There are many types of
arthritis (disease of the joints). This topic is about
rheumatoid arthritis. If you are looking for information about how juvenile
rheumatoid arthritis affects young children, see the topic
Juvenile Rheumatoid Arthritis. If you are looking for
information on the most common form of arthritis in older adults, see the topic
Osteoarthritis.
Over time, this
inflammation may destroy the joint tissues. This can limit your daily
activities and make it hard for you to walk and use your hands.
Rheumatoid arthritis is 2 to 3 times more common in women than in men. It often
begins between the ages of 40 and 60.
What causes rheumatoid arthritis?
The exact cause of rheumatoid
arthritis is not known. But rheumatoid arthritis is an
autoimmune disease. This means that the body's natural
defense system attacks the joints. The disease also runs in some
families.
What are the symptoms?
The main symptoms of rheumatoid arthritis are pain, stiffness, and
swelling in the joints of the hands, wrists, elbows, feet, ankles, knees, or
neck. The disease usually affects both sides of the body at the same time. In
rare but severe cases, it may affect the eyes, lungs, heart, nerves, or blood
vessels.
Sometimes rheumatoid arthritis
can cause bumps called nodules to form over the elbows, knuckles, spine, and
lower leg bones.
How is rheumatoid arthritis diagnosed?
There is no single test for rheumatoid
arthritis. Your doctor will look at your joints for signs of swelling or
tenderness. He or she will also ask about your symptoms and past health.
You may have blood tests,
X-rays, and other tests to find out if another problem
is causing your joint pain.
How is it treated?
There is no cure for rheumatoid arthritis, but
treatment may help relieve symptoms and control the disease. Treatment
continues throughout your life.
Treatment includes medicine,
exercise, and lifestyle changes.
Experts recommend early
treatment with medicines that may control rheumatoid arthritis or keep it from
getting worse. Early treatment also may lower the chances that inflammation
will destroy your joints and limit your daily activities.
Many of
the medicines used to treat rheumatoid arthritis have side effects. So it is
important to have regular checkups and talk with your doctor about any
problems. This will help your doctor find a treatment that works for you.
At home, you can relieve your symptoms and help control your
disease if you:
Rest when you are tired.
Protect
your joints from injury by using special kitchen tools or
doorknobs.
Use splints, canes, or walkers to ease pain and take
stress off your joints, if your symptoms are severe.
Eat a
balanced diet.
Exercise regularly.
Stay at a healthy
weight.
If medicine, exercise, and lifestyle changes do not help
enough, surgery may be an option. Total joint replacement can be done for many
joints in the body.
It can be hard to live with a long-term
illness that can limit your ability to do things. It is common for people with
rheumatoid arthritis to have some depression. Be sure to seek the help and
support you need from friends and family members. Professional counseling also
can help you cope with long-term pain and depression.
Health Tools
Health Tools help you make wise health decisions or take action to improve your health.
Actionsets are designed to help people take an active role in managing a health condition.
The cause of
rheumatoid arthritis (RA) is not fully understood.
Genes play a role in rheumatoid arthritis, but experts
do not know exactly what that role is. For most people with RA, the disease
does not run in their families and they do not pass it along to their children.
One or more genes may make it more likely that the body's
immune system will attack the tissues of the
joints. This immune response may also be triggered by
bacteria, a virus, or some other foreign substance.
The abnormal
immune response causes ongoing
inflammation of the tissues lining the joint, a
breakdown of
cartilage, and loosening of the ligaments and tendons
supporting the joint. Ongoing inflammation also causes the membrane that lines
the joint (synovium) to grow into a thick, abnormal tissue called pannus. These
processes result in destruction of the cartilage, the underlying bone
surrounding the joint,
ligaments, and
tendons and can eventually lead to deformed
joints.
Joint pain can be an early symptom of many
different diseases. In
rheumatoid arthritis, symptoms often develop slowly
over a period of weeks or months. Fatigue and stiffness are usually early
symptoms of rheumatoid arthritis. Weight loss and a low-grade fever can also
occur.
Joint symptoms of rheumatoid arthritis include:
Painful, swollen, tender, stiff
joints. The same joints on both sides of the body
(symmetrical) are usually affected, especially the
hands, wrists, elbows,
feet, ankles, knees, or neck.
Morning
stiffness. Joint stiffness may develop after long periods of sleeping or
sitting and lasts at least 60 minutes and often up to several
hours.
Bumps (nodules). Rheumatoid nodules ranging in
size from a pea to a mothball develop in nearly one-third of people who have
rheumatoid arthritis.
Nodules usually form over pressure points in the body
such as the elbows, knuckles, spine, and lower leg bones.
Rheumatoid arthritis can affect the hands, wrists, elbows,
feet, ankles, knees, or neck. It usually affects both sides of the body at the
same time, and more than three sets of joints are affected at one time.
In addition to specific joint symptoms, rheumatoid arthritis can cause
symptoms throughout the body (systemic). These include:
Fatigue.
A loss of
appetite.
Weight loss.
Mild fever.
