -- whether liquor, beer, or wine -- helped people more before he'd suggest to his patients who have mild forms of RA that they might benefit from drinking alcohol.
Methotrexate, like many other medications, is metabolized by the liver. And that's often where the dangers of drinking and medication mixing come into play.
Arava, which goes by the generic name leflunomide, is a companion drug to methotrexate. Moore says he won't offer his patients either unless they agree to stop drinking completely or at least curtail their use of alcohol.
Some patients also use over-the-counter drugs such as acetaminophen, found in many pain relievers and other medications, to help control their pain. Acetaminophen at doses higher than recommended can also cause liver damage.
Physicians keep an eye on their patients' liver functions through regular blood work that monitors liver enzymes. They can sometimes diagnose liver damage caused by both the medications and alcohol.
RA and Drinking
The bottom line: If you're wondering how much you can drink, talk to your doctor.
"Each rheumatologist is different about where they draw the line in the sand about how much they'll let their patients drink," Ruthberg says.
For his patients to stay on methotrexate, Ruthberg allows them no more than a few drinks per week.
Moore asks his patients to keep their drinking to a minimum. And drug interactions aren't the only reason he suggests this.
Limiting alcohol, he says "is once again in respect to different things like obesity, alcohol issues, and accidents. For patients with RA, they may have problems with falling or less control with their hands. And alcohol may complicate that aspect of RA.
"For the type of practice that I have here at Georgia Heath Sciences University, we are really managing patients with more severe disease, more progressive disease. We’re in the fight of our lives to preserve their joints. To do anything to compromise these medicines, I would really be reluctant to do that."
Reviewed by Michael W. Smith, MD - Source WebMD.com
(ĐTĐ) - Painful, swollen joints are a hallmark of rheumatoid arthritis. But for people with RA, it's not the only thing to watch out for.
A result of the body’s immune system attacking its own tissues, rheumatoid arthritis requires more than just managing the pain. Other symptoms that might even seem unrelated to the condition may pose a threat.
“This is a disease process, not just something that happens in the joints,” rheumatologist Joan Bathon, MD, tells WebMD. “It can be in all your tissues, causing problems wherever inflammation occurs,” says Bathon, who is chief of the rheumatology department at New York-Presbyterian Hospital/Columbia University Medical Center.
People with more severe rheumatoid arthritis are more likely to have other complications. But it can also happen in milder cases.
Here are the top 10 symptoms rheumatoid arthritis patients should never ignore.
1. Shortness of breath or chest pain
Because rheumatoid arthritis can affect the blood vessels and muscle of the heart, people with the condition are at a greater risk for heart attacks and heart failure.
“Chest pains or shortness of breath are big red flags,” says rheumatologist Brian Mandell, MD, PhD, of Cleveland Clinic’s Arthritis and Musculoskeletal Center.
If you’re getting winded easily, you could also have a lung infection. Or you could have some form of interstitial lung disease, which causes lungs to become inflamed and scarred, Mandell says. Fluid might also be surrounding the lungs, which would require drugs and drainage to treat.
Seek medical attention immediately if you’re having these problems, even if you've never had heart or lung issues before.
2. Numbness or tingling
Rheumatoid arthritis can cause connective tissues in the hand or foot to become inflamed and push up against a nerve causing numbness and tingling. As a result, you might experience weakness or clumsiness, or even nerve damage.
This type of swelling can happen in tissues throughout the body. But it most commonly occurs around the wrist area, causing carpal tunnel syndrome, Mandell says.
If you experience numbness or tingling, you need to be evaluated by your rheumatologist or another health care provider as soon as possible to determine the cause.
3. Inability to move or raise your hand or foot
Compared to numbness or tingling, suddenly not being able to raise or move a hand or foot is a much more severe complication to result from rheumatoid arthritis.
It’s also a much more rare occurrence, involving damage to nerves that are connected to muscles.
“It’s like having a heart attack for the nerves,” Bathon tells WebMD.
Seek emergency treatment for this symptom. Bathon says not doing so could lead to permanent paralysis.
4. Spots on or around your fingertips
Little red or black spots on or around the fingernails may mean that the tissue in those areas has died from inflamed small blood vessels.
Although very uncommon, the spots can signal an advanced form of inflammation, says Bathon, who suggests promptly seeing a rheumatologist.
If the symptom goes untreated, it may ultimately lead to losing fingers or toes.
5. Red, inflamed eyes
Blood vessels in the eyes are another common target of rheumatoid arthritis, especially among people with more serious forms of the disease.
If the outer layer of your eye feels dry or irritated, eye drops can usually treat the problem, Mandell says.
However, sudden severe pain and redness of the eyes could mean deeper parts of the eye are affected. That’s a very serious complication, so see a doctor immediately if that happens, Mandell says.
6. Tummy troubles
If you take a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen or naproxen to treat your rheumatoid arthritis, you are at risk for stomach problems.
These drugs can cause stomach ulcers, which could in turn make the stomach bleed or form a hole in its wall.
When taking an NSAID, report any tummy pain, black or bloody bowel movements, or nausea to your doctor.
7. High fever and other signs of infection
Another problem from rheumatoid arthritis treatment is infection related to biologic drugs such as Cimzia, Enbrel, Humira, Remicade, and Simponi.
The most telling sign of an infection is high fever (greater than 101 or 102 degrees Fahrenheit), Bathon says. Others are an unexplained cough, or an area of the skin that is extremely hot, red, swollen, or more painful than usual.
