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Diagnosing and treating rheumatoid arthritis
is a team effort between the patient and several types of
health care professionals. A person can go to his or her family
doctor or internist or to a rheumatologist. A rheumatologist
is a doctor who specializes in arthritis and other diseases
of the joints, bones, and muscles. As treatment progresses,
other professionals often help. These may include nurses,
physical or occupational therapists, orthopedic surgeons,
psychologists, and social workers.
Studies have shown that people who are well informed
and participate actively in their own care experience less
pain and make fewer visits to the doctor than do other people
with rheumatoid arthritis.
Patient education and arthritis self-management
programs, as well as support groups, help people to become
better informed and to participate in their own care. An example
of a self-management program is the arthritis self-help course
offered by the Arthritis Foundation and developed at one of
the NIAMS-supported Multipurpose Arthritis and Musculoskeletal
Diseases Centers. Self-management programs teach about rheumatoid
arthritis and its treatments, exercise and relaxation approaches,
patient/health care provider communication, and problem solving.
Research on these programs has shown that they have the following
clear and long-lasting benefits:
- They help people understand the disease.
- They help people reduce their pain while remaining active.
- They help people cope physically, emotionally, and mentally.
- They help people feel greater control over their disease
and help build a sense of confidence in the ability to function
and lead a full, active, and independent life.
Diagnosis
Rheumatoid arthritis can be difficult to diagnose
in its early stages for several reasons. First, there is no
single test for the disease. In addition, symptoms differ
from person to person and can be more severe in some people
than in others. Also, symptoms can be similar to those of
other types of arthritis and joint conditions, and it may
take some time for other conditions to be ruled out as possible
diagnoses. Finally, the full range of symptoms develops over
time, and only a few symptoms may be present in the early
stages. As a result, doctors use a variety of tools to diagnose
the disease and to rule out other conditions.
Medical history: This is the patient's
description of symptoms and when and how they began. Good
communication between patient and doctor is especially important
here. For example, the patient's description of pain, stiffness,
and joint function and how these change over time is critical
to the doctor's initial assessment of the disease and his
or her assessment of how the disease changes.
Physical examination: This includes the
doctor's examination of the joints, skin, reflexes, and muscle
strength.
Laboratory tests: One common test is for
rheumatoid factor, an antibody that is eventually present
in the blood of most rheumatoid arthritis patients. (An antibody
is a special protein made by the immune system that normally
helps fight foreign substances in the body.) Not all people
with rheumatoid arthritis test positive for rheumatoid factor,
however, especially early in the disease. And, some others
who do test positive never develop the disease. Other common
tests include one that indicates the presence of inflammation
in the body (the erythrocyte sedimentation rate), a white
blood cell count, and a blood test for anemia.
X rays: X rays are used to determine the
degree of joint destruction. They are not useful in the early
stages of rheumatoid arthritis before bone damage is evident,
but they can be used later to monitor the progression of the
disease.
Treatment
Doctors use a variety of approaches to treat rheumatoid
arthritis. These are used in different combinations and at
different times during the course of the disease and are chosen
according to the patient's individual situation. No matter
what treatment the doctor and patient choose, however, the
goals are the same: relieve pain, reduce inflammation, slow
down or stop joint damage, and improve the person's sense
of well-being and ability to function.
Treatment is another key area for communication
between patient and doctor. Talking to the doctor can help
ensure that exercise and pain management programs are provided
as needed and that drugs are prescribed appropriately. Talking
can also help in making decisions about surgery.
| Goals of Treatment
- Relieve pain
- Reduce inflammation
- Slow down or stop joint damage
- Improve a person's sense of well-being and ability
to function
Current Treatment Approaches
- Lifestyle
- Medications
- Surgery
- Routine monitoring and ongoing care
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Lifestyle
This approach includes several activities that
help improve a person's ability to function independently
and maintain a positive outlook.
Rest and exercise: Both rest and exercise
help in important ways. People with rheumatoid arthritis need
a good balance between the two, with more rest when the disease
is active and more exercise when it is not. Rest helps to
reduce active joint inflammation and pain and to fight fatigue.
The length of time needed for rest will vary from person to
person, but in general, shorter rest breaks every now and
then are more helpful than long times spent in bed.
Exercise is important for maintaining healthy
and strong muscles, preserving joint mobility, and maintaining
flexibility. Exercise can also help people sleep well, reduce
pain, maintain a positive attitude, and lose weight. Exercise
programs should be planned and carried out to take into account
the person's physical abilities, limitations, and changing
needs.
Care of joints: Some people find that using
a splint for a short time around a painful joint reduces pain
and swelling by supporting the joint and letting it rest.
Splints are used mostly on wrists and hands, but also on ankles
and feet. A doctor or a physical or occupational therapist
can help a patient get a splint and ensure that it fits properly.
Other ways to reduce stress on joints include self-help devices
(for example, zipper pullers, long-handled shoe horns); devices
to help with getting on and off chairs, toilet seats, and
beds; and changes in the ways that a person carries out daily
activities.
Stress reduction: People with rheumatoid
arthritis face emotional challenges as well as physical ones.
The emotions they feel because of the disease--fear, anger,
frustration--combined with any pain and physical limitations
can increase their stress level. Although there is no evidence
that stress plays a role in causing rheumatoid arthritis,
it can make living with the disease difficult at times. Stress
may also affect the amount of pain a person feels. There are
a number of successful techniques for coping with stress.