Numbness
and tingling in the hands.
Some of the symptoms of rheumatoid arthritis may be similar
to symptoms of
other health conditions.
The course of
rheumatoid arthritis is difficult to predict because
it may progress slowly or quickly. If the disease progresses, joint pain can
restrict simple movements, such as your ability to grip, and daily activities,
such as climbing stairs. Rheumatoid arthritis is a common cause of permanent
disability. But early treatment may significantly control the course of the
disease.
In rare cases, you may get better on your own with no
remaining signs or symptoms. This is called spontaneous remission. Partial
remission is more common. It involves the relief of some, but not all,
symptoms. Although a minority of people with rheumatoid arthritis will achieve
a complete remission with treatment, the majority will have improvement in
their symptoms.
Rheumatoid arthritis usually progresses gradually.
Most rheumatoid arthritis cases begin slowly,
over weeks to months.
In a few rheumatoid arthritis cases, symptoms
come on rapidly, within days.
Progression of the disease is more likely when:
A rheumatoid factor blood test is
positive.
A blood test for the antibody CCP (cyclic citrullinated
peptide) is positive.
In most cases, rheumatoid arthritis does not affect a
woman's ability to become pregnant and have a healthy baby. Pregnancy often
improves rheumatoid arthritis symptoms, especially from the end of the first
trimester on. More than 75% of women have remission of
disease activity during pregnancy; however, approximately 80% experience a
flare of disease symptoms in the weeks after delivery.1
Other organ involvement may occur later
in the course of the disease. In a small number of severe cases, rheumatoid
arthritis may cause damage to the heart, lungs, skin, blood vessels, nerves,
and eyes. It is common for people with rheumatoid arthritis to have some degree
of
depression, which may be caused by pain and
progressive disability.
Some people with rheumatoid arthritis
cannot keep working because of the symptoms. But experts hope that the newer
treatments for rheumatoid arthritis will help more people stay active and be
able to work.
Studies have shown that damage to joints occurs in
60% of people with rheumatoid arthritis within 2 years. Because irreversible
joint damage, chronic pain, and long-term disability can occur if rheumatoid
arthritis is not diagnosed and treated early, it is now recommended that a
person with rheumatoid arthritis see a specialist in joint disease
(rheumatologist) within the first 3 months after symptoms appear.2 As soon as rheumatoid arthritis is diagnosed, early treatment
includes medicines known as disease-modifying antirheumatic drugs (DMARDs).
Joint destruction
The pain, stiffness, and
whole-body (systemic) symptoms associated with rheumatoid arthritis can be
disabling. Over time, rheumatoid arthritis can cause significant
joint destruction, leading to deformity and difficulty with daily activities.
Specific joint problems may also occur later in the course of the
disease.
Hands and wrists are the most common location for
deformities caused by rheumatoid arthritis.3
Swan-neck and boutonniere deformities:
Changes in the tissues around the finger joints cause abnormal bending or
straightening.
Swelling of the joints can push the supporting
tendons and ligaments out of position, causing the fingers to bend toward the
little finger (ulnar drift).
The tendons may break (rupture),
making it impossible to straighten or bend the finger, depending on which
tendon ruptures. Tendon loosening is very common in rheumatoid arthritis, due
to inflammation of the joints.
Inflammation in the wrist can limit
the ability to bend the wrist up or down.
The
feet are a common site of rheumatoid-arthritis-caused
deformities that affect more than one-third of people with this
disease.4
Hammer toes: Changes in the tissues around
the toe joints cause abnormal bending (flexion).
Hallux
valgus/bunion: Changes in the tissues around the big toe joint cause it to bend
toward the little toe and develop a bony enlargement.
Movement of
the joints between the toes and foot (metatarsophalangeal subluxation): The
ball joints loosen, and the bones press down to the ground.
Pes
planus: The arch joint of the middle foot loosens, which causes a painful flat
foot.
Valgus hind foot: The joint below the ankle loosens, which
causes the foot to bend outward.
Inflammation of the knees, if not controlled by
treatment, can cause erosion of cartilage and can eventually lead to the need
for knee replacement surgery.
X-rays of the neck joints show some
damage in 15% of people with rheumatoid arthritis.5
This damage can limit how easily you can move your neck. In rare cases, the
damage can pinch a nerve or affect the spinal cord and cause numbness, pain, or
weakness in the arms or legs.
The only known risk factor
for
rheumatoid arthritis is a possible inherited factor in
some families (genetic predisposition). A genetic factor may affect
how the
immune system functions, causing inflammation and
eventual destruction of the membranes that line the
joints.
Other factors that may influence
your risk of developing rheumatoid arthritis include:
Being female. Rheumatoid arthritis affects
women 2 to 3 times as often as men.3
Being
between the ages of 40 and 60. Rheumatoid arthritis can begin at any age, but
it most often begins in adulthood.4
When to Call a Doctor
Call your health professional immediately if you have:
Sudden, unexplained swelling and pain in any
joint or joints.
Joint pain associated
with a fever or rash.
Pain that is so severe that you cannot use
the joint.
Call your health professional within the next few days if
you have:
Mild to moderate joint pain that continues and
has not improved for over 6 weeks.
It is reasonable to try home
treatment for mild joint pain and stiffness. If there is no improvement after 6
weeks, or if any other symptoms are present, call your doctor.
Early treatment can slow and sometimes prevent significant joint damage.
So if you have symptoms similar to rheumatoid arthritis, it is important to see
your health professional to determine whether you have rheumatoid arthritis.
Early diagnosis and treatment allows for possible reduction of joint pain,
slows joint destruction, and reduces the chance of permanent disability.
Family medicine doctor or internist in
consultation with a rheumatologist.
Specialist in inflammatory
diseases of the joints (rheumatologist).
Specialist in bone,
muscle, and joint problems (orthopedic surgeon) if surgery is being considered
to treat joint problems.
Supportive treatment can be provided by:
A physical therapist, to assist with exercise
and pain management (physical therapy).
An occupational
therapist, to assist with splinting or assistive devices (occupational therapy).
A counselor, to help manage emotional issues that
may occur in a long-term illness (counseling).
Exams and Tests
No single lab test can diagnose
rheumatoid arthritis. Instead, rheumatoid arthritis is
diagnosed by symptoms and physical signs and by eliminating other diseases that
can cause similar symptoms. Physical signs include joint swelling or
tenderness. Symptoms that help in diagnosis are stiffness and pain in the same
joints on both sides of the body (symmetrical), morning stiffness, and
development of
rheumatoid nodules.
A
medical history and physical examination are usually
done to help determine the cause of joint pain. The pattern and nature of
joint signs and symptoms are the most important clues
to the diagnosis.
Diagnosis is based on a set of
classification criteria for rheumatoid arthritis. The
following tests may be done to evaluate your symptoms, to rule out other
problems, or to monitor treatment:
Because rheumatoid arthritis can lead to severe joint
destruction and disability over time, regular evaluation by a health
professional is important to determine whether current treatment is working or
needs to be adjusted.
Rheumatoid arthritis is most often treated with medicine, exercise, and lifestyle
changes. Treatment may help relieve symptoms and control the disease, but there
is no cure. Treatment for rheumatoid arthritis usually continues throughout
your life, but will vary depending on:
The stage (active or in
remission) and severity of your
disease.
Your treatment history.
The benefits and risks
of treatment options.
Your preferences for treatment options, such
as cost, side effects, and daily schedules.
The goal of treatment is to help you maintain your
lifestyle, reduce joint pain, slow joint damage, and prevent disability.
Initial treatment
Treatment
of
rheumatoid arthritis should start with education about
this disease, the possibility of joint damage and disability, and the risks and
benefits of potential treatments. A long-term treatment plan should be
developed by you and your health professional team.6
The purpose of early treatment is to:
Relieve or reduce pain.
Reduce
joint inflammation.
Improve daily function.
Prevent or
delay significant
joint damage and deformity.
Prevent
permanent disability.
Improve the quality of life.
Experts recommend early and aggressive treatment of
rheumatoid arthritis with medicines called disease-modifying antirheumatic
drugs (DMARDs) that can actually slow or sometimes prevent joint
destruction.6 Examples of DMARDs include:
One study suggested that advances in the treatment of
rheumatoid arthritis, including DMARDs, has improved the health of people with
the disease over the last 20 years.7 DMARD treatment,
begun as soon as possible after diagnosis and continued for a prolonged period
of time, may prevent damage to joints and other complications of rheumatoid
arthritis.8
Joint pain, tenderness, and
swelling are the most important means of measuring how the disease is
progressing or responding to treatment. Nonsteroidal anti-inflammatory drugs
(NSAIDs) and/or analgesics (pain relievers, such as
acetaminophen, codeine, or hydrocodone) may be used to
relieve these symptoms. NSAIDs relieve pain and lower inflammation. Analgesics
relieve pain but do not affect inflammation. These medicines do not change the
course of the disease or prevent joint destruction. Analgesics or NSAIDs are
used as helpers in combination with DMARDs.
Corticosteroids may be used to treat your rheumatoid
arthritis. They may be used as:
Initial therapy until a DMARD has a chance to
work (bridge therapy).
A means of controlling flares of rheumatoid
arthritis. When a single joint is inflamed, a corticosteroid injection can be
effective in relieving symptoms.
Disease management when DMARDS do
not fully control the disease.
Because of the side effects of corticosteroids, your health
professional will use the lowest possible dose and will try to reduce and
eventually discontinue use of oral corticosteroids. But this is not always
possible.
Exercise, physical therapy, and lifestyle changes can
help you decrease joint pain. Many people with rheumatoid arthritis benefit
from self-management plans that balance rest and activity. Steps you can take
at home to relieve your symptoms and help control your disease include:
Becoming involved in the day-to-day management
of your disease. For more information, see:
Staying active physically, mentally, and
socially.
Resting when you are tired.
Protecting your
joints from injury.
Eating a balanced diet.
