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What's the treatment for rheumatoid arthritis?
Many of the treatments used in the various rheumatic diseases are similar, and it is helpful to understand what they do. The treatment of arthritis includes the use of non-drug treatment such as rest and physiotherapy , but drugs may also be required both to control symptoms and to slow down the progression of the disease. This is important, because the longer
the disease persists, the more the joints get damaged. Once damaged, they heal very poorly, so it is vital to prevent the damage occurring.
The first line of treatment of any arthritis is usually anti-inflammatory tablets. Many types are available, and frequently this is enough to manage the disease. If the disease gets worse, other drugs such as gold, methotrexate and steroids ("second line drugs") may be used.These are well-established treatments for arthritis, but new treatments are constantly being developed. In addition, many alternative or complementary therapies are propounded as being effective in arthritis. Finally, surgery is an option where a joint is badly damaged and painful.
Pharmacological treatment of RA can be divided into disease-modifying agents of rheumatoid disease (DMARDs), anti-inflammatory agents and analgesics. DMARDs have been found to produce durable remissions and delay or halt disease progression. This is not true of anti-inflammatories and analgesics. DMARDs can be further subdivided into xenobiotic agents and biological agents. Xenobiotic agents are those DMARDs that do not occur naturally in the body, as opposed to biologicals. The most important and most common adverse events relate to liver and bone marrow toxicity (MTX, SSZ, leflunomide, azathioprine, gold compounds, D-penicillamine), renal toxicity (cyclosporine A, parenteral gold salts, D-penicillamine), pneumonitis (MTX), allergic skin reactions (gold compounds, SSZ), autoimmunity (D-penicillamine, SSZ, minocycline) and infections (azathioprine, cyclosporine A). Hydroxychloroquine may cause ocular toxicity.
Nonsteroidal anti-inflammatory agents and aspirin are used to decrease inflammation and to treat pain. While these medications can be helpful, they do not interrupt the progress of the disease. Low-dose steroid medications can be helpful at both managing symptoms and slowing the progress of RA, as well as other drugs called disease-modifying antirheumatic drugs. These include gold compounds, D-penicillamine, antimalarial drugs, and sulfasalazine. Methotrexate, azathioprine, and cyclophosphamide are all drugs that suppress the immune system and can decrease inflammation. All of the drugs listed have significant toxic side effects, which require healthcare professionals to carefully compare the risks associated with these medications versus the benefits.
Sometimes, corticosteroids such as prednisone, can be taken orally or injected directly into the joint to quickly stop the inflammation. Corticosteroids are never used for more than a few days to avoid side effects. When over-the-counter drugs are not effective or the disease is progressing very rapidly, drugs such as gold compounds, D-penicillamine, antimalarial drugs, and sulfasalazine might be used. Gold compounds can slow the formation of bone deformities, and are usually injected directly into the joint. Or, a drug that actually suppresses the immune system might be prescribed. These include methotrexate, azathioprine, and cyclophosphamide.
Exercise is a key strategy in the treatment of arthritis, but the person with RA needs to be careful to balance exercise and rest to conserve energy. The exercise program should consist of a combination of aerobic exercise, strengthening (joint protection) exercises, and flexibility (or stretching) exercises. For aerobic exercise, 30 minutes of moderate exercise a day can help prevent complications of arthritis, as well as heart disease, stroke, and diabetes. Exercise should be kept to a level where the person can talk without shortness of breath and is comfortable with the pace of the activity. The 30 minutes a day can be done in one session or broken up into several shorter segments. Walking and water aerobics are exercises that keep joint stress to a minimum. Stretching exercises and corticosteroid injections also can reduce pain. Steroidal injections lose their effectiveness after three injections, however, after which their usage can become detrimental.
Occasionally, surgery is performed for severely affected joints. Prosorba column removes certain antibodies that contribute to pain and inflammation in your joints and muscles and is usually performed once a week for 12 weeks as an outpatient procedure. For many people with rheumatoid arthritis, medicines and therapies can't prevent joint destruction. When joints are severely damaged, joint replacement surgery can often help restore joint function, reduce pain or correct a deformity. You may need to have an entire joint replaced with a metal or plastic prosthesis. Surgery may also involve tightening tendons that are too loose, loosening tendons that are too tight, fusing bones to reduce pain or removing part of a diseased bone to improve mobility. Your doctor may also remove the inflamed joint lining (synovectomy).