This type of infection can spread very quickly and is usually tough to control since rheumatoid arthritis patients have compromised immune systems to begin with. That gives them a lower tolerance for fever, Bathon says.
If you suspect an infection, see a doctor immediately, even if it means a trip to the ER, she says.
8. Feeling blah
Symptoms that just make you feel not well could also signify infection. So don’t ignore your body when it’s telling you something isn’t right, Mandell says.
Specifically, things like loss of energy, night sweats, sudden weight loss, unexplained fatigue, or a low-grade fever might mean it’s time to re-evaluate your treatment regimen.
Be sure to discuss any of these symptoms with your doctor.
9. Bone fracture
A bone fracture in someone with rheumatoid arthritis may reveal underlying osteoporosis, especially among women.
Because of its inflammatory nature, rheumatoid arthritis can cause bone loss. On top of that, the risks of fracture can skyrocket if you’re taking prednisone, a common treatment for rheumatoid arthritis.
In addition to exercising and following a diet rich in calcium and Vitamin D, people with rheumatoid arthritis should consider having a bone density test to detect osteoporosis soon after their RA diagnosis.
10. Suddenly bruising easily
If you find you’re suddenly bruising very easily, you could be experiencing a complication from rheumatoid arthritis that lowers your blood platelet count, Mandell says.
That could either be because of your treatment, or due to the disease itself.
Be sure to see your doctor soon so you can get a blood platelet count. When blood platelet counts are very low, you are at increased risk of bruising and may experience serious bleeding.
Reviewed by Michael W. Smith, MD - Source WebMD.com
(ĐTĐ) - Most people with rheumatoid arthritis can live full, active lives despite their disease. But living a good life with RA often means you need to work at managing your disease and get the help you need. Take care to avoid these six common mistakes.
RA Mistake 1: Not Seeing a Rheumatologist
If you’re like most people with RA, the first doctor you saw for your joint symptoms was a primary care physician. But a specialist has more training in treating RA.
Just 20 years ago, RA was often treated with medications that relieved pain but didn't stop ongoing joint damage. Today, there are many new, effective -- and highly complex -- treatments for rheumatoid arthritis that do both. It's important to see a rheumatologist, who has the training and experience to prescribe and monitor those medications.
If you haven't seen a rheumatologist, your primary care doctor should be able to refer you to one. The American College of Rheumatology (ACR) also lists rheumatologists in your area.
Mistake 2: Becoming a Couch Potato
When you have joint pain and fatigue, it's hard to get up and get moving. But regular exercise is one of the best things that you can do for your health. While rest is also important for managing your disease, too much inactivity can make pain, fatigue, and stiffness worse.
Even when your RA is flaring, you can -- and should -- do gentle range-of-motion exercises. Range-of-motion exercises help maintain joint movement and flexibility by taking joints through their full span of movements. No weights are used.
You may also be able to gently exercise in water during flares.
When your disease is less active, you should be more active. Add exercises to build muscle strength and joint stability and improve aerobic fitness.
Talk to your rheumatologist or a physical or occupational therapist about the best and safest exercises for you. Walking can be a good exercise for people with RA, and it doesn't even require going to a gym! Warm-water aerobic exercise may be another choice to consider -- the water gives sore joints some additional support.
Mistake 3: Skipping Doctor Appointments
While you may not feel the need to see your rheumatologist when your RA is less active, keeping your appointments is still important.
During regular visits, your doctor will:
- Monitor the course of your disease
- Determine how well your treatment is working
- Look for harmful side effects
- Adjust your treatment, if necessary
In addition to seeing your doctor, you also may need periodic lab tests or X-rays. It's important that keep those appointments, too.
Mistake 4: Not Taking Prescribed Medications
Pain relievers and nonsteroidal anti-inflammatory drugs (NSAIDs) may help your joints feel better. But they do nothing to stop the joint damage that is going on inside. That requires a more powerful disease-modifying antirheumatic drug (DMARD) or biologic response modifier, or both.
Years ago, doctors started RA treatment with aspirin and other pain relievers. If the disease got worse, they then prescribed a DMARD. Today, doctors are likely to prescribe a DMARD or a biologic (or both) early on, particularly for aggressive RA.
In fact, ACR guidelines recommend that all people diagnosed with RA be given a DMARD, regardless of how active or severe their RA is. Studies have shown that starting powerful drugs earlier may be more effective in reducing or preventing joint damage.
If your rheumatologist recommends a DMARD or biologic and you don't take it, you may be risking serious joint damage that cannot be repaired. If you have active RA and your doctor has not recommended one of these drugs, ask if you need one.
Mistake 5: Skipping Medication When You Feel Good
You may be tempted to skip your medications on days when you’re feeling better. But failing to take your medications could cause the pain -- or even your rheumatoid arthritis -- to get worse.
If you take medication for pain and inflammation, you should take it consistently. Missing a dose could cause the pain to return, and it may be more difficult to relieve. The same is true for joint inflammation. It's better to keep it under control than allow it to flare and try to get it under control again.
To control your RA, some medications need to stay in your bloodstream at therapeutic levels. If you miss a dose of medication, you should take it as soon as you remember (but don't take a double dose). If you miss a dose often -- even if you are feeling better at the time -- blood levels of the drug may drop and could cause a flare of your RA.
Mistake 6: Accepting Depression
Living with RA isn't easy. It can be painful and unpredictable and make it hard to do the things you enjoy. It's understandable that you may become sad at times, but you don't have to accept depression as a part of your disease.
