Barry Fox - Arthritis For Dummies

Interleukin-6 (IL-6) inhibitors (Actemra, Kevzara): Injection given every one to two weeks. There is also an infusion version of Actemra.

Janus kinase (JAK) inhibitors (Rinvoq, Xeljanz): Pills taken 1 to 2 times daily.

Suppressing the immune system increases your risk of developing infections. Since each biologic partially disables an “arm” of the immune system, you will become more susceptible to certain infections when taking these drugs. For example, the TNF inhibitor biologics can increase your risk of tuberculosis and fungal infections. B-cell inhibitors can cause chest pain, difficulty breathing and flu-like symptoms, and increase your susceptibility to colds and sinus infections. Interleukin inhibitors can cause bowel perforation in rare instances. And selective co-stimulation modulators can contribute to pneumonia, tuberculosis and flu. Ask your doctor about these risks before taking biologics.

Steroids, which are technically called corticosteroids or glucocorticoids and include the drugs prednisone, hydrocortisone and dexamethasone, are powerful weapons against inflammation. They work by suppressing the immune system, which brings about the inflammation seen in RA. Although often prescribed in pill form, steriods can also be injected into the RA-affected joints to relieve pain and swelling. While the relief can be dramatic, unfortunately it doesn’t last, and the long term side effects and consequences of chronic steroid use are numerous.

Steroids are “souped-up” versions of cortisone, the body’s natural immune suppressor. Because they act quickly to reduce inflammation and suppress flare-ups, they may be prescribed during early RA in addition to DMARDs and/or other medications which can take weeks or months to produce results. However the routine use of steroids to treat RA, even in early stages, is not recommended because of severe side effects. Steroids are typically reserved for severe cases and used for only short periods of time. Once the DMARDs or other drugs take effect, steroid therapy must be tapered off.

Side effects include high blood pressure, osteoporosis, increased blood glucose, cataracts, accelerated atherosclerosis (clogged arteries), weight gain, bruising and thinning of the skin, and a substantially increased risk of infections.

If you suddenly stop taking steroids, you may suffer from pain, swelling, critical illness, or even death due to adrenal crisis. Always taper off your use of these drugs.

When all else fails and RA becomes severe or disabling, surgery may be an option. Surgeons have different approaches to relieving the symptoms. Some of the approaches are included in the following list:

Diseased joint linings can be surgically removed.

Joint replacement can correct deformities and ease pain.

Fusing or removing joints in the foot may relieve the pain experienced when walking.

Fusing vertebrae in the neck may prevent spinal cord compression.

Fusing of the thumb joint can aid in grasping.

Repairing ruptured tendons can re-enable movement of fingers.

Other sophisticated surgical techniques on the horizon may ensure a healthier and less painful future for RA sufferers who already have permanent deformities.

Many studies have shown that the risk of coronary artery disease is much higher in patients with RA. This is most likely because the chronic inflammation caused by RA speeds up the progression of atherosclerosis, the main cause of heart attack and stroke. Those with RA are also more likely to be smokers and to have high blood pressure, metabolic syndrome, obesity, and abnormal lipid levels than the general population. Most rheumatologists recommend that their RA patients exercise, watch their weight, eat a nutritious diet, keep their cholesterol and blood pressure under control, and stop smoking as part of their routine care. Check out Preventing & Reversing Heart Disease For Dummies (Wiley) to find out more.

Predicting how a person with RA will fare is difficult; after all everyone is different. But certain factors can suggest that the course of the disease may be either easier or more difficult. For example, RA may be less severe if one or more of the following factors applies to you:

You’re female. Women are more likely to get RA; however the disease often takes a greater toll on men.

You have a college degree or better. Educated people tend to seek help earlier, are more likely to follow doctor’s orders to the letter, often have less physically strenuous jobs, and have better access to care.

You’re middle-aged or older when stricken.

You are diagnosed and treated as soon as possible. Studies confirm a “window of opportunity” in RA whereby people who are treated sooner and get the disease under control faster do better in the long run.

Your cartilage and bone ends have not been worn away, and you don’t yet have joint deformities.

You don’t have rheumatoid nodules.

Your level of rheumatoid factor is low and/or your anti-CCP test is negative. Remember, however, that some people who have little or no rheumatoid factor still suffer severely.

You don’t smoke. Smoking has been linked to more aggressive destruction of the joints.

You’re pregnant. Some women enjoy a nine-month period of time with fewer symptoms.

Today, rheumatoid arthritis rarely manifests as the crippling, deforming disease of just a few years ago. Researchers in genetics and immunology are constantly uncovering new and fascinating parts of this puzzle, and many new, highly effective drugs have been introduced to treat RA over the past 20 years. Great strides have also been made in surgical techniques, enabling surgeons to offer hope to those with deformed, painful joints. Through our rapidly expanding arsenal of knowledge, our medications, certain lifestyle changes, and new surgical techniques, we should soon be able to tame, if not conquer, the beast known as rheumatoid arthritis.

RA and OA have two things in common: namely joint pain and damage to certain joint structures, such as the cartilage and the bone. Other than that, they’re about as different as night and day. Table 3-1outlines the differences between RA and osteoarthritis.

TABLE 3-1Rheumatoid Arthritis Compared to Osteoarthritis

Chapter 4