Living With Rheumatoid Arthritis
By: Kristy Haugen
Rheumatoid arthritis is the second most common form of arthritis. Rheumatoid arthritis affects about 1% or 2.1 million Americans. However, rheumatoid arthritis is 2-3 times more common in women than in men.
Rheumatoid arthritis is another common type of arthritis. Rheumatoid arthritis is an autoimmune disease that affects different joints of the body as well as the heart, lungs, and blood. This type of disorder develops when the body’s immune system begins attacking the synovium. The synovium is the lining within the joint that produces a thick lubricating fluid that nourishes the joint. Inflammation of the synovium causes pain, stiffness, warmth, and redness in the joint. The joint may become misshapen resulting in abnormal movement and mobility of the joint.
Common symptoms of rheumatoid arthritis include joint stiffness, decreased joint mobility, warmth, redness, fatigue, joint tenderness, occasional fever, pain, and general malaise (not feeling well). Rheumatoid arthritis has a characteristic “symmetrical pattern†of inflammation affecting the joint bilaterally. Rheumatoid arthritis can affect children (juvenile rheumatoid arthritis) but is more likely seen in people between the ages of 20-50. Women are more likely than men (2-3 times) to contract this disorder. Currently there is no cure for rheumatoid arthritis but treatments exist focusing on pain reduction, prevention of deformities, improvement of joint mobility, and to maintain a productive life.
NSAID’s or non-steroidal anti-inflammatory drugs such as aspirin, naproxen, and ibuprofen are over the counter pain medications used to treat rheumatoid arthritis pain. NSAID’s inhibit prostaglandin synthesis. Prostaglandins are hormone like substances that mediate pain and inflammation. NSAID’s are effective agents at reducing acute inflammation which decreases pain and improves function.
However, NSAID’s raise a concern regarding gastrointestinal irritation which in severe cases may cause ulceration and bleeding. NSAID’s do affect the body’s blood clotting ability and can interfere with kidney function. NSAID’s should always be taken with food to decrease stomach irritation or upset. Do not drink alcohol while taking NSAID’s. NSAID’s should not be taken for extended periods of time unless directed otherwise by a qualified medical provider.
Cyclooxygenase-2 inhibitors (COX-2 inhibitors) are a class of NSAID’s such as Vioxx, Bextra, and Celebrex. Vioxx and Bextra have been removed from the market for safety reasons. Celebrex is still available by prescription but does have a black box warning stipulating that the drug can increase the risk for cardiovascular events and gastrointestinal bleeding. COX-2 inhibitors suppress arthritis pain much the same way but with less stomach irritation.
Corticosteroids are a class of steroid hormones produced by the body in the adrenal cortex. Corticosteroids are responsible for a wide array of physiological responses in the body including immune response and the regulation of inflammation. Synthetic corticosteroids similar to the body’s corticosteroids are used to treat rheumatoid arthritis. Synthetic corticosteroids may be applied topically, taken orally or injected intra-articularly (within the joint). A few familiar synthetic corticosteroids include Prednisone, Cortisone, Dexamethasone, and Methylprednisolone.
Corticosteroids are very effective at reducing joint inflammation but also hold many side effects such as osteoporosis, weight gain, diabetes, muscle weakness, slow wound healing, acne, and mood swings to name a few. Long term use of corticosteroids can increase the risk of developing serious side effects. The dosage of corticosteroids must be tapered slowly because these drugs mimic the effect of the natural hormone cortisol. When taking corticosteroids, the body recognizes the similarity to cortisol. In response, the body produces less of this hormone. If corticosteroid therapy is stopped abruptly adrenal insufficiency may develop because the adrenal gland cannot resume production of the cortisol hormone.
Disease modifying anti-rheumatic drugs (DMARD’s) have been shown to alter the course of rheumatoid arthritis. DMARD’s work to slow inflammation which can alter and slow disease progression. DMARD’s include methotrexate, leflunomide (Arava), soluble interleukin-1 receptor therapy (Kineret), tumor necrosis factor inhibitors (Remicade, Enbrel, Humira), antimalarials (sulfasalazine, hydroxychloroquine, chloroquine), intramuscular gold salts (Myochrysine, Solganal), and cytotoxic agents (cyclosporine A, cyclophosphamide, azathioprine).
Generally rheumatoid arthritis is an inflammatory process of the synovium, structural or mechanical derangement is a frequent cause of pain and loss of joint function. A surgical approach may be necessary to alleviate pain and improve joint mobility. There are many risks and benefits to surgery. The decision to opt for surgery must take into consideration the motivation and goals of the patient, the patient’s medical status, and ability to endure post surgical rehabilitation.
Obesity does put undo stress on the musculoskeletal system. Therefore, maintaining your ideal body weight is beneficial for arthritis treatment. Regular exercise is also an important part of arthritis treatment. Regular exercise increases joint mobility, strengthens muscles, and reduces joint stiffness. Exercise also produces endorphins which are natural pain relievers.
There are a few ways you can prevent arthritis or at least reduce the severity of arthritis. You can take precautions to reduce repetitive joint use and injury, maintain an ideal weight, and always warm-up before performing any exercise. While some cannot prevent arthritis, treatment options remain available. Treating rheumatoid arthritis at an earlier stage is preferable. Many treatment options are available and hope is on the horizon.