Exercising
regularly.
Controlling your weight.
Ongoing treatment
Treatment for
rheumatoid arthritis usually continues throughout your
life. Your health professional will want to closely monitor your condition. A
rheumatologist should evaluate you regularly. Depending on your symptoms and
treatment, this could be done as often as every 2 to 3 months or as
infrequently as every 6 to 12 months. Testing, such as blood tests, may be done
more often.
During each follow-up visit, your health professional
will assess how active your disease is. Markers of disease activity are:
Disease-modifying antirheumatic drugs (DMARDs), such as
methotrexate,
etanercept,
adalimumab,
infliximab, and
leflunomide, will probably be used early in the course
of your disease and for a prolonged period after treatment begins. DMARDs have
been shown to slow the disease and may prevent joint destruction.
Corticosteroids may be used to treat your rheumatoid
arthritis. They may be used as:
Initial therapy until a DMARD has a chance to
work (bridge therapy).
A means of controlling flares of rheumatoid
arthritis. When a single joint is inflamed, a corticosteroid injection can be
effective in relieving symptoms.
Disease management when DMARDS do
not fully control the disease.
Because of the side effects of corticosteroids, your health
professional will use the lowest possible dose and will try to reduce and
eventually discontinue use of oral corticosteroids. But this is not always
possible.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and/or analgesics (pain relievers, such as
acetaminophen) also may be used to relieve symptoms.
NSAIDs can relieve pain and reduce inflammation in less severe cases of
rheumatoid arthritis.
Exercise, physical therapy, and lifestyle
changes can help you decrease joint pain. Many people with rheumatoid arthritis
benefit from self-management plans that balance rest and activity. Steps you
can take at home to relieve your symptoms and help control your disease
include:
Becoming involved in the day-to-day management
of your disease. For more information, see:
Staying active, physically, mentally, and
socially.
Resting when you are tired.
Protecting your
joints from injury.
Eating a balanced diet.
Exercising
regularly.
Controlling your weight.
Treatment if the condition gets worse
In some cases of
rheumatoid arthritis, the disease does not respond to
the first several treatments. Treatment-resistant rheumatoid arthritis may be
treated with much higher doses of medicines or with different combinations of
medicines. Surgery may be considered when the joints-especially the hips,
knees, or feet-are severely damaged or deformed and are causing extreme pain.
Surgery may include total joint replacement or other techniques to improve
joint function.
What to Think About
Treatment to manage rheumatoid
arthritis can be effective at slowing the progression of the disease, and you
may have periods of time in which the disease is in remission. But if you have
joint destruction from rheumatoid arthritis, you may need treatment such as
pain relief, physical therapy, and/or surgery.
The course of
rheumatoid arthritis is difficult to predict, and some people respond to
treatment better than others. Scientists are studying the role that a person's
genes may play in disease progression.9
There is no known way to prevent
rheumatoid arthritis because the exact cause of the
disease is not known.
It is important for people who worry that
they may be at risk of rheumatoid arthritis to realize that at this time there
are no medicines to take or lifestyle modifications to make that can prevent
rheumatoid arthritis. Only after the disease is diagnosed can you take measures
to control the disease. Until it is known for sure if certain bacteria or
viruses trigger the disease, contact with people with the disease will not
change your risk for developing it.
Researchers continue to study
possible triggers of the disease. When researchers determine how the body's
immune system becomes activated, we may be closer to
knowing how to prevent rheumatoid arthritis.
Living With Rheumatoid Arthritis
Living with
rheumatoid arthritis often means making changes to
your lifestyle. You can do things at home, such as staying active and taking
medicines, to help relieve your symptoms and prevent the disease from getting
worse.
People who have rheumatoid arthritis also have an increased
risk of heart disease. But healthy lifestyle changes, such as exercise and a
healthy diet, may reduce your risk of heart disease.10
For more information, see the topics
Healthy Eating and
Fitness.
It is common to feel pain,
fatigue, and joint stiffness with rheumatoid arthritis. Some activities may
make your discomfort worse, while others might provide relief. Thousands of
people with arthritis have benefited from developing and following plans to
help them manage their symptoms. These plans often include education about the
disease, exercise, diet changes, assistive devices, and other supports to help
you stay as active as possible. For more information on managing your disease,
see:
You can also plan for those times when the disease symptoms
may be more severe. It is important to work closely with your health
professionals, who may include a
physical therapist or counselor, to find ways to
reduce pain.
People with rheumatoid arthritis have a high risk of
developing
osteoporosis because of the action of the disease
itself, side effects from some treatments, and a decrease in physical activity
as a result of disabling pain. It is recommended that people with rheumatoid
arthritis take 1,000 mg to 1,500 mg of
calcium and 800 IU of
vitamin D daily. This calcium and vitamin D can come
from dietary sources and supplements. If you do not consume significant amounts
of milk and dairy products, you may need to take most of this requirement as
supplements. Many health professionals also recommend that people with
rheumatoid arthritis take bisphosphonates, such as alendronate (Fosamax) or
risedronate (Actonel), which increase bone formation.3
For more information, see the topic
Osteoporosis.