Ask your doctor to refer you to a mental health professional who works with people with chronic diseases. Counseling may help you develop better skills for coping with RA. Attending a support group, such as those offered by the Arthritis Foundation, may also help.
If you still experience feelings of depression, let your doctor know. Some people with rheumatoid arthritis benefit from taking antidepressants. Simply accepting depression can take the joy out of life and make it more difficult to manage your disease.
(ĐTĐ) - At 35, Chicago flight attendant Michele Mason says her bones felt like “pins and needles” were in them, and her hands were so swollen that she found it difficult to put on her infant son’s socks. Her knees ached, too. “I couldn’t even get out of the bathtub by myself,” she says.
When her doctor suspected rheumatoid arthritis, Mason worried that traditional medicines might not be good for her breastfeeding baby. So with her doctor’s blessing, she took a very low-dose steroid and turned to herbs and supplements, including boswellia (Indian frankincense) and fish oil, to help relieve the pain and inflammation.
A year later, her diagnosis of rheumatoid arthritis was confirmed. “I was happier to go with what I felt was a safer route with herbs,” she says. “While they didn’t make it go away, they did give me some relief."
Like Mason, about 30% of patients surveyed from North Carolina with rheumatoid arthritis have tried supplements, according to a study in Preventing Chronic Disease . “And use is increasing,” says study co-author Leigh Callahan, PhD, associate professor of medicine, orthopaedics and social medicine at the Thurston Arthritis Research Center at the University of North Carolina at Chapel Hill.
So what are the best herbs and supplements for RA? And, are they safe? Here's what you need to know.
Supplements and Herbs for RA: The Basics
First, know that herbs and supplements haven't been studied in the same way that prescription medicines for RA have. “There’s a tremendous disconnect between their widespread usage and people’s belief in their efficacy compared to what we’ve actually proven scientifically,” says Chaim Putterman, MD, chief of rheumatology at Montefiore Medical Center and Albert Einstein College of Medicine.
That is changing as the National Institutes of Health has a well-established center dedicated to studying complementary and alternative medicine . In the meantime, experts say that although some herbs and supplements may help relieve inflammation, don’t count on them to cure rheumatoid arthritis. “At best, they’re adjunctive therapies,” says William St. Clair, interim chief of the division of rheumatology at Duke University Medical Center. “It’s not a good reason to throw out their disease-modifying anti-rheumatic drugs.”
Always talk to your doctor first, because herbs and supplements may interfere with other medicines you are taking. Remember, too, that since they are not regulated in the same way that drugs are, you cannot always be sure what you are buying, says St. Clair.
The National Center for Complementary and Alternative Medicine (NCCAM) recommends that women who are pregnant or nursing, or those considering CAM use in children use extra caution and consult their health care provider.
With that in mind, here are the herbs and supplements some experts suggest for RA.
Supplements and Herbs for RA: The Best
Omega-3 fatty acids: Omega-3 fatty acids are anti-inflammatories found in products like fish oil, says David Leopold, MD, director of integrative medical education at the Scripps Center for Integrative Medicine. Fish oil comes from coldwater fish such as salmon and tuna. Studies of fish oil in chronic inflammatory diseases show benefits such as decreased pain and morning joint stiffness and lowered use of nonsteroidal anti-inflammatory drugs.
The downsides: Fish oil may increase risk for bleeding, especially if it is being taken with certain other medicines. It can also interact with other medications you may be taking for conditions such as high blood pressure. It can taste fishy and can cause gas, diarrhea, and bloating. Leopold recommends getting good products that don’t taste that fishy, and freezing capsules. “By the time they melt, they’ve gone past the point where they can cause a fishy burp,” he says. Check for supplements that contain mercury-free fish oils.
Borage oil: Borage oil reduces swollen and tender joints, says Robert Zurier, MD, professor of medicine in the division of rheumatology at the University of Massachusetts Medical School. With it, patients may need less prednisone, a steroid, for relief of symptoms, he says. Borage oil may cause bloating or an upset stomach. Borage oil products may hurt the liver and may also increase risk for bleeding, especially in those who are also using NSAIDs or anti-clotting medications.
Green tea extract (EGCG), curcumin (turmeric), quercetin, ginger,white willow bark, boswellia: These are potential anti-inflammatory agents. “They act very similarly to ibuprofen, but at a lesser level,” says Leopold. Curcumin, boswellia, and ginger have been used in Ayurvedic medicine for inflammatory conditions, according to the NCCAM, which is supporting research with these botanicals in the treatment of arthritis and asthma.
According to the NCCAM, ginger may increase risk for bleeding and should not be used in people with bleeding problems, heart problems, or diabetes, Curcumin may cause upset stomach and diarrhea and shouldn't be used in people with gallbladder disease or gallstones. Boswellia may also cause upset stomach. White willow bark can cause a serious allergic reaction to patients with a history of allergy to salicylates (aspirin allergy). Other side effects may include upset stomach, bleeding, rash, and kidney problems.
Avocado-soy unsaponifiables: This vegetable extract made from avocado and soybean oils “seems to help the body regenerate normal connective tissue,” says Leopold. ASUs, as they’re often called, may cause upset stomach. Even just eating avocado and soy should give people “a mild effect,” he says.
SAM-e may act as an anti-inflammatory and analgesic but may cause vomiting, diarrhea, headache, and nausea.
