Rheumatoid arthritis can be successfully managed using a combination of medications and non-pharmaceutical treatments. The goals of therapy are to control the disease, relieve pain, maximize quality of life and to slow or stop joint damage. Therapy should also be as affordable and free of side effects as possible.

For many years RA was treated with aspirin, rest and other non-pharmaceutical approaches, with powerful drugs introduced only after the disease got much worse. This approach changed, however, when studies showed that NSAIDS did little to alter the course of RA and that most of the damage occurs during the first two years. Now moderate or severe RA is treated with aggressive medication before damage can occur, and the long-term outcome is significantly improved.

Another positive change concerns the doctor-patient relationship. Today's RA patients are better-informed medical consumers who are more likely to take active roles in their therapy. Similarly, physicians now seek ways to empower patients, knowing that those who feel less victimized by their disease find it easier to comply with their treatment regimen.

Most patients are treated with a combination of therapies. Medication, rest and exercise, physical and/or occupational therapy, diet, emotional support, and in some cases, surgery may be used.

Medication

Medication plays a vital role in the treatment of RA. Patients frequently use two or more medications, each of which has both potential side effects as well as benefits. Together, patient and physician must weigh the benefits of the drugs against the possible side effects.

Disease modifying anti-rheumatic drugs, or DMARDs, can alter the course of the disease if started early. DMARDs include hydroxychloroquine, gold compounds, methotrexate, sulfasalazine, and cyclosporine. DMARDs are slow acting, and patients will not see progress until they have been taking a DMARD for one or two months.

Nonsteroidal anti-inflammatory drugs, or NSAIDs, do not affect the disease itself, but may be given to help alleviate pain and stiffness. NSAIDS work by slowing the production of prostaglandins, which promote inflammation and pain. Most NSAIDS cause stomach irritation or gastric problems. Low doses of Prednisone, a steroid, may be safer and more effective than NSAIDs.

Rest and exercise

Every RA patient must find the right balance of rest and exercise. During disease flares, rest is needed. Sometimes a specific joint may need to be splinted to gain sufficient rest. If the overall disease is active and painful, sometimes complete bed rest is appropriate. Too much rest, however, can cause stiffness and reduce joint mobility. During flