New treatments for a painful disease.
About 2 million Americans suffer from rheumatoid arthritis (RA), a painful, disabling and potentially life-threatening disease. Back in Grandma's day, all doctors could offer was pain management as RA crippled their patients. Today, newer treatments relieve painful symptoms but also provide damage control and hope for a new generation of people with RA.
RA is a disorder where part of your immune system attacks your body. It worsens with time and twists your joints. It affects more women than men. Usually, it starts in middle age, but it can strike any time, including in childhood. It usually begins with pain throughout small joints, like your hand, wrist, ankle or feet joints, and then moves to larger joints, like your shoulders, hips and neck.
The Arthritis Foundation says RA gets worse in three stages:
- The joint lining (synovial membrane) swells, causing joint pain, warmth, stiffness, redness and soreness.
- Rapid reproduction and growth of the cells in your joints thickens the joint lining.
- Inflamed cells release enzymes that dissolve bone and cartilage, often twisting joints so that they don't move well.
You start to look twisted and gnarled. You get red, puffy hands, firm bumps under your skin, stiffness and weight loss. It's an ongoing condition that flares up, causing fever and fatigue, and then seems to get better, then flares up again. Currently, there's no cure for RA, and you usually have it the rest of your life.
Unlike other kinds of arthritis, RA does more than damage joints. Untreated, it can attack major organs. Severe cases include life-threatening complications like heart damage and inflammation of the blood vessels, open sores in the skin, infections, stomach ulcers and nerve damage.
What causes RA?
According to Dr. Dennis Bley, internal medicine physician at Broadway Medical Group in Portland, Oregon, "We don't know why people get RA. It's not genetic, but a predisposition, for it runs in families, making you susceptible to environmental triggers. In studies, RA looks a lot like infection. The body attacks itself as a defense against illness. People who smoke and live unhealthy lifestyles are at higher risk for developing it."
How is RA diagnosed?
No single test tells you that you have RA. Instead, your doctor determines if you have it through a physical exam, medical history, blood tests and medical imaging. Medical imaging includes X-rays, an MRI, ultrasounds and a DEXA scan to see if you have joint swelling and bone loss.
How is RA treated?
You get the best relief from RA with treatments that combine drugs with occupational and physical therapy. The sooner treatment starts, the better chance you can avoid the permanent damage RA can cause. Unfortunately, many drugs that treat RA have unpleasant side effects.
Commonly used drugs include:
- NSAIDs, including aspirin, ibuprofen, naproxen, indomethacin and Cox-2 inhibitors (like Celebrex), reduce inflammation and pain. Side effects include ringing in the ears, bleeding, bruising, stomach irritation, stomach ulcers, heart problems, and liver and kidney damage.
- Analgesics like Tylenol and narcotics provide pain relief but don't reduce inflammation.
- Steroids like prednisone reduce inflammation, but long-term use can cause serious complications, including diabetes.
- DMARDs (disease-modifying antirheumatic drugs) slow RA's progress and prevent joint and organ damage. Side effects include liver damage, interference with how your bone marrow works and lung infections. Common DMARDs include methotrexate (Rheumatrex, Trexall), lefunomide (Arava), hydroxychloroquite (Plaquenil), sulfasalazine (Azulfidine) and minocycline (Dynacin, Minocin).
- Biologic response modifiers keep the immune system from making certain proteins that cause inflammation.
- Protein-A immunoadsorption therapy filters inflammatory antibodies and immune complexes out of your blood.
- Immunosuppressant medications target inflammatory substances.
Physical therapists prescribe massage, heat and cold therapies, and exercises to strengthen the muscles surrounding your joints, reduce stiffness and reduce further damage. If your joints get severely damaged, you may need surgery, including joint replacement, tendon repair, removal of the joint lining and joint fusion.
According to Dr. Bley, treating RA is difficult. "It's frustrating because there's no cure. DMARDs are our best tool to slow disease progression [and] save joints and organs from permanent damage, but [they] cause their own complications. For example, steroids are effective for flare-ups, but cause swelling, anxiety, weight gain and make patients extremely grumpy. Physical therapy, occupational therapy, stress management and exercise all help."
After that, Dr. Bley says, it all depends on how patients respond. "Some do really well; others can't stand the side effects. The trick is finding the right medications and treatments that patients can tolerate. That's all we've got, and that's tough for patients and doctors. Besides medication, the best thing patients can do is get educated about RA and live a balanced life. Exercise, eat well, sleep and control stress."
What's down the road for RA?
Researchers are working to better understand the disease to tailor treatments, to increase how well drugs work and their availability, and to reduce side effects. Scientists hope that someday they'll find gene markers for RA so that they can treat the disease before it causes damage.
- What Is Rheumatoid Arthritis?
- The Mayo Clinic: Rheumatoid arthritis
- Rheumatoid Arthritis and Complementary Health Approaches
Published on May 17, 2010; updated on June 5, 2014.