Cat’s claw, from the bark of an Amazon vine, may slightly reduce joint swelling and pain, but there is no conclusive evidence that it can successfully treat rheumatoid arthritis. Cat’s claw may cause nausea, headaches, and dizziness.
Supplements and Herbs for RA: The Worst
Arnica : When ingested, may be poisonous, says Leopold. Used topically, it can cause itchiness and rash.
Kombucha tea: A fungal mushroom fermented product with a high risk of contamination.
Colloidal silver: This actually contains silver, says Leopold, which can turn the whole body blue permanently. It can also cause kidney problems, fatigue, stomach upset, and neurological problems.
Thunder god vine: This may cause stomach upset, skin reactions, temporary infertility in men, and a stop to periods in women. Extended use may lead to decreased bone density. Some parts of the plant are poisonous and could cause death.
Supplements and Herbs for RA: The bottom line?
Live a healthy life. Exercise may even reduce inflammation. And most important, talk to your doctor before trying any herb or supplement. Even if your doctor doesn’t ask you point blank about any herbs and supplements you’re taking, remember to volunteer the information.
Reviewed by Laura J. Martin, MD - Source WebMD.com
(ĐTĐ) - Although anyone can get rheumatoid arthritis, women with RA outnumber men by three to one. Many women with rheumatoid arthritis are diagnosed in their 20s and 30s, just when marriage and family start to take life's center stage.
With pain, fatigue, and medication side effects to consider, there's no question rheumatoid arthritis makes family planning more complicated. But RA doesn't have to put your dreams of having a family out of reach, experts tell WebMD. If you're thinking about starting a family while living with rheumatoid arthritis, consider these tips.
1. Don't Worry That Rheumatoid Arthritis Could Hurt Your Baby
Rheumatoid arthritis itself doesn't seem to harm the developing baby, even if RA is active during pregnancy. In fact, 70% to 80% of women with RA improve during pregnancy. Although some women with RA may have a slight risk of miscarriage or low-birth-weight babies, the vast majority of women have normal pregnancies without complications. And while rheumatoid arthritis has a small genetic component, mothers don't pass it to their babies.
However, many medicines for rheumatoid arthritis can cause birth defects. It's important to talk to your doctor about altering treatment several months before you try to get pregnant.
With the right treatment and prenatal care, babies born to moms with rheumatoid arthritis are as healthy and happy as any.
2. Have Patience as You Try to Get Pregnant
Experts disagree whether rheumatoid arthritis reduces fertility in women or men. It's true that many women with RA take longer to conceive than comparable women without rheumatoid arthritis. Inconsistent ovulation, decreased sex drive, or having sex less often due to pain and fatigue are possible explanations.
For men, acute flares of rheumatoid arthritis temporarily reduce sperm count and function, and can cause erection problems and decreased libido. For both men and women, effective treatment for RA improves sexual symptoms and function. In well-treated rheumatoid arthritis, fertility in most men and women is probably normal.
3. Know That the Future Looks Bright for RA Treatment
New biologic medicines for RA have created a new era of treatment for rheumatoid arthritis, according to rheumatologists. With early and aggressive treatment, most people with RA can avoid joint deformities and major disability.
For most women, that means being present and active throughout your children's years at home. While bad days from RA symptoms may be unavoidable, doctors believe most women will keep their independence for decades, and possibly their lifetimes.
4. Alter Treatment Well Ahead of Your Pregnancy
As soon as you're considering starting a family, see your rheumatologist. Some medicines need a months-long "washout" period before trying to conceive. And that goes for men as well as women; although unproven, methotrexate might result in sperm problems that could cause birth defects.
If you're taking leflunomide for RA, even more advance planning is necessary. Due to its long half-life, leflunomide needs to be stopped two years before trying to conceive a baby.
5. Work Closely With Your Doctor on Treatment During Pregnancy
Your rheumatologist will help you decide on a treatment plan that includes both control of your RA symptoms and safety for your baby.
Prednisone, for example, is generally considered safe during pregnancy. Hydroxychloroquine (Plaquenil) and sulfasalazine are also considered safe. While evidence is limited for biologic medicines like Enbrel and Remicade, many rheumatologists are confident in their relative safety during pregnancy.
One way to avoid the risk of pregnancy problems from RA medications is to simply not take any. Under a doctor's supervision, some women quit RA drugs "cold turkey" from when they begin trying to conceive, through delivery and breastfeeding.
This method has its own risk, of course: possible progression of joint damage from flares during the treatment holiday. In certain women, though, some rheumatologists endorse the approach, with close monitoring for disease activity.
6. Expect Improvement in RA Symptoms During Pregnancy
Interestingly, pregnancy usually has a positive effect on rheumatoid arthritis, albeit temporary. About 70% to 80% of women experience improvement in their RA symptoms during pregnancy.
In many of these women, medications for RA may be safely reduced or even eliminated during pregnancy. For about one-quarter of women, though, rheumatoid arthritis activity continues during pregnancy, or gets worse.
Unfortunately, the respite from RA symptoms during pregnancy is short-lived. Most women relapse after delivering their babies.
7. Until You're Ready to Get Pregnant, Use Contraception
Again, remembering the potentially harmful effects of some rheumatoid arthritis drugs on the fetus, it's essential to avoid pregnancy until you're ready. Experts say that used properly, a variety of methods are appropriate and effective:
- Oral contraceptives
- Vaginal ring
- Intrauterine device (IUD)
Although controversial studies have suggested oral contraceptives might prevent rheumatoid arthritis in some women, there is no evidence that they help control RA symptoms.
(ĐTĐ) - Osteoarthritis is the result of the wear and tear on joints. Rheumatoid arthritis, on the other hand, occurs when the immune system goes haywire and begins attacking joint linings. This chronic inflammatory condition also affects other tissue, but the joints are usually the most severely affected.
Here is what we know about the causes of rheumatoid arthritis.
What causes rheumatoid arthritis?
Although doctors aren't sure of the exact cause, it's thought that rheumatoid arthritis may result from a combination of genetics and environmental triggers. Some researchers believe an infection with a bacteria or virus can trigger the development of rheumatoid arthritis in someone who's genetically susceptible. However, to date, no infection or organism has been found that could be said to be the cause.
As rheumatoid arthritis develops, some of the body's immune cells recognize a protein as a foreign intruder. The exact protein is unknown and may be one of any number of potential candidates. Some of them are produced by infection, such as a viral, bacterial, or fungal infection. Other candidate proteins may have a genetic connection or stem from other causes.
Whatever the source, cells called lymphocytes react to this protein. The reaction then causes the release of cytokines, which are chemical messengers that trigger more inflammation and destruction. With rheumatoid arthritis, the main target of inflammation is the synovium, the thin membrane that lines the joints. The inflammation also spills to other areas in the body causing joint damage, inflammation, chronic pain, fatigue, and loss of function.
There are many cytokines, but the most important in rheumatoid arthritis are tumor necrosis factor (TNF) and interleukin-1. These cytokines are thought to trigger the process of joint damage in rheumatoid arthritis. Some treatments for rheumatoid arthritis aim to block these cytokines, reducing inflammation and joint damage.
What risk factors increase the chance of rheumatoid arthritis?
Rheumatoid arthritis is more common in women than in men. In fact, 70% of the patients with rheumatoid arthritis are women. In addition, there's an increased risk of rheumatoid arthritis in women who have never been pregnant and in those who have recently given birth.
Rheumatoid arthritis has a genetic link, and the disease can run in families. People with specific human leukocyte antigen (HLA) genes have a greater chance of developing rheumatoid arthritis than people who do not have the HLA genes. Still, not everyone with the HLA genes develops rheumatoid arthritis. In other words, genes can increase the risk of rheumatoid arthritis, but other unknown factors are also involved.
Older age and cigarette smoking may increase the risk of getting rheumatoid arthritis. So can stress. In fact, many patients with rheumatoid arthritis tell of having an extremely stressful life event within the six months before the disease appeared.
Symptoms of rheumatoid arthritis include joint pain, swelling, stiffness, and fatigue -- which can be mild or severe. Doctors recommend treating rheumatoid arthritis early, before there are visible signs of joint destruction.
(ĐTĐ) - Although there have been cases of remission without rheumatoid arthritis treatment, these are not common. So you're right to be concerned. Most people with rheumatoid arthritis experience some progression of their disease during their lives.
But there are treatments that can help, and each person responds to the disease differently. What can you expect? That depends on many factors.
- How advanced your rheumatoid arthritis is at the time you are diagnosed
- Your age at the time you are diagnosed
- How "active" your disease is
Each person's rheumatoid arthritis is unique, and the disease affects each person differently. Over the long-term, though, there are a few common patterns.
- Long remissions. Remission means near-disappearance of symptoms without an actual cure. About 10% to 20% of people diagnosed with rheumatoid arthritis have a sudden onset of the illness, but then have no symptoms for many years, even decades.
- Intermittent symptoms. About 15% to 30% of people with rheumatoid arthritis have disease that waxes and wanes slowly. They have periods of low or no symptoms that can last months between flare-ups.
- Progressive rheumatoid arthritis. Unfortunately, that leaves the majority of people, who have the most common and serious form of rheumatoid arthritis. Because it's progressive, it requires a long-term treatment plan and a coordinated medical team to manage the treatment and slow or stop progression.
How can you tell which kind of rheumatoid arthritis you have and whether it will progress? There is no easy way, but there are some general signs that suggest you might have the progressive form of rheumatoid arthritis. You might have progressive RA if you:
- Have long duration or high intensity of disease activity (flares)
- Were diagnosed at a young age, which means the rheumatoid arthritis has more time to become active in your body
- Have rheumatoid nodules -- bumps under the skin that most often appear on the elbows
- Have active inflammation that shows up in tests of your joint fluid or in blood tests
- Had a lot of damage already on X-rays when you were diagnosed
- Have elevated blood tests for rheumatoid factor or citrulline antibody
What's the most important thing you can do to follow the progression of rheumatoid arthritis? See a rheumatologist. Your doctor will do a complete joint examination, lab tests, and X-rays to see if your disease has progressed.
At later visits, your doctor can recheck your joints, tests, and X-ray films and see if any further progression has occurred. If your rheumatoid arthritis is progressing, there are good treatment options to slow it down.
A "functional questionnaire" may also help you track the progression of your rheumatoid arthritis. The Health Assessment Questionnaire (HAQ) is a commonly used tool to keep track of rheumatoid arthritis progression, and it's available for free on the Internet.
- Download the HAQ at aramis.stanford.edu/HAQ.html
- Fill it out, get a copy in your medical record, and recheck it periodically. Your rheumatologist, or another member of your treatment team, will suggest a schedule.
- Note any changes in your level of function and discuss them with your treatment team.
