Rheumatoid arthritis

Alternative names:

RA

Treatment:

OVERVIEW:
RA usually requires lifelong treatment. There is no cure for RA. The treatment includes various medications, physical therapy, education, and possibly surgery aimed at relieving the signs and symptoms of the disease.

MEDICATIONS:
Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, fenoprofen, indomethacin, naproxen, and others are effective in relieving pain and inflammation associated with RA and are widely used. Side effects are associated with may of these medications and they are best tolerated when taken with food.

Corticosteroids can also be used to reduce inflammation. However, because of potential side-effects (for example, Cushing's syndrome) corticosteroid use is limited to short courses when other therapies fail. Side effects may include, bruising, thinning of the bones (osteoporosis), cataracts, weight gain, a round face, susceptibility to infections, diabetes, and high blood pressure. CONSULT YOUR HEALTH CARE PROVIDER BEFORE LONG-TERM USE OF ANY MEDICATION, INCLUDING OVER-THE-COUNTER MEDICATIONS.

Another group of medications appears to alter the course of the disease. Included in this group are gold compounds, which can be either injectible (Myochrysine and Solganal) or oral (auranofin ( Ridaura)), D-penicillamine, antimalarial medications, and neoplastic drugs, especially methotrexate (Rheumatrex). The benefit from these medications may take weeks or months to be apparent. They are associated with toxic side effects and consistent monitoring while on these medications is necessary.

Drugs that suppress new cell growth and suppress the immune system, azathioprine (Imuran) and cyclophosphamide (Cytoxan), may be used in people who have failed other therapies. These medications are associated with toxic side effects.

SURGERY:
Occasionally, surgery is indicated for severely affected joints. The most successful surgeries are those on the knees and hips. Usually, the first surgical treatment is removal of the synovium. A later alternative is total joint replacement with a joint prosthesis or an arthroplasty.

Surgeries can be expected to relieve joint pain, correct deformities, and modestly improve joint function. In extreme cases, total knee or hip replacement can mean the difference between being totally dependent on others and having an independent life at home.

LIFESTYLE CHANGES:
Range of motion exercises and individualized exercise programs prescribed by a physical therapist can delay the loss of joint function.

Joint protection techniques, heat and cold treatments, and splints or orthotic devices to support and align joints may be very helpful.

Frequent rest periods between activities as well as 8 to 10 hours of sleep per night are recommended.

OTHER THERAPY:
Sometimes therapists will use special machines to apply deep heat or electrical stimulation to reduce pain and improve joint mobility.

Occupational therapists can construct splints for your hand and wrist and teach you how to best protect and use your joints when they are affected by arthritis. They also show people how to better cope with day-to-day tasks at work and at home, despite limitations that may be caused by RA.

MONITORING:
Depending on the medications being taken, regular blood or urine tests should be done to monitor both progress and negative side effects.

Support groups:

The stress of illness can often be helped by joining a support group where members share common experiences and problems. See arthritis - support group.

Expectations (prognosis):

Frequently, the disease can be controlled by using a combination of treatments. Other times surgery may be needed, and on occasion a significant amount of relief is not found.

The course of the disease varies. People with high titers of rheumatoid factor or subcutaneous nodules seem to have more severe cases of the disease. Remission is most likely to occur in the first year.

After having the disease for 10 to 15 years, about 20 percent of people will have had remission. Fifty to 70% will remain capable of full-time employment. After 15 to 20 years, only 10 percent of victims are invalids.

The average life expectancy may be shortened by 3 to 7 years with this disease. Factors contributing to death may be infection, gastrointestinal bleeding, and drug side effects.

Complications:

Rheumatoid vasculitis (inflammation of the blood vessels) is the most serious complication of RA and can be life threatening. It can lead to skin ulcerations, bleeding intestinal ulcers and neuropathies. Skin rashes, Raynaud's phenomenon, and massive hemorrhage may also result from vasculitis.

Severe disability sometimes results and some infections are more prevalent.

Medications sometimes cause gastrointestinal bleeding.

Calling your health care provider:

Call for an appointment with your health care provider if you have symptoms of rheumatoid arthritis.