Rheumatoid Arthritis

This group of medications, which includes Aspirin, helps relieve both pain and inflammation if you take the drugs regularly. NSAIDs that are available over the counter include aspirin, ibuprofen (Advil, Motrin, others), and Naproxen Sodium (Aleve). These are available at higher dosages, and other NSAIDs are available by prescription such as Ketoprofen (Oruvail), Naproxen (Anaprox, Naprosyn), Tolmetin (Tolectin), Diclofenac (Arthrotec, Voltaren), Nabumetone (Relafen) and Indomethacin (Indocin). Taking NSAIDs can lead to side effects such as indigestion and stomach bleeding. Other potential side effects may include damage to the liver and kidneys, ringing in your ears (tinnitus), fluid retention, and high blood pressure.

This class of NSAIDs may be less damaging to your stomach. Like other NSAIDs, COX-2 inhibitors celecoxib (Celebrex) and valdecoxib (Bextra) suppress an enzyme called cyclooxygenase (COX) that’s active in joint inflammation. Other types of NSAIDs work against two versions of the COX enzyme that are present in your body: COX-1 and COX-2. However, there’s evidence that by suppressing COX-1, NSAIDs may cause stomach and other problems because COX-1 is the enzyme that protects your stomach lining. Unlike other NSAIDs, COX-2 inhibitors suppress only COX-2, the enzyme involved in inflammation. Side effects may include fluid retention and causing or exacerbating high blood pressure. Some reports indicate that COX-2 inhibitors may be associated with an increased risk of a heart attack. One called Viox has been removed from the market. Talk to your physician about recent findings in this debate.

These medications, such as prednisone (Deltasone) and Methylprednisolone (Medrol), reduce inflammation and pain and slow joint damage. In the short term, corticosteroids can make you feel dramatically better. But when used for many months or years, they may become less effective and cause serious side effects. Side effects may include easy bruising, thinning of bones, cataracts, weight gain, a round face, and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, to gradually taper off the medication.

Physicians prescribe DMARDs to limit the amount of joint damage that occurs in rheumatoid arthritis. Taking these drugs at early stages in the development of rheumatoid arthritis is especially important in the effort to slow the disease and save the joints and other tissues from permanent damage. Because many of these drugs act slowly it may take weeks to months before you notice any benefit  DMARDs typically are used with an NSAID or a corticosteroid. While the NSAID or corticosteroid handles your immediate symptoms and limits inflammation, the DMARD goes to work on the disease itself. Some commonly used DMARDs include Hydroxychloroquine (Plaquenil), the gold compound Auranofin (Ridaura), Sulfasalazine (Azulfidine), and Minocycline (Dynacin, Minocin). Other forms of DMARDs include immunosuppressants and tumor necrosis factor (TNF) blockers.

 These medications act to tame your immune system, which is out of control in rheumatoid arthritis. In addition, some of these drugs attack and eliminate cells that are associated with the disease. Some of the commonly used immunosuppressants include Methotrexate (Rheumatrex), leflunomide (Arava), azathioprine (Imuran), Cyclosporine (Neoral, Sandimmune), and Cyclophosphamide (Cytoxan). These medications can have potentially serious side effects such as increased susceptibility to infection.

These are a class of DMARDs known as biological response modifiers. TNF is a cytokine, or cell protein, that acts as an inflammatory agent in rheumatoid arthritis. TNF blockers, or anti-TNF medications, target or block this cytokine and can help reduce pain, morning stiffness, and tender or swollen joints usually within one or two weeks after treatment begins. There is evidence that TNF blockers may halt the progression of the disease. These medications often are taken with the immunosuppressant methotrexate. TNF blockers approved for the treatment of rheumatoid arthritis are Etanercept (Enbrel), Infliximab (Remicade), and Adalimumab (Humira). If you have an active infection, don’t take these medications.

IL-1Ra is another type of biological response modifier and is a recombinant form of the naturally occurring interleukin-1 receptor antagonist (IL-1Ra). Interleukin-1 (IL-1) is a cell protein that promotes inflammation and occurs in excess amounts in people who have rheumatoid arthritis or other types of inflammatory arthritis. If IL-1 is prevented from binding to its receptor, the inflammatory response decreases.

The first IL-1Ra that has been approved by the Food and Drug Administration for use in people with moderate to severe rheumatoid arthritis who haven’t responded adequately to conventional DMARD therapy is anakinra (Kineret). It may be used alone or in combination with methotrexate. Anakinra is given as a daily self-administered injection under the skin. Some potential side effects include injection site reactions, decreased white blood cell counts, headache, and an increase in upper respiratory infections. There may be a slightly higher rate of respiratory infections in people who have asthma or chronic obstructive pulmonary disease. If you have an active infection, don’t use anakinra.

Some people with arthritis also experience symptoms of depression. The most common antidepressants used for arthritis pain and nonrestorative sleep are Amitriptyline (Elavil), Nortriptyline (Aventyl, Pamelor), and Trazodone (Desyrel).

This blood-filtering technique 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. Some of the side effects include fatigue and a brief increase in joint pain and swelling for the first few days after the treatment. The Prosorba column treatment isn’t recommended if you’re taking angiotensin-converting enzyme (ACE) inhibitors or if you have heart problems, high blood pressure, or blood-clotting problems.

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).

Different types of exercise achieve different goals. Check with your doctor or physical therapist first and then begin a regular exercise program for your specific needs. If you can walk, walking is a good starter exercise. If you can’t walk, try a stationary bicycle with little or no resistance or do hand or arm exercises. A chair exercise program may be helpful. Aquatic exercise is another option, and many health clubs with pools offer such classes.

It’s good to move each joint in its full range of motion every day. As you move, maintain a slow, steady rhythm. Don’t jerk or bounce. Also, remember to breathe. Holding your breath can temporarily deprive your muscles of oxygen and tire them. It’s also important to maintain good posture while you exercise. Avoid exercising tender, injured, or severely inflamed joints. If you feel new joint pain, stop. New pain that lasts more than two hours after you exercise probably means you’ve overdone it. If the pain persists for more than a few days, call your doctor.

Excess weight puts added stress on joints in your back, hips, knees, and feet the places where arthritis pain is commonly felt. Excess weight can also make joint surgery more difficult and risky.

 A healthy diet emphasizing fruit, vegetables, and whole grains can help you control your weight and maintain your overall health, allowing you to deal better with your arthritis. However, there’s no special diet that can be used to treat arthritis. It hasn’t been proven that eating any particular food will make your joint pain or inflammation better or worse.

Heat will help ease your pain, relax tense, painful muscles and increase the regional flow of blood. One of the easiest and most effective ways to apply heat is to take a hot shower or bath for 15 minutes. Other options include using a hot pack, an electric heat pad set on its lowest setting, or a radiant heat lamp with a 250-watt reflector heat bulb to warm specific muscles and joints. If your skin has poor sensation or if you have poor circulation, don’t use heat treatment.

Cold may dull the sensation of pain. Cold also has a numbing effect and decreases muscle spasms. Don’t use cold treatments if you have poor circulation or numbness. Techniques may include using cold packs, soaking the affected joints in cold water, and ice massage.

Hypnosis, guided imagery, deep breathing, and muscle relaxation can all be used to control pain.

By taking medications regularly instead of waiting for the pain to build, you will lessen the overall intensity of your discomfort.