Don't overlook the affect your rheumatoid arthritis has on your mental health. If you are having trouble coping, seek help. Psychologists, social workers, and psychiatrists can help you deal with the struggle of living with the long-term uncertainty and limitations of rheumatoid arthritis.
There is good news for people with rheumatoid arthritis. Treatment is improving and, in many cases, can delay progression of this disease. What does this mean for you? Today, patients may have less progression in their lifetimes than patients of the past.
(ĐTĐ) - Juvenile rheumatoid arthritis (JRA), also called juvenile idiopathic arthritis (JIA) and juvenile chronic arthritis (JCA), is the most common childhood arthritis. This disease may affect up to 294,000 children in North America alone.
What is juvenile rheumatoid arthritis?
Juvenile rheumatoid arthritis causes joint inflammation and stiffness for more than six weeks in a child aged 16 or younger. Inflammation causes redness, swelling, warmth, and soreness in the joints. Still, many children with JRA do not complain of joint pain.
Any joint can be affected with JRA. The ongoing inflammation may limit the mobility of affected joints.
What causes JRA?
JRA is an autoimmune disorder. This means that the body mistakenly identifies some of its own cells and tissues as foreign. Normally, the immune system fights off harmful, foreign substances such as bacteria or viruses. With JRA, the immune system attacks healthy cells and tissues. The result is inflammation -- marked by redness, heat, pain, and swelling.
Researchers don't know exactly why the immune system goes awry in children with JRA. They suspect that it's a two-step process. First, something in a child's genetic makeup gives them a tendency to develop JRA. Then an environmental factor, such as a virus, triggers the development of JRA.
How is JRA different from adult rheumatoid arthritis?
The main difference between juvenile and adult rheumatoid arthritis is that some people with JRA outgrow the illness. Adults usually have lifelong symptoms. Studies show that by adulthood, JRA symptoms disappear in more than half of all affected children. Another difference between JRA and adult rheumatoid arthritis is the percentage of people who have rheumatoid factor in their blood. The presence of rheumatoid factor indicates an increased chance that JRA will continue into adulthood. About 70% to 80% of adults with rheumatoid arthritis have rheumatoid factor. However, fewer than half of all children with rheumatoid arthritis have rheumatoid factor.
What are symptoms of juvenile rheumatoid arthritis?
JRA may cause chronic fever and anemia. It can affect the heart, lungs, eyes, and nervous system.
These arthritic episodes may last for several weeks. The arthritis flares often recur, but the symptoms may be less severe in recurrent attacks. Symptoms of JRA may include:
- Repetitive fevers of 103 degrees or higher
- Pink rash that comes and goes
- Eye inflammation
- Joint pain and/or stiffness
- Joint swelling
- Reduced activity levels
- Decreased activity level
- Weakening of fine motor skills
- Impaired bone development and growth
Are there different types of juvenile rheumatoid arthritis?
Doctors classify three kinds of JRA. Each type of JRA is based on the number of joints involved, the symptoms, and the presence of certain antibodies in the blood. These three different classifications help determine how the disease will progress.
Pauciarticular (paw-see-are-tick-you-lar) means that four or fewer joints are involved. This is the most common form of JRA; about half of all children with JRA have this type.
This type of JRA typically affects large joints, such as the knees. Girls under age 8 are most likely to develop this type of JRA. Some children with pauciarticular JRA have special proteins in the blood called antinuclear antibodies (ANAs).
Eye disease affects from 20% to 30% of children with pauciarticular JRA and is more common in children with ANAs. Regular exams by an ophthalmologist (a doctor specializing in eye diseases) are necessary with JRA.
The ophthalmologist treats serious eye problems such as iritis (inflammation of the iris, the colored part of the eye) or uveitis (inflammation of the inner eye). Many children with pauciarticular disease outgrow JRA by adulthood. Still, eye problems can continue and joint symptoms may recur in some people.
About 30% of all children with JRA have polyarticular disease, in which five or more joints are affected. The small joints, such as those in the hands and feet, are most commonly involved. However, the disease may also affect large joints.
Polyarticular JRA often is symmetrical. This means it affects the same joints on both sides of the body. Some children with polyarticular disease have rheumatoid factor in their blood. These children often have a more severe form of the disease. Doctors consider this to be the same as adult rheumatoid arthritis.
Along with joint swelling, the systemic form of JRA is characterized by fever and a light pink rash. This type of JRA may affect internal organs such as the heart, liver, spleen, and lymph nodes.
The systemic form (called Still's disease) affects 20% of children with JRA. Almost all children with this type of JRA test negative for both rheumatoid factor and ANA.
A small percentage of these children with systemic JRA develop arthritis in many joints. They may have severe arthritis that continues into adulthood.
How is juvenile rheumatoid arthritis diagnosed?
JRA is often difficult to diagnose. Sometimes children with JRA do not complain of pain. In fact, parents may not be aware of symptoms such as swelling.
Some symptoms of JRA are similar to other serious conditions such as infection, cancer, bone disorders, Lyme disease, and lupus.
Physicians usually go through a series of discussions and tests to see if the patient has JRA. During the examination, the physician will review the family medical history to see if there's a possible genetic link. The physician will also review the patient's medical history to see how long the child has had symptoms.
In addition, the physician will do a physical exam to look for joint swelling, rashes, signs of internal organ inflammation, and/ or eye problems. A series of blood tests and joint and tissue fluid tests are also done to check for infection and to confirm the diagnosis.
