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How Do I Know If I Have Rheumatoid Arthritis?

In addition to a physical examination and symptoms, blood tests and X-rays are commonly used to confirm rheumatoid arthritis. A blood test called an erythrocyte sedimentation rate (ESR or "sed rate") indicates the presence of inflammation. The majority — about 4/5 — of sufferers have antibodies called rheumatoid factors (RF) in their blood, although RF may also be present in other disorders.

What Are the Treatments?

Controlling inflammation is the goal — usually with anti-inflammatory drugs or medications that suppress the immune system, occupational or physical therapy, exercise, and sometimes surgery to correct joint damage. Sometimes arthritic damage can be slowed or stopped, but in some cases the damage continues as the disease runs its course, regardless of whether drugs or other treatments are used. The duration and intensity of pain vary from person to person.

Treatment for rheumatoid arthritis involves three stages:

• medication to relieve pain and inflammation.
• rest to let injured tissues heal themselves.
• exercise to rebuild mobility and strength.

Methods of treatment include:

Joint Protection
Learning to protect your joints is an important part of treatment. With the help of an occupational therapist, you can learn easier ways to do your normal activities, such as avoiding positions that strain your joints, using your strongest joints and muscles while sparing weaker ones, wearing braces or supports for certain joints, and using grab bars in the bath, modified door knobs, canes, walkers and devices to help you with tasks such as opening jars or pulling up socks.

Doctors may recommend pain relievers combined with regimens of heat, rest, and exercise; physical therapy; and controlled application of deep heat to soothe affected joints.

Medication
Controlling inflammation is the primary goal of rheumatoid arthritis treatment. To reduce pain and inflammation in mild cases, your doctor will probably prescribe aspirin or another nonsteroidal anti-inflammatory drug (NSAID). Those that are available over the counter include aspirin, ibuprofen (Advil, Motrin) and naproxen sodium (Aleve). These, at higher doses, and other NSAIDs are available by prescription - some are Voltaren, Oruvail, Anaprox, Relafen and Indocin. NSAIDs have the potential for serious side effects such as stomach irritation, including the development of an ulcer and potentially bleeding.

Another class of NSAIDs are called Cox-2 inhibitors. They are thought to be easier on the stomach but are not shown to be any more effective in pain control. Celebrex is an example of this class of medication. Side effects can include swelling and worsening of high blood pressure. They have been linked to an increase risk of heart attack or stroke in some patients.

In more advanced cases, your doctor may recommend steroids to ease the pain and stiffness of affected joints. Steroids can be given as injections directly into the inflamed joint or as a pill. Depending on the individual, results range from temporary relief to long-lasting suppression of symptoms. Potential side effects of long-term steroid use include high blood pressure, osteoporosis, and diabetes. But when used appropriately, steroids are often very effective at quickly improving pain and inflammation.

There are also other medications called disease modifying anti-rheumatic drugs (DMARDs) that are used to treat rheumatoid arthritis. Taking these drugs early in the course of the disease is especially important in an effort to slow down the disease and preserve joints. Some commonly used DMARDs are Plaquenil, the gold compound Ridaura, Azulfidine and Minocin. Other forms or DMARDs are the immunosuppressants and tumor necrosis factor (TNF) blockers.

Immunosuppressants act to keep the immune system in check. Low doses of chemotherapy medications such as methotrexate (Rheumatrex) have produced dramatic improvements in severe rheumatoid arthritis and can help preserve joint function. Methotrexate was originally used to treat cancer but is now used — in much lower doses — to suppress the immune system and calm the inflammation of rheumatoid arthritis. Rheumatrex is considered to be the gold-standard drug for treating rheumatoid arthritis. Other immunosuppressants include Arava, Imuran, Cytoxan and Neoral.

TNF blockers help to reduce pain by blocking an inflammatory protein. There is some evidence that they may stop the progression of rheumatoid arthritis. Recent studies have shown benefits when they are combined with the immunosuppressant methotrexate. Some examples are Enbrel, Remicade and Humira. These medicines should be avoided if you have an active infection.
Kineret is another medicine that blocks inflammation and has shown good success in the treatment of rheumatoid arthritis in those not responding to the other DMARDs. It may be used alone or in combination with methotrexate.

Some antidepressants can be helpful for arthritis pain and poor sleep. The most commonly used ones are Elavil, Pamelor and Desyrel.

