Rheumatoid arthritis is one of the most disabling diseases affecting the elderly population in the western world. This condition makes your joints stiff and swollen. Most people with this condition complain of severe pain. The good news is that there are treatments that can protect your joints and assist you in living a pain free and active life. The following article is designed to discuss the most up to date research to see what treatments are most effective in dealing with this condition. The hope is that this information will give you a starting point to go to your doctor and discuss treatments with him.
What is rheumatoid arthritis?
Those who have rheumatoid arthritis know how painful and swollen joints in the body become. This condition happens as a result of a problem with your immune system, that is the system that fights off infection. The problem in those with this form of arthritis is that as well as fighting off the infection that you want to fight off, your body makes a mistake and also attacks your own joints.
What are the symptoms?
The symptoms that affect those with rheumatoid arthritis are usually slow to come on and get worse over a long period of time. The first thing that some people notice is that their joints begin to feel a little bit stiff, especially in the mornings. The joints that are usually affected first are the small ones, usually in your hands and feet. As time goes on your joints may become stiff and painful. Pain is often worse after you wake up from sleep or if you have been sitting still for a while and get better when you get active and move around. Another thing people notice is that they get swelling in their joints and some people even notice lumps or swellings under their skin. These are usually noticed on the back of your elbows or finger joints and they can be removed via surgery if they cause you problems.
What treatments work?
Fortunately there are a number of treatments that have been proven to be very effective in those with rheumatoid arthritis. It is important to note that there is not one standard treatment and so many people are on a number of medications to help fight off the disease. Also treatment will not cure your arthritis, but it will certainly help with pain and halt the bad effects on your joints. There is strong evidence to suggest that the sooner you start taking the drugs for rheumatoid arthritis, the better your outcome will be. It is most likely that you will have to take these medications for your entire life and so forming good habits early on is very important. Drugs that protect your joints are called disease-modifying drugs. These may in fact take a few months to begin working and so it important to persist with taking them. Most of these drugs are in tablet form and some of the more common ones are:
Methotrexate
Sulfasalazine
Azathioprine
Ciclosporin
Leflunomide
It is quite likely that you will be put on methotrexate or sulfasalazine first. In fact your doctor may suggest that you take several of these disease modifying drugs at the same time, so be aware that this is not unusual. Also note that your doctor may change your treatment over time depending on how well it is going. Unfortunately all of the above medications can have side effects. When you are first prescribed them your doctor will go through these and warn you of what to expect. If you do get bad side effects it is important to visit your doctor and get a check up. As there are a wide range of medications to be on it is likely that changing these medications will be no problem. If you get continued problems despite changing your medications, your doctor may decide to put you on a medication called a tumour necrosis factor antagonist. These are given as injections or on a drip and include:
Etanercept
Infliximab
Adalimumab
Once again your doctor will inform you of side effects that you can expect on these medications. Also low doses of steroids may be used to help reduce the swelling and pain associated with rheumatoid arthritis in the short term. It is important to note that these are not the same steroids that are used by body builders and are similar to chemicals that your body makes naturally. But steroids used for a long time can cause side effects and you will usually be given a low dose for this reason. In fact it is not known if steroids work well if given over a long time period. Rituximab is new treatment that is suitable for people who haven’t been helped by other drugs. They usually give this drug at the same time as methotrexate.
Treatments to help with pain
As mentioned earlier rheumatoid arthritis can be a very painful disease and although some of the above medications can help with pain they are often not enough. For this reason it is important to talk to your doctor about painkillers. Paracetamol can be an effective short term medication for pain but is often not effective over the long term and can be associated with overdose if too much is taken. If you need stronger painkillers then your doctor can prescribe drugs called NSAID’s, these are quite effective as they help with pain and inflammation. Some examples of these medications you may be offered include; diclofenac, ibuprofen and naproxen. If one of these drugs do not work for you then another one might. One of the problems with NSAIDs is that they can cause an upset stomach if taken for a long time and can even cause stomach ulcers. For this reason doctors will often suggest that you take an additional medication that will protect the lining of your stomach from this. Also taking increased doses of NSAID’s regularly for a long time may increase your risk of heart attack and stroke. Therefore it is advisable to only take these drugs when necessary and if pain persists see your doctor.
Things you can do to help yourself
There are things that you can do to help your symptoms as well as taking medications. There are people who find that taking a warm bath or shower may help to relieve their pain and swelling. Sometimes putting ice on a painful joint may relieve pain. Also exercise may help relieve the pain and swelling of yours joints, so long as it is not exercise that stresses your joints. Swimming and cycling are recommended, as they are softer on your joints than running. You may want to consider seeing you physiotherapist to suggest a good exercise regime for you. Some people talk about eating certain foods that they relieve symptoms and although this may be true there is no evidence to suggest that this does work.
What will happen to me?
An important thing to note is that every person with rheumatoid arthritis will experience a very different disease course. For this reason it is very hard to know exactly what will happen to you and when. Some people will suffer very little with symptoms and others will have major problems. But fortunately new treatments out there are helping those with this disease stay mobile and active for longer and consequently live happier and healthier lives. Most people do find that their symptoms become more severe over time and sometimes they can flare up and become more painful. About 1 in every 20 people will get more severe damage to their joints, which can make everyday tasks very difficult. Many find having arthritis a scary thing, however treatments today can really make a big difference so it is worth persisting with medication schedules. If pain does get worse don’t hesitate to contact your doctor, as there are often extra treatments that will help. Support is certainly important, so share your experiences with your friends and family and join one of the many support groups out there for those with rheumatoid arthritis.