Lastly, the physician may use X-rays to check for fractures, infections, or tumors. Also, lab tests are done including ANA, rheumatoid factor, HLA-B27 typing, hemoglobin and blood count testing and urinalysis, and erythrocyte sedimentation rate.
How is juvenile rheumatoid arthritis treated?
Treatment for JRA is essentially the same as for adults with RA. Treatment usually includes medications along with exercise.
The goals of treatment for JRA include:
- Easing pain and swelling
- Increasing joint motion and strength
- Preventing joint damage and other complications that can occur.
Which medications are used to treat JRA?
Medications for juvenile rheumatoid arthritis may include:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are used to reduce pain, fever and inflammation.
NSAIDs are given through a liquid or pill. These drugs are typically taken from one to four times a day. Some common NSAIDs on the market are naproxen (Naprosyn), ibuprofen (Motrin or Advil), tolmentin, and aspirin.
While NSAIDs may help ease pain and inflammation, they also have side effects. Some common side effects include stomach pain, nausea, vomiting, headache, and anemia. Sometimes the doctor will give another stomach-protecting medication to take with the NSAIDs to reduce the risk of stomach bleeding.
Disease-modifying anti-rheumatic drugs (DMARDs)
DMARDs may be added to the medication regimen to alter the progression of the joint disease. These drugs also help with joint stiffness, pain, and swelling.
The true effects of DMARDs are not felt immediately and may take about 3-6 months to work. This is why DMARDs are referred to as "slow-acting." Examples of DMARDs include Plaquenil, Azulfidine, and Rheumatrex.
Because DMARDs are strong medications, the child will need frequent tests to monitor the drug and side effects such as anemia, low blood count, and kidney and liver problems. Other side effects may include stomachaches, diarrhea, vomiting, nausea, headaches, rashes, loss of appetite, and weakness.
Biological modifying agents
Biological agents, or biologics, are also DMARDs. Biologics are made of synthetic proteins and antibodies that block TNF and other substances that cause inflammation.
Examples of biologics include Enbrel, Humira, Kineret, and Remicade).
Potentially serious side effects of the biologics include allergic reactions and an increased risk of infection including tuberculosis. Because some biologics have only been FDA-approved for use in adults, clinical trials are under way to check their effectiveness in children.
These powerful anti-inflammatory medications are usually only prescribed when the patient does not respond to other treatment or if the disease is severe.
Steroid medications come in pills or liquids. When a patient is only affected in a single joint, a steroid injection may be given directly into that joint.
Oral steroids are usually prescribed for short periods of time and in low dosages. There are some serious side effects associated with long-term usage. Side effects include stunted growth, ulcers, mood swings, weight gain, moon face, muscle weakness, high blood pressure, osteoporosis, cataracts, and infections.
Examples of steroids include dexamethasone, methylprednisolone, hydrocortisone, prednisolone, and prednisone.
What exercises are used to treat JRA?
Exercise and physical activity are important for children with JRA. Exercise helps reduce pain, increase muscle strength, keep joints moving in a normal range of motion, and improve endurance.
With the help of physical and occupational therapists, children with JRA learn simple ways to perform their activities of daily living. Therapists teach them range-of-motion exercises to help with flexibility and strengthening exercises for muscle building.
Hot and cold treatments performed before exercise can also help to make the therapy easier as well as relieve stiffness and pain. Examples of these treatments are hot or cold soak or applying hot or cold packs.
Therapists can also make splints for children to correctly position the joints and reduce pain. Splints are typically used on the knees, wrists, and fingers.
Children with JRA should be encouraged to participate in recreational activities. Contact sports are not recommended, but activities that are not stressful on the joints, such as swimming, are beneficial.
Are there complications with juvenile rheumatoid arthritis?
There can be complications with JRA and the medications used for treatment. Certain medications such as steroids can stunt growth. Poor growth may also occur as a result of a poor appetite.
Eye problems are associated with some forms of JRA. It's important to have an ophthalmologist check the child's eyes frequently.
JRA patients also have complications with dental care. Their oral health is compromised because of their limited jaw movement. This makes it difficult for patients to brush and floss properly. Dentists can recommend special toothbrushes and flossing equipment to help children take care of their mouths.
Patients with JRA often have temporal mandibular joint (TMJ) or jaw pain. Pain and stiffness of the jaw can be alleviated by certain exercises. A JRA sufferer may also develop an overbite if the lower jaw doesn't develop correctly. This can usually be fixed by an orthodontist or, if necessary, by surgery.
Some patients with JRA need additional calories for growth because of the demands of their chronic disease. Other JRA sufferers may also gain too much weight because of their limited mobility and medication side effects. Too much weight can be dangerous because of the excess stress placed on the joints.
What's the prognosis for juvenile rheumatoid arthritis?
Permanent damage from juvenile rheumatoid arthritis is now rare with proper treatment. Most children with JRA recover from the disease fully without experiencing any lasting disabilities if treated early.
(ĐTĐ) - Arthritis is a general term that means inflammation in a joint. Joint inflammation is characterized by redness, warmth, swelling and pain within the joint.
Rheumatoid arthritis is a type of chronic arthritis that typically occurs in joints on both sides of the body (such as hands, wrists or knees). This symmetry helps distinguish rheumatoid arthritis from other types of arthritis.
In addition to affecting the joints, rheumatoid arthritis may occasionally affect the skin, eyes, lungs, heart, blood, or nerves.