Regular rest periods can help, as can relaxation, distraction,
or visualization exercises. Exercise programs, participation
in support groups, and good communication with the health
care team are other ways to reduce stress.
Healthful diet: With the exception of several
specific types of oils (mentioned in the Current Research
section), there is no scientific evidence that any specific
food or nutrient helps or harms most people with rheumatoid
arthritis. However, an overall nutritious diet with enough--but
not an excess of--calories, protein, and calcium is important.
Some people may need to be careful about drinking alcoholic
beverages because of the medications they take for rheumatoid
arthritis. Those taking methotrexate may need to avoid alcohol
altogether. Patients should ask their doctors for guidance
on this issue.
Climate: Some people notice that their
arthritis gets worse when there is a sudden change in the
weather. However, there is no evidence that a specific climate
can prevent or reduce the effects of rheumatoid arthritis.
Moving to a new place with a different climate usually does
not make a long-term difference in a person's rheumatoid arthritis.
Medications
Most people who have rheumatoid arthritis take
medications. Some medications are used only for pain relief;
others are used to reduce inflammation. Still others--often
called disease-modifying antirheumatic drugs, or DMARDs--are
used to try to slow the course of the disease. The person's
general condition, the current and predicted severity of the
illness, the length of time he or she will take the drug,
and the drug's effectiveness and potential side effects are
important considerations in prescribing drugs for rheumatoid
arthritis. The table below about "Medications Commonly Used
To Treat Rheumatoid Arthritis" shows currently used rheumatoid
arthritis medications, along with their effects, side effects,
and monitoring requirements.
Traditionally, rheumatoid arthritis therapy has
involved an approach in which doctors prescribed aspirin or
similar drugs, rest, and physical therapy first, and prescribed
more powerful drugs later only if the disease became much
worse. Recently, many doctors have changed their approach,
especially for patients with severe, rapidly progressing rheumatoid
arthritis. This change is based on the belief that early treatment
with more powerful drugs, and the use of drug combinations
in place of single drugs, may be more effective ways to halt
the progression of the disease and reduce or prevent joint
damage.
Medications Commonly Used To Treat Rheumatoid
Arthritis
* Brand names included in this booklet are provided
as examples only, and their inclusion does not mean that these
products are endorsed by the National Institutes of Health
or any other Government agency. Also, if a particular brand
name is not mentioned, this does not mean or imply that the
product is unsatisfactory.
Surgery
Several types of surgery are available to patients
with severe joint damage. The primary purpose of these procedures
is to reduce pain, improve the affected joint's function,
and improve the patient's ability to perform daily activities.
Surgery is not for everyone, however, and the decision should
be made only after careful consideration by patient and doctor.
Together they should discuss the patient's overall health,
the condition of the joint or tendon that will be operated
on, and the reason for and the risks and benefits of, the
surgical procedure. Cost may be another factor. Commonly performed
surgical procedures include joint replacement, tendon reconstruction,
and synovectomy.
Joint replacement: This is the most frequently
performed surgery for rheumatoid arthritis, and it is done
primarily to relieve pain and improve or preserve joint function.
Artificial joints are not always permanent and may eventually
have to be replaced. This may be an issue for younger people.
Tendon reconstruction: Rheumatoid arthritis
can damage and even rupture tendons, the tissues that attach
muscle to bone. This surgery, which is used most frequently
on the hands, reconstructs the damaged tendon by attaching
an intact tendon to it. This procedure can help to restore
hand function, especially if the tendon is completely ruptured.
Synovectomy: In this surgery, the doctor
actually removes the inflamed synovial tissue. Synovectomy
by itself is seldom performed now because not all of the tissue
can be removed, and it eventually grows back. Synovectomy
is done as part of reconstructive surgery, especially tendon
reconstruction.
Routine Monitoring and Ongoing Care
Regular medical care is important to monitor the
course of the disease, determine the effectiveness and any
negative effects of medications, and change therapies as needed.
Monitoring typically includes regular visits to the doctor.
It may also include blood, urine, and other laboratory tests
and x rays.
Osteoporosis prevention is one issue that patients
may want to discuss with their doctors as part of their long-term,
ongoing care. Osteoporosis is a condition in which bones lose
calcium and become weakened and fragile. Many older women
are at increased risk for osteoporosis, and their rheumatoid
arthritis increases the risk further, particularly if they
are taking corticosteroids such as prednisone. These patients
may want to discuss with their doctors the potential benefits
of calcium and vitamin D supplements, hormone replacement
therapy, or other treatments for osteoporosis.
Alternative and Complementary Therapies
Special diets, vitamin supplements, and other
alternative approaches have been suggested for the treatment
of rheumatoid arthritis. Although many of these approaches
may not be harmful in and of themselves, controlled scientific
studies either have not been conducted or have found no definite
benefit to these therapies. Some alternative or complementary
approaches may help the patient cope or reduce some of the
stress associated with living with a chronic illness. As with
any therapy, patients should discuss the benefits and drawbacks
with their doctors before beginning an alternative or new
type of therapy. If the doctor feels the approach has value
and will not be harmful, it can be incorporated into a patient's
treatment plan. However, it is important not to neglect regular
health care. The Arthritis Foundation publishes material on
alternative therapies as well as established therapies, and
patients may want to contact this organization for information.
(See the For More Information section.)
Current
Research
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Be sure to visit the Glucosamine Product Guide for a review of commercially available glucosamine products broken down by 9 different categories such as price per month, quality and type. Learn what the best products out there are and what criteria was used to ranked each. |