Removing antibodies from the blood — called apheresis — is yet another treatment for rheumatoid arthritis, particularly for severe cases. This involves passing the blood through a Prosorba column that binds to the antibodies contributing to pain and inflammation, therefore removing them. The blood is then put back into the body. It is generally done weekly over 12 weeks. Some studies report that 30-50% of people may slow or even stop the progression of their RA.

Surgery
If arthritic pain and inflammation become truly unbearable or arthritic joints simply refuse to function, the answer may lie in surgical joint replacement. Today, joint replacement is commonly done on the hips and knees and sometimes the shoulders. This type of surgery can dramatically improve function and mobility but is typically done only after the age of 50 since the artificial replacements tend to wear down after 15-20 years.

Some joints don't respond well to artificial replacement and do better with joint fusion, such as the ankles.

Pain Management
Because one of the most trying aspects of arthritis is learning to live with pain, many doctors recommend training in pain management, including cognitive therapy, which combines behavior modification with relaxation techniques.

Such programs focus on improving patients' emotional and psychological well-being by teaching them how to relax and conduct their daily activities at a realistic pace. Learning to overcome mental stress and anxiety can be the key to coping with the physical limitations that may accompany chronic rheumatoid arthritis and osteoarthritis. Cognitive therapy may include various techniques for activity scheduling, imaging, relaxation, distraction, and creative problem-solving.

At-Home Remedies
Heat and rest — traditional remedies for arthritic pain — are very effective in the short run for most people with the disease. Heat is particularly effective when there is joint swelling. Rest is good for joints during a rheumatoid arthritis flare. Overweight people should lose weight, especially when arthritis affects the lower back, knees and legs. Consult a registered dietitian who can help you plan a healthy weight-loss program.

Regular exercise is important to keep the various joints mobile.

People with weakened, badly deformed fingers from rheumatoid arthritis benefit from specially designed utensils and door and drawer handles.

Alternative Medicine

A variety of alternative therapies are used for rheumatoid arthritis. But you should let your doctor know if you're considering them because they should be used in addition to conventional medicine.

Acupuncture
The National Institutes of Health considers acupuncture an acceptable alternative treatment for arthritis. Studies have shown that acupuncture helps reduce pain, may lower the need for painkillers, and can help increase flexibility in affected joints.

Homeopathy may improve pain, joint tenderness, stiffness and grip strength for those with rheumatoid arthritis, especially when used in conjunction with NSAIDs.

Nutritional Supplements
Fish oil has been used for rheumatoid arthritis. It reduces inflammation, lessens the need for painkillers, and may decrease joint stiffness. A diet low in animal and dairy fats has similar effects. Excellent sources of fish oil include EPA/DHA capsules and oily fish such as salmon and mackerel.

Several studies have shown that glucosamine and chondroitin supplements work well for arthritis in some people and may even be as effective as drugs such as ibuprofen. However, these studies, which have shown the supplements can improve symptoms and even slow progression of osteoarthritis of the knee, have all been done in people with osteoarthritis. These supplements are not generally used for rheumatoid arthritis, and no studies have shown their benefit for this condition.

As well, the supplement SAMe has been shown in some studies to be as effective against osteoarthritis pain as NSAIDs, with the added benefit of fewer side effects.

Herbs
At least a dozen different herbs are used to ease the symptoms of rheumatoid arthritis; most are considered anti-inflammatories. Check with your doctor about using any herbs, since they can interact with each other or with medication you are taking. In most cases, lack of careful studies means little is known about long-term effects. Herbs that have been tried include powdered ginger, borage seed oil, or devil's claw to reduce pain and swelling. Stinging nettles or turmeric may also lessen pain, stiffness, and inflammation.

Ayurvedic medicine uses herbal compounds internally and externally for symptom relief. Topical curcumin may relieve the inflammation of rheumatoid arthritis; if taken in capsule form, it can reduce morning stiffness and boost endurance. A combination of Withania somnifera, Boswellia serrata, and Cucurma longa caused a significant drop in pain and disability for study participants with osteoarthritis.

Aromatherapy
When you inhale oils or rub them on your skin, you are using the scent as well as the properties of the oil (essential fatty acids) for healing. Thyme has been used to relieve joint pain.

Prevention
Though arthritis is not preventable, many people are able to prevent disability with a well-designed exercise program.

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