Barry Fox - Arthritis For Dummies

Treatment begins with immunosuppressive medications. Not all people respond to the same medicines, so there may be some trial and error while you and your provider find the treatment that works for you and your RA. Sometimes, surgery is needed for permanent deformity, but the goal is to get RA under control before you get to that point. While RA is considered a chronic, lifelong condition, our current treatments can bring about dramatic improvements in the signs and symptoms of the disease.

Resting the affected joints during a flare is a must, because using them tends to increase inflammation. Regular rest periods should be worked into the daily schedule, and at times, total bed rest may be necessary during a flare. Immobilizing a severely affected joint with a splint may help, but the joint should be moved from time to time to keep it from locking up. You may want to wear a splint during the most active times of the day, and take it off during the least active times — for example, 12 hours on and 12 hours off.

Mental outlook appears to affect RA symptoms. Stress tends to make flares worse, whereas a positive outlook can help keep complications at bay.

What you do and don’t eat can make a difference to the arthritis disease process and how much pain you feel. Because many forms of arthritis and arthritis-related conditions involve inflammation, eating foods that help reduce the inflammation response (like fatty fish and fish oil) may make a positive difference. Eating plenty of fruits, vegetables, and whole grains supplies ample amounts of antioxidants like vitamins C and E and selenium, which can fight the cellular damage that contributes to arthritis. (See Chapter 11to find out more about how what you eat may affect how you feel.)

A good overall exercise program helps strengthen joint-supporting structures, increases endurance, and maintains or improves flexibility. Even inflamed joints should be exercised a little to prevent them from freezing up. A physical therapist can provide exercises that gently take the joints through their full range of movement. Exercising in water, especially during flares, may be easier than exercising on land, because it’s low impact and the cool water may help ease inflammation. (See Chapter 12.)

Not only do you make your mom happy when you stand up straight, but you reduce the pressure on your joints. Maintaining proper posture while walking, standing, and sitting can go a long way toward easing joint stress. And understanding how to lift or move heavy objects correctly is also a must. (See Chapter 13.)

Applying hot or cold packs to inflamed joints may ease the pain and help reduce inflammation. Use heat to ease sore muscles and increase circulation, and try cold to dull the pain and reduce inflammation. (See Chapter 10.)

Many drugs can be used to combat RA symptoms. The following subsections give you the details on the five types of medication commonly prescribed.

NSAIDs (pronounced n-seds) reduce swelling, relieve pain, and are the most commonly used drugs for pain management in RA. While these medicines can help with symptom control, they do not prevent disease progression or stop the immune attack on the joints. Therefore, they should never be the only treatment for your RA.

Ibuprofen (Advil) and naproxen (Aleve) are two well-known over-the-counter NSAIDs, but prescription NSAIDs such as celecoxib (Celebrex) may be preferred because they come in higher doses (which means you take fewer pills) and have longer-lasting results.

As with all drugs, certain side effects can occur when taking NSAIDs, including upset stomach, nausea, diarrhea, stomach ulcers, and stomach bleeding. Take this type of medication with food to prevent these reactions. However, if you have kidney disease, high bleeding risk, or heart disease, NSAIDs many not be a good choice. Discuss them with your provider first.

DMARDs are first-line treatments for RA that turn off a part of the immune system that is overactive in RA, addressing the problem at the source. They can alter the course of the disease by reducing inflammation and joint damage, while preserving joint function. DMARDs often used to treat RA include methotrexate, sulfasalazine, hydroxychloroquine, and leflunomide. Some DMARDs are also used to treat autoimmune diseases such as lupus.

DMARDs are also known as remittive drugs and slow-acting drugs. They’re called slow acting because you may not see results for 8 to 12 weeks.

These drugs may influence the immune system — whose errant behavior can lead to RA — to slow the formation of joint deformities, affect cell growth, or otherwise lessen the progress of RA. They can even send the disease into remission, at least temporarily.

Typically DMARDs are used for life, although the dose may be reduced once the disease has been in remission for a while. Potential side effects of DMARDs include increased infections, gastrointestinal distress (diarrhea, loss of appetite, vomiting, and so on), liver problems, rashes, and blood cell disorders.

Biologics are proteins that are genetically engineered to target specific parts of the immune system that affect inflammation. Each one zeroes in on a particular cause of inflammation and either tamps it down or turns it off completely, or shores up certain immune system components that fight inflammation. Biologics can slow joint damage significantly or actually bring it to a halt.

While they can be used alone, all of them work better in combination with DMARDs such as methotrexate. Two biologics should not be used together. Biologics are quite expensive because they must either be injected or infused. Generally speaking, they take about three months to start working, although some people start to feel better sooner.

Many different types of biologics exist:

Tumor necrosis factor (TNF) inhibitors (Humira, Enbrel, Simponi, Cimzia, Remicade): All but Remicade are injections given anywhere from once a week to once a month; Remicade is an infusion. Since they have been around the longest, these are typically the first type of biologic used when DMARDs alone fail to provide adequate relief.When TNF inhibitiors fail, there are several other types of biologics that can be tried next. Which drug is chosen will depend on the patient’s health, personal preferences, and insurance coverage.

B-cell inhibitors (Rituxan): One treatment (two infusions given two weeks apart every four to six months) may provide relief of RA symptoms.

Interleukin-1 (IL-1) inhibitors (Kineret): A daily injection.

Selective co-stimulation modulators (Orencia): A once a month injection thought to have the lowest risk of infection.