Rest when tired
Rheumatoid arthritis itself causes fatigue, and the
strain of dealing with pain and limited activities also can make you tired. The
amount of rest you need depends on how severe your symptoms are.
With severe symptoms, you may need long periods
of rest. You might need to rest a joint by lying down for 15 minutes several
times a day to relax. Experiment until you find a good balance between daily
activities that you must do or want to do and the amount of rest you need in be
able to do those activities.
Plan your day carefully, including
rest periods, and pace your activities so that you don't get
overtired.
Don't feel guilty if you have to give up some tasks,
such as making the bed or housework. Do the things you must do or really want
to do, and find other ways to get less important things done.
Don't rest too much. Prolonged joint inactivity can lead to more
stiffness and, eventually, to weakness of underused muscles. Gently moving each
joint through a comfortable range of motion each day will help prevent
stiffness.
Protect your joints
You may need to change the way you do certain activities so that you are not
overusing your joints. Try to find different ways to relieve your joint
pain.
Joint pain and stiffness may improve with heat
therapy, which includes:
Taking warm showers or baths after long
periods of sitting or sleeping.
Soaking hand joints in warm wax
baths.
Sleeping under a warm electric blanket.
Use
assistive devices to reduce strain on your joints,
such as special kitchen tools or door knobs.
Use splints, canes, or
walkers to reduce pain and improve function.
Exercise
Keep moving to
maintain muscle strength, flexibility, and overall health.
Physical therapy may be recommended by
your health professional.
Exercise can reduce pain and improve
function in people with rheumatoid arthritis.
Exercise for arthritis takes three forms-stretching,
strengthening, and conditioning. Recent reviews of exercise studies report that
both weight-bearing exercise and strength training improve or maintain the
quality of life for people with rheumatoid arthritis.11, 12 Your specific joint problem may
dictate what type of exercise will help the most. For example:
Swimming is a good conditioning exercise if
you have joint problems in the lower extremities, such as the knees, ankles, or
feet.
Bicycling and walking are good conditioning exercises if your
joint problems are not in the lower extremities.
Eat a balanced diet
Some people with rheumatoid arthritis may not eat a healthy, balanced
diet because symptoms may make it difficult to shop or cook.
The
best diet for people with rheumatoid arthritis is a healthy, balanced diet that
is low in saturated fat, cholesterol, and salt and high in fiber and complex
carbohydrate (whole grains, beans, fruits, and vegetables).
Although studies have been done to determine
whether certain foods or special diets can improve the symptoms of rheumatoid
arthritis, there is no consistent evidence that eating certain foods can help.
The exception is fish. Fish oil (omega-3 fatty acids) has a modest effect in
reducing inflammation and has been shown to slightly reduce swelling in
rheumatoid arthritis. Although the doses of fish oil used in the studies were
much higher than what a person can eat in an average serving of fish, eating
fish may improve symptoms.
Be sure to get enough
calcium and
vitamin D to protect your bones against osteoporosis.
For more information, see the topic
Osteoporosis.
Lose weight, if you are
overweight. For more information, see the topic
Weight Management.
Medications
Medicines are the main treatment for
rheumatoid arthritis. The types of medicines used
depend on the severity of your disease, how fast it is progressing, and how it
affects your daily life.
It is common for people with rheumatoid
arthritis to have periods when the disease eases and then times when it gets
worse. A long-range treatment plan that takes into account your lifestyle,
medical history, and treatment options should be developed, followed, and
regularly reviewed by all those involved in your health care-most importantly,
you.
If your symptoms ease and you are in remission, you and your
doctor will decide whether you can take less medicine or stop taking medicine.
If your symptoms get worse, you will have to start taking medicine again.
Medicines to treat rheumatoid arthritis are used to:
Relieve or reduce pain.
Improve
daily function.
Reduce joint inflammation. Signs of joint
inflammation include swelling, tenderness, and limited range of
motion.
Prevent or delay significant
joint damage and deformity.
Prevent
permanent disability.
Improve quality of life.
Medicines called disease-modifying antirheumatic drugs
(DMARDs) that can slow or sometimes prevent joint destruction are now
recommended early in the course of the disease. All people with rheumatoid
arthritis are considered candidates for DMARD treatment. DMARDs can help
prevent the significant joint damage that may occur in the early stages of
rheumatoid arthritis. DMARDs are also called immunosuppressive drugs or
slow-acting antirheumatic drugs (SAARDs).
Early treatment with
DMARDs may significantly reduce disease severity. Experts recommend that DMARD
treatment be continued for a prolonged period of time to sustain the benefit of
disease control.8
DMARDS can be divided
into two general categories based on how they work: oral DMARDs and biological
DMARDs. Oral DMARDS are taken by mouth. They interfere with the making or
working of immune cells that cause joint inflammation. Biological DMARDS are
given by injection (infusion). They act in several different ways to affect how
immune cells work. DMARDs decrease joint
inflammation and damage.
Medicines may be
given together. This is called combination therapy. Oral medicines are combined
with each other or with biological DMARDs. But biological DMARDs are not used
with each other because of a higher risk of infection.
Combination therapy may allow for lower doses of an individual drug to be
used, which may reduce the risk of side effects that can occur with higher
doses. Combination therapy may be an effective way to reduce symptoms of
rheumatoid arthritis, control the disease, and prevent it from getting worse.
And you may need fewer treatment adjustments with combination therapy than with
treatment using individual medicines.13
Some medicines for rheumatoid arthritis may cause birth defects. If you
are pregnant or are trying to become pregnant, talk with your health
professional about your medicines.
Medication Choices
Medications to slow the progression of disease: Disease-modifying antirheumatic drugs
(DMARDs) are usually started within 3 months of your diagnosis and are used to
control the progression of rheumatoid arthritis and to try to prevent joint
deterioration and disability. DMARDs are often given in combination with other
DMARDs or with other medications, such as corticosteroids or nonsteroidal
anti-inflammatory drugs (NSAIDs).
Medications to relieve symptoms,
such as pain, stiffness, and swelling, may also be used. These include:
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen. NSAIDs are used to
control pain and may help reduce inflammation. They do not control the disease
or stop it from getting worse. NSAIDs may be combined with disease-modifying
antirheumatic drugs (DMARDs).
Corticosteroids
such as prednisone or Medrol. Corticosteroids are used to reduce disease
activity and joint inflammation. But using corticosteroids as the only therapy
for an extended time is not considered the best treatment. Corticosteroids are
often used to control symptoms and flares of joint inflammation until DMARDs
reach their full effectiveness, which can take up to 6
months.
Analgesics (pain relievers). These do not reduce
inflammation but may assist with pain control. Commonly used prescription
analgesics include:
Acetaminophen with codeine (such as
Tylenol with codeine).
Acetaminophen with hydrocodone (such as
Vicodin).
Tramadol.
Propoxyphene (such as
Darvon).
Nonprescription
acetaminophen, which may be used to reduce
pain.
What to Think About
Some DMARDs can take up to 6
months to work. In some people, a certain DMARD may not work at all, and a
different DMARD will be used. Rapid improvement should not be expected.
Medications for rheumatoid arthritis are best managed by a doctor who
specializes in inflammatory diseases of the joints (rheumatologist).
Many DMARDs have serious side effects. Regular blood and urine tests are
usually needed when using a DMARD to monitor the drug's effects on
blood-producing cells (bone marrow), the kidneys, and the liver.
Experts are studying many medicines that might be used for rheumatoid
arthritis. Examples include:
Tacrolimus (Prograf), an inhibitor of a
protein called calcineurin. In one 6-month trial, people who had rheumatoid
arthritis that had not responded to DMARD treatment experienced a reduction in
disease activity and symptoms.14
Tocilizumab, another biological DMARD that slows
inflammation by inhibiting cytokine function. The results of research trials
suggest that tocilizumab may reduce disease activity in rheumatoid
arthritis.15
Surgery
Surgical treatment in
rheumatoid arthritis is used to relieve severe pain
and improve function of severely deformed joints that do not respond to
medication and physical therapy.
Total joint replacement
(arthroplasty) can be done for many different joints in the body. Its success
varies depending on which
joint is replaced.
Surgery Choices
Surgeries considered for people
who have severe rheumatoid arthritis include:
Joint surgery often restores
near-normal movement in a person who has
osteoarthritis in just one or two joints. But this is
not the case in people affected by rheumatoid arthritis.
Rheumatoid arthritis usually affects multiple
joints, particularly smaller joints, such as finger joints, which are needed
for many daily activities. Surgical treatment may not be an option for all of
the affected joints.
Joint surgery or replacement can relieve
disabling pain and restore enough motion to allow you to complete daily
activities, but it will seldom restore the joint to normal.
The
most successful procedures for rheumatoid arthritis are carpal tunnel release
(in the wrist), resection of the metatarsal heads (in the foot), and total hip
and total knee joint replacements.
A consultation with an
orthopedic surgeon who is experienced in joint surgery
for rheumatoid arthritis is important before making a decision to have surgery.
For more information on questions before surgery, see:
Other types of treatment that may
help you control some of the symptoms of
rheumatoid arthritis include:
Physical therapy, to improve joint
function. Physical therapy includes exercise, hot and cold therapy, and
massage.
Occupational therapy, to learn how to maintain
movement in the joints while carrying out the activities of daily living.
Therapists can teach techniques to avoid excessive force being applied on
non-weight-bearing joints and to avoid unnecessary impact on weight-bearing
joints. A review of studies reported that instruction on joint protection and
comprehensive occupational therapy can help people with rheumatoid arthritis
overcome problems in performing daily activities.16
Products that reduce stress on joints and aid
with daily activities. This wide range of products includes foot supports,
wrist or finger splints,
assistive devices such as household aids (for example,
specialized kitchen tools), or mobility aids (such as canes and walkers). For
more information and a catalog, contact the Arthritis Foundation, listed in the
Other Places to Get Help section of this topic.