What Are the Symptoms of Rheumatoid Arthritis?
Symptoms of rheumatoid arthritis include:
- Joint pain and swelling
- Stiffness, especially in the morning or after sitting for long periods
Rheumatoid arthritis affects everyone differently. In most people, joint symptoms develop gradually over several years. But in some, rheumatoid arthritis may progress rapidly and yet other people may have rheumatoid arthritis for a limited period of time and then enter a period of remission.
Who Gets Rheumatoid Arthritis?
Rheumatoid arthritis affects about 1% of the U.S. population. While it is two to three times more common in women than in men, men tend to be more severely affected when they get it. It usually occurs in middle age, however, young children and the elderly also can develop rheumatoid arthritis.
What Causes Rheumatoid Arthritis?
The exact cause of rheumatoid arthritis is unknown, but it is thought to be due to a combination of genetic, environmental and hormonal factors. With rheumatoid arthritis, something seems to trigger the immune system to attack the joints and sometimes other organs. Some theories suggest that a virus or bacteria may alter the immune system, causing it to attack the joints.
Research hasn't been able to determine exactly what role genetics plays in rheumatoid arthritis. However, some people do seem to have a genetic or inherited factor that increases their chance of developing rheumatoid arthritis.
How Does Rheumatoid Arthritis Affect the Body?
Once the immune system is triggered, immune cells migrate from the blood into the joints and joint-lining tissue, called synovium. There the immune cells produce inflammatory substances. The increased number of cells and inflammatory substances within the joint cause irritation, wearing down of cartilage (cushioning material at the end of bones), and swelling and inflammation of the joint lining. Inflammation of the joint lining stimulates it to produce excessive joint fluid within the joint.
As the cartilage wears down, the space between the bones narrows. If the condition worsens, the bones could rub against each other.
As the joint lining expands, it may invade into, or erode, the adjacent bone, resulting in irreversible bone damage. All of these factors cause the joint to become very painful, swollen, and warm to the touch.
How Is Rheumatoid Arthritis Diagnosed?
The diagnosis of rheumatoid arthritis is based on a combination of factors, including:
- The specific location and symmetry of painful joints, especially the hand joints.
- The presence of joint stiffness in the morning.
- Presence of bumps and nodules under the skin (rheumatoid nodules).
- Results of X-ray tests that suggest rheumatoid arthritis.
- Positive results of a blood test called the rheumatoid factor.
Most, but not all, people with rheumatoid arthritis have the rheumatoid-factor antibody in their blood. (Rheumatoid factors are actually antibodies that bind other antibodies.) Rheumatoid factor may sometimes be present in people who do not have rheumatoid arthritis. Other diseases can also cause the rheumatoid factor to be produced in the blood. Therefore, the diagnosis of rheumatoid arthritis is based on a combination of the joint symptoms and appearance as well as laboratory information and not just the presence of the rheumatoid factor in the blood.
A newer, more specific blood test for rheumatoid arthritis is the citrulline antibody test. When positive, it is very suggestive of rheumatoid arthritis. Citrulline antibody presence also implies a tendency toward a more aggressive form of rheumatoid arthritis.
People with rheumatoid arthritis may have a mild anemia. Blood tests may also reveal an elevated erythrocyte sedimentation rate (ESR) or elevated C-reactive protein (CRP) levels, which are markers of inflammation.
Some people with rheumatoid arthritis may also have a positive antinuclear antibody test (ANA). This test is indicative of the fact that rheumatoid arthritis is an autoimmune disease.
How Is Rheumatoid Arthritis Treated?
There are many different ways to treat rheumatoid arthritis. Treatments include medications, rest and exercise, 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 severity of the arthritis.
There are many medications available to decrease joint pain, swelling and inflammation. Some of these medications prevent or minimize the progression of the disease.
Medications that offer relief of arthritis symptoms (joint pain, stiffness and swelling) include:
- Anti-inflammatory painkiller drugs, such as aspirin, ibuprofen or naproxen
- Topical (applied directly to the skin) pain relievers
- Corticosteroids, such as prednisone
- Narcotic pain relievers
There are also many strong medications called disease-modifying antirheumatic drugs (DMARDs) that are used to treat rheumatoid arthritis. These medicines usually work by interfering with or suppressing the immune system attack on the joints. They include:
- Plaquenil (originally used to treat malaria)
- Immune suppression drugs such as methotrexate, Imuran, Cytoxan, and cyclosporin
- Biologic treatments, such as Enbrel, Humira, Remicade, Orencia, and Rituxan
- Other drugs, such as Azulfidine and Arava
Why Is Rest and Exercise Important?
A balance of rest and exercise is important in treating rheumatoid arthritis. During flare-ups (worsening of joint inflammation), it is best to rest the joints that are inflamed. This may be accomplished by the temporary use of a cane or joint splints.
When joint inflammation is decreased, guided exercise programs are necessary to maintain flexibility of the joints and to strengthen the muscles that surround the joints. Range-of-motion exercises should be done regularly to maintain joint mobility.
When Is Surgery Necessary?
When joint damage from the arthritis has become severe or pain is not controlled with medications, surgery may be an option to help restore function to a damaged joint.
Can Rheumatoid Arthritis Be Cured?
Although there is not yet a cure for rheumatoid arthritis, early, aggressive treatment has been shown to help prevent disability.
Reviewed by the doctors at The Cleveland Clinic Department of Rheumatic and Immunologic Diseases.