Low level laser therapy employs pure light with a single wave length. It does not heat the body but it produces certain chemical responses. It is being investigated for rheumatoid arthritis, and, according to a major analysis of the evidence, it appears to reduce pain and morning stiffness. However, the technique has not yet been standardized, and it is not clear which factors produce benefits.
The Prosorba column is a device approved by the FDA in 1999 for the treatment of moderate to severe RA in adults with long-standing disease (who have not responded to DMARD's). It works by removing inflammatory antibodies from the blood. The blood is removed through a small catheter and then passed through a column that binds the antibodies and removes them from the blood. The blood is then given back. The procedure takes 2-3 hours, and must be done once a week for 12 weeks. Studies have reported that one third to one half of the people who receive this treatment may slow down, or even stop, the RA from worsening. Side effects include anemia, fatigue, fever, low blood pressure, and nausea. Some people have developed an infection from the catheter. Often there is a flare-up of joint pain for several days after the treatment.
More information on rheumatoid arthritis and other arthritis conditions (osteoarthritis, septic arthritis, psoriatic arthritis, Reiter's syndrome, ankylosing spondylitis, gout)
What is rheumatoid arthritis? - Rheumatoid arthritis (RA) is an autoimmune disorder that marked by stiffness and inflammation of the joints, weakness, loss of mobility, and deformity.
What causes rheumatoid arthritis? - The cause of rheumatoid arthritis (RA) is unknown. Rheumatoid arthritis involves an attack on the body by its own immune cells (auto-immune disease).
What're the symptoms of rheumatoid arthritis? - The symptoms that distinguish rheumatoid arthritis are inflammation and soft-tissue swelling of many joints at the same time (polyarthritis).
How is rheumatoid arthritis diagnosed? - Health professionals diagnose rheumatoid arthritis by examining joints and evaluating ymptoms, medical history, and results of several tests.
What's the treatment for rheumatoid arthritis? - The treatment of rheumatoid arthritis includes the use of non-drug treatment such as rest and physiotherapy, drugs may be required both to control symptoms of the disease.
What rheumatoid arthritis medications are available? - Rheumatoid arthritis medications include nonsteroidal anti-inflammatory drugs, injectable gold salts, plaquenil or hydroxychloroquine.
What rheumatoid arthritis diet is suggested? - Certain vitamin supplements may be beneficial. Many herbs also are useful in the treatment of rheumatoid arthritis.
What is juvenile rheumatoid arthritis? - Juvenile rheumatoid arthritis (JRA) is a form of arthritis in children ages 16 or younger that causes inflammation and stiffness of joints for more than six weeks.
What causes juvenile rheumatoid arthritis? - Juvenile rheumatoid arthritis is an autoimmune disorder. Juvenile rheumatoid arthritis is considered to be a multifactorial condition.
What're the symptoms of juvenile rheumatoid arthritis? - Symptoms of juvenile rheumatoid arthritis may appear during episodes (flare-ups) or may be chronic and continuous.
How is juvenile rheumatoid arthritis diagnosed? - Diagnosis of juvenile rheumatoid arthritis is often made on the basis of the child's collection of symptoms.
What're the treatments for juvenile rheumatoid arthritis? - The treatment of juvenile rheumatoid arthritis centers on decreasing joint inflammation, suppressing pain, and preserving movement.
What is osteoarthritis? - Osteoarthritis (OA), also known as arthrosis or degenerative joint disease, is a disease featuring pain and impaired function of the joints.
What causes osteoarthritis? - Primary osteoarthritis is mostly related to aging. Osteoarthritis results from a combination of genetic predisposition and joint injuries.
What're the risk factors for osteoarthritis? - Risk factors for osteoarthritis are congenital hip luxation, obesity, osteoporosis, and inflammatory diseases.