Counseling, to
help you cope with long-term pain and disability.
Complementary and alternative medicine therapies
Although not proven in scientific studies, complementary therapies are
used by many people to relieve symptoms caused by rheumatoid arthritis and
improve their quality of life. These therapies include:
Acupuncture. Acupuncture is used to
relieve pain and treat certain health conditions. It is done by inserting very
thin needles into the skin at specific points on the body.
Massage. Massage can help relieve stress and reduce
pain. But do not massage swollen or painful joints.
Transcutaneous electrical nerve stimulation (TENS).
TENS is a therapy that uses electrical current delivered through electrodes to
the skin for pain relief. Electrical stimulation to the nerves may cause the
body to produce natural painkillers called endorphins, which may block the
perception of pain. Although TENS may help relieve pain caused by rheumatoid
arthritis for some people, it has no effect on the disease itself and is not
considered to be a long-term solution to pain.17
Herbs and dietary supplements. If you decide to
use herbs or dietary supplements, be sure to tell your health professional.
For some people, herbs (such as ginger or
evening primrose) or essential fatty acids (such as fish oil) may provide some
relief of symptoms caused by rheumatoid arthritis.18
The dietary supplement glucosamine is sometimes used to
try to relieve joint pain. Studies do not show it is effective for rheumatoid
arthritis.19
Other Places To Get Help
Organizations
American College of Rheumatology
1800 Century Place
Suite 250
Atlanta, GA 30345
Phone:
(404) 633-3777
Fax:
(404) 633-1870
Web Address:
www.rheumatology.org
The American College of Rheumatology (ACR) and the
Association of Rheumatology Health Professionals (ARHP, a division of ACR) are
professional organizations of rheumatologists and associated health
professionals who are dedicated to healing, preventing disability from, and
curing the many types of arthritis and related disabling and sometimes fatal
disorders of the joints, muscles, and bones. Members of the ACR are physicians;
members of the ARHP include research scientists, nurses, physical and
occupational therapists, psychologists, and social workers. Both the ACR and
the ARHP provide professional education for their members.
The ACR
Web site offers patient information fact sheets about rheumatic diseases, about
medicines used to treat rheumatic diseases, and about care
professionals.
Arthritis Foundation
1330 West Peachtree Street
Suite 100
Atlanta, GA 30309
Phone:
1-800-283-7800
Web Address:
www.arthritis.org
The Arthritis Foundation provides grants to help find a cure,
prevention methods, and better treatment options for arthritis. It also
provides a large number of community-based services nationwide to make living
with arthritis easier, including self-help courses; water- and land-based
exercise classes; support groups; home study groups; instructional videotapes;
public forums; free educational brochures and booklets; the national, bimonthly
consumer magazine Arthritis Today; and continuing
education courses and publications for health professionals.
National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), National Institutes of Health
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS Web site provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
Harrison MJ (2003). Young women with chronic disease:
A female perspective on the impact and management of rheumatoid arthritis.
Arthritis and Rheumatism, 49(6): 846-852.
O'Dell JR (2004). Therapeutic strategies for
rheumatoid arthritis. New England Journal of Medicine,
350(25): 2591-2602.
O'Dell JR (2005). Rheumatoid arthritis: The clinical
picture. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 1, pp. 1165-1194.
Philadelphia: Lippincott Williams and Wilkins.
Harris ED Jr (2005). Clinical features of
rheumatoid arthritis. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 2, pp. 1043-1078. Philadelphia:
Elsevier Saunders.
Casey ATH, et al. (2002). Rheumatoid arthritis of the
cervical spine: Current techniques for management. Orthopedic Clinics of North America, 33(2): 291-309.
Kwoh CK, et al. (2002). Guidelines for the management
of rheumatoid arthritis. Arthritis and Rheumatism,
46(2): 328-346.
Ward MM (2004). Decreases in rates of hospitalizations
for manifestations of severe rheumatoid arthritis, 1983-2001. Arthritis and Rheumatism, 50(4): 1122-1131.
Verstappen SMM, et al. (2003). Five-year follow-up of
rheumatoid arthritis patients after early treatment with disease-modifying
antirheumatic drugs versus treatment according to the pyramid approach in the
first year. Arthritis and Rheumatism, 48(7):
1797-1807.
Goronzy JJ, et al. (2004). Prognostic markers of
radiographic progression in early rheumatoid arthritis. Arthritis and Rheumatism, 50(1): 43-54.
Nicola PJ, et al. (2005). The risk of congestive heart
failure in rheumatoid arthritis: A population-based study over 46 years.
Arthritis and Rheumatism, 52(2): 412-420.
Häkkinsen A (2004). Effectiveness and safety of
strength training in rheumatoid arthritis. Current Opinion in Rheumatology, 16(2): 132-137.
De Jong Z, et al. (2003). Is a long-term,
high-intensity exercise program effective and safe in patients with rheumatoid
arthritis? Arthritis and Rheumatism, 48(9):
2415-2424.
