Rheumatoid Arthritis
Alternate Names : RA
What are the treatments for the disease?
People who have RA should learn all they can about self-care and
managing their disease. There are many treatment approaches.
Overview
Early treatment is the key. Effective self-management of RA
will focus on the following goals:
relieve pain
decrease inflammation in the joints
slow down or stop damage to the joints
improve joint function and ability to do daily activities
increase feelings of general well-being
Specific self-care measures may include:
managing one's stress
applying splints to rest acutely inflamed joints
using assistive devices, such as zipper pulls, to decrease strain on joints
Medicine
Symptom control and disease management may be
enhanced when medicines are started early in treatment. A wide variety
of highly effective medicines are used to treat RA. Most fall into one of two
groups, including medicines that relieve symptoms and medicines that actually
modify the disease process. These two types of medicines are sometimes
used in combination. Examples of medicines that relieve symptoms
include:
anti-inflammatory medicines, called NSAIDs, such as aspirin,
naproxen, and ibuprofen
COX-2 specific inhibitor NSAIDs, such as celecoxib and rofecoxib
corticosteroids, such as prednisone, which can be taken orally or
by injection into the joint
analgesics, such as acetaminophen or propoxyphene
Examples of medicines that modify disease include:
immunosuppressant medicines, which alter the body's immune
response, such as methotrexate, azathioprine, and cyclophosphamide
anti-inflammatory medicines, such as infliximab and etanercept, which
block the effects of a key protein involved in the rheumatoid process
antibiotics, such as doxycycline and minocycline
medicines that slow down joint destruction, such as d-penicillamine,
sulfasalazine, hydroxychloroquine, and gold
Diet and Nutrition
All people should be sure to eat a healthy diet, following
the food guide pyramid.
It's important to get the right amount of calories,
protein,
and calcium.
The findings of some studies have shown that symptoms
of RA improve with high doses of omega-3 fatty acids. These substances
occur naturally in certain fish and in some plant seeds. However,
it is hard to get enough of these acids to affect the disease, and some
people cannot tolerate the high doses.
There has been a great deal of interest in the last few years in the use of
glucosamine and chondroitin, dietary supplements that may decrease
the joint pain
linked with another form of arthritis called osteoarthritis. People who have RA
should discuss the value of such supplements with their doctors
before taking them.
Exercise
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.
Strengthening exercises can be done with light weights or a resistance
band. The goal is to build strength and tone in the muscles
around the joints affected by RA, rather than to build big muscles. Improving
muscle strength and tone can help protect the joint and prevent further joint
damage. Most people with RA should talk with a doctor or physical
therapist to set up a program that is right for him or her.
Stretching exercises will help maintain flexibility and should be done
each day. They can be done while lying in bed or in various positions or at
different times during the day.
Surgery
Surgery may be performed when pain cannot be controlled or
when significant function is lost. Several types of surgery may be done, such as:
arthroscopy,
a procedure that uses a small scope and instruments to get inside the joint
without opening it
arthrotomy, which means opening the joint through a larger incision
synovectomy, which is the removal of the lining of the joint
osteotomy, which realigns the bone next to the joint
arthroplasty, which is the partial or total replacement of the joint. People
with severe arthritis are often candidates for a knee joint replacement
or a hip joint replacement.
Prosorba Therapy
The Food and Drug Administration has approved a
blood-filtering treatment called Prosorba for moderate to severe cases of
RA that have not responded well to disease-modifying medicines.
In this procedure, blood is drawn from the arm and then separated
into two different parts called the plasma and the red blood cells.
Next, the plasma is filtered through a
special cylinder the size of a soup can that is filled with a sandlike substance.
This is called a Prosorba column, and the filtering sand in it is coated with
protein A, which removes certain antibodies from the plasma. These
antibodies contribute to pain and inflammation in the joints. The plasma is
then combined again with the red blood cells and put back into the
person's body.
Therapy is given once a week for 12 weeks as an outpatient
procedure. Each session lasts 2 to 2.5 hours. This therapy can bring
remission from RA symptoms, but it will take up to 12 to 16 weeks before the
person begins to feel the benefits. Once remission is reached, it may last
as long as a year and a half.
What are the side effects of the treatments?
Medicines used to treat RA may cause
stomach upset or bleeding , allergic reaction,
less resistance to infection, and other side effects. Surgery may
cause bleeding, infection, or allergic reaction
to anesthesia.
Nearby bones, ligaments, tendons, nerves, or blood vessels can also be
injured by accident.
What happens after treatment for the disease?
Treatment of RA is lifelong. There is no cure
for the disease, but careful management can help to reduce some of its
effects.
How is the disease monitored?
A doctor will watch the person's level of
comfort and function of the joint. Any new or worsening symptoms
should be reported to the doctor.
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