What're the complications of osteoarthritis? - The major complication of osteoarthritis is pain. The degree of pain can vary greatly. Osteoarthritis itself is not life threatening.
What are symptoms of osteoarthritis? - The main symptoms of osteoarthritis are is pain that worsens during activity and that gets better during rest.
How is osteoarthritis diagnosed? - The doctor makes the diagnosis of osteoarthritis based on the characteristic symptoms, physical examination, and the x-ray appearance of joints.
What's the treatment for osteoarthritis? - Osteoarthritis is treated with nonsteroidal anti-inflammatory drugs. Severe pain in specific joints can be treated with local injections with lidocaine.
What're the medications for osteoarthritis? - Acetaminophen is used for mild to moderate osteoarthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs) or COX-2 medications for moderate to severe arthritic pain.
What nutritional supplements cure osteoarthritis? - A combination of glucosamine and chondroitin sulfate is used as a dietary supplement to cure osteoarthritis. Vitamin D and calcium are recommended for strong bones.
Treatments for osteoarthritis pain relief - OTC pain relievers like acetaminophen (Tylenol) and aspirin are familiar choices for the treatment of osteoarthritis pain relief.
What osteoarthritis exercise is suggested? - Regular exercise is very important for successful control of osteoarthritis. Exercise helps patients ostearthritis in the hip or in the knee.
Can osteoarthritis be prevented? - Obese people are at risk of osteoarthritis and that weight loss can help prevent or delay osteoarthritis from occurring.
What is osteoarthritis of the hip? - Osteoarthritis of the hip can cause insidious pain in the groin or inguinal region and, on occasion, pain in the side of the buttock or upper thigh.
What is arthritis? - Arthritis is a group of conditions that affect the health of the bone joints in the body. Arthritis is painful inflammation of a joint or joints of the body.
What types of arthritis are there? - Types of arthritis include osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, gout, infectious arthritis, fibromyalgia, lupus.
What causes arthritis? - The causes of arthritis depend on the form of arthritis. The cause of arthritis may be an infection, injury, abnormality of the immune system, aging.
What're the risk factors for arthritis? - Risk factors for arthritis include age, gender, obesity, injury, ethnicity. The risk of developing arthritis increases with age.
What're the signs and symptoms of arthritis? - Different types of arthritis have different symptoms. Other arthritis symptoms include fatigue, fever, a rash and the signs of joint inflammation.
How is arthritis diagnosed? - The diagnosis of arthritis is based on the pattern of symptoms, medical history, family history, physical examination, X-rays and lab tests.
What's the treatment for arthritis? - The objectives in the treatment of arthritis are controlling inflammation, preserving joint function, and curing the disease if that is possible.
Therapies for arthritis pain relief - Short-term relief for arthritis pain and inflammation may include pain relievers. NSAIDs are used to reduce pain and inflammation.
What natural therapies are available to cure arthritis? - Natural therapies for arthritis pain relief include glucosamine, chondroitin sulfates, nettle leaf, S-adenosylmethionine, and exrutine.
What can be done to prevent arthritis? - Consumption of green tea may prevent arthritis damage and benefit the arthritis patient by reducing inflammation and slowing cartilage breakdown.
What is the Arthritis Foundation? - The Arthritis Foundation is the only nationwide, nonprofit health organization helping take greater control of arthritis in the United States.
What is septic arthritis (infectious arthritis)? - Septic arthritis, also known as infectious arthritis or pyogenic arthritis, is an infection in the joint (synovial) fluid and joint tissues.
What causes septic arthritis? - Septic arthritis develops when bacteria spread from a source of infection through the bloodstream to a joint or the joint is directly infected by traumatic penetration.
What're the symptoms of septic arthritis? - The symptoms of septic arthritis (infectious arthritis) include swelling in the infected joint and pain when the joint is moved.
How is septic arthritis diagnosed? - The diagnosis of infectious arthritis depends on a combination of laboratory testing with careful history-taking and physical examination of the affected joint.
What is the treatment for septic arthritis? - The goal of treatment for septic arthritis is to eliminate the infection with antibiotic therapy. Septic arthritis requires immediate treatment.