Goekoop-Ruiterman YPM, et al. (2007). Comparison of
treatment strategies in early rheumatoid arthritis. Annals of Internal Medicine, 146(6): 406-415.
Yocum DE, et al. (2003). Efficacy and safety of
tacrolimus in patients with rheumatoid arthritis. Arthritis and Rheumatism, 48(12): 3328-3337.
Nishimoto N, et al. (2004). Treatment of
rheumatoid arthritis with humanized anti-interleukin-6 receptor antibody.
Arthritis and Rheumatism,
50(6): 1761-1769.
Steultjens EMJ, et al. (2007). Occupational therapy
for rheumatoid arthritis. Cochrane Database of Systematic Reviews (4).
Brosseau L, et al. (2007). Transcutaneous electrical
nerve stimulation (TENS) for the treatment of rheumatoid arthritis in the hand.
Cochrane Database of Systematic Reviews (4).
Murray MT, Pizzorno JE Jr (2006). Rheumatoid
arthritis. In JE Pizzorno, MT Murray, eds., Textbook of Natural Medicine, 3rd ed., vol. 2, pp. 2089-2108. St. Louis:
Churchill Livingstone Elsevier.
Firestein GS (2007). Rheumatoid arthritis. In DC Dale,
DD Federman, eds., ACP Medicine, section 15, chap. 2.
New York: WebMD.
Other Works Consulted
Saag KG, et al. (2008). American College of
Rheumatology 2008 recommendations for the use of nonbiologic and biologic
disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis and Rheumatism, 59(6): 762-784.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
Harrison MJ (2003). Young women with chronic disease:
A female perspective on the impact and management of rheumatoid arthritis.
Arthritis and Rheumatism, 49(6): 846-852.
O'Dell JR (2004). Therapeutic strategies for
rheumatoid arthritis. New England Journal of Medicine,
350(25): 2591-2602.
O'Dell JR (2005). Rheumatoid arthritis: The clinical
picture. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 1, pp. 1165-1194.
Philadelphia: Lippincott Williams and Wilkins.
Harris ED Jr (2005). Clinical features of
rheumatoid arthritis. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 2, pp. 1043-1078. Philadelphia:
Elsevier Saunders.
Casey ATH, et al. (2002). Rheumatoid arthritis of the
cervical spine: Current techniques for management. Orthopedic Clinics of North America, 33(2): 291-309.
Kwoh CK, et al. (2002). Guidelines for the management
of rheumatoid arthritis. Arthritis and Rheumatism,
46(2): 328-346.
Ward MM (2004). Decreases in rates of hospitalizations
for manifestations of severe rheumatoid arthritis, 1983-2001. Arthritis and Rheumatism, 50(4): 1122-1131.
Verstappen SMM, et al. (2003). Five-year follow-up of
rheumatoid arthritis patients after early treatment with disease-modifying
antirheumatic drugs versus treatment according to the pyramid approach in the
first year. Arthritis and Rheumatism, 48(7):
1797-1807.
Goronzy JJ, et al. (2004). Prognostic markers of
radiographic progression in early rheumatoid arthritis. Arthritis and Rheumatism, 50(1): 43-54.
Nicola PJ, et al. (2005). The risk of congestive heart
failure in rheumatoid arthritis: A population-based study over 46 years.
Arthritis and Rheumatism, 52(2): 412-420.
Häkkinsen A (2004). Effectiveness and safety of
strength training in rheumatoid arthritis. Current Opinion in Rheumatology, 16(2): 132-137.
De Jong Z, et al. (2003). Is a long-term,
high-intensity exercise program effective and safe in patients with rheumatoid
arthritis? Arthritis and Rheumatism, 48(9):
2415-2424.
Goekoop-Ruiterman YPM, et al. (2007). Comparison of
treatment strategies in early rheumatoid arthritis. Annals of Internal Medicine, 146(6): 406-415.
Yocum DE, et al. (2003). Efficacy and safety of
tacrolimus in patients with rheumatoid arthritis. Arthritis and Rheumatism, 48(12): 3328-3337.
Nishimoto N, et al. (2004). Treatment of
rheumatoid arthritis with humanized anti-interleukin-6 receptor antibody.
Arthritis and Rheumatism,
50(6): 1761-1769.
Steultjens EMJ, et al. (2007). Occupational therapy
for rheumatoid arthritis. Cochrane Database of Systematic Reviews (4).
Brosseau L, et al. (2007). Transcutaneous electrical
nerve stimulation (TENS) for the treatment of rheumatoid arthritis in the hand.
Cochrane Database of Systematic Reviews (4).
Murray MT, Pizzorno JE Jr (2006). Rheumatoid
arthritis. In JE Pizzorno, MT Murray, eds., Textbook of Natural Medicine, 3rd ed., vol. 2, pp. 2089-2108. St. Louis:
Churchill Livingstone Elsevier.
Firestein GS (2007). Rheumatoid arthritis. In DC Dale,
DD Federman, eds., ACP Medicine, section 15, chap. 2.
New York: WebMD.
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