What is psoriatic arthritis? - Psoriatic arthritis is a chronic inflammation of the joints that occurs in some people with a chronic skin and nail condition known as psoriasis.
What causes psoriatic arthritis? - The cause of psoriatic arthritis is unknown. Psoriatic is triggered by an attack of the body's own immune system on itself.
What're the symptoms of psoriatic arthritis? - Symptoms of psoriatic arthritis include dry, scaly, silver patches of skin combined with joint pain and destructive changes in the feet, hands, knees, and spine
How is psoriatic arthritis diagnosed? - The diagnosis of psoriatic arthritis is made by identifying the typical symptoms of arthritis in a person with psoriasis.
What's the treatment for psoriatic arthritis? - Treatment of psoriatic arthritis focuses on controlling the skin rash and relieving joint inflammation.
What is Reiter's syndrome (reactive arthritis)? - Reiter's syndrome (reactive arthritis) is a group of symptoms consisting of arthritis, urethritis, conjunctivitis, and lesions of the skin.
What causes Reiter's syndrome (reactive arthritis)? - Reiter's syndrome appears to be a reaction to an infection that begins in an area of the body other than the joints.
What're the symptoms of Reiter's syndrome? - The symptoms of of Reiter's syndrome appear within days or weeks of infection followed by a low-grade fever, conjunctivitis.
How is Reiter's syndrome diagnosed? - Diagnosis of Reiter's syndrome is often difficult because there is no specific test to confirm that a person has reactive arthritis.
What's the treatment for Reiter's syndrome? - The objective of treatment for Reiter's syndrome is to alleviate the symptoms associated with the syndrome and to treat any underlying infection.
What is ankylosing spondylitis? - Ankylosing spondylitis is a chronic inflammatory disease that affects the joints between the vertebrae of the spine, and the joints between the spine and the pelvis.
What causes ankylosing spondylitis? - The specific cause of ankylosing spondylitis is unknown, but the disease tends to run in families, indicating that genetics plays a role.
What're the symptoms of ankylosing spondylitis? - Symptoms of ankylosing spondylitis include back pain, loss of appetite, weight loss, fatigue, and anemia.
How is ankylosing spondylitis diagnosed? - Doctors usually diagnose ankylosing spondylitis simply by the patient's report of pain and stiffness.
What's the treatment for ankylosing spondylitis? - Physical therapy for ankylosing spondylitis can provide a number of benefits, from pain relief to improved physical strength and flexibility.
What is gout (gouty arthritis)? - Gout or gouty arthritis is a form of arthritis caused by the accumulation of uric acid crystals (due to hyperuricemia) in joints.
What causes gout (gouty arthritis)? - Gout is caused by a defect in metabolism which results in an overproduction of uric acid or leads to reduced ability of the kidney to eliminate uric acid.
What are the risk factors for gout? - Risk factors for gout (gouty arthritis) include genetics, age, gender, alcohol use, obesity, medications, and medical conditions.
What're the complications of gout? - Gout often accompanies heart problems, including high blood pressure, coronary artery disease, and congestive heart failure.
What are the symptoms of gout (gouty arthritis)? - An attack of chronic gout is similar to an attack of acute gouty arthritis. The affected joints show signs of warmth, redness, and tenderness.
How is gout diagnosed? - The diagnosis of gout is generally made on a clinical basis. Physicians can diagnose gout based on the physical examination and medical history.
What's the treatment for gout (gouty arthritis)? - The goals of treatment for gout consist of alleviating pain, avoiding severe attacks in the future, and preventing long-term joint damage.
What gout medications are available? - Gout medications include nonsteroidal anti-inflammatory drugs, colchicine, corticosteroids, xanthine oxidase inhibitors, uricosuric agents.
What gout diet is suggested? - The principle of a gout diet is to reduce purines or lower uric acid when we take food. Avoid foods high in purines. Alcohol should be avoided.
How to prevent gout (gouty arthritis)? - Prevention is the best defense against gout (gouty arthritis). Losing weight and limiting alcohol intake can help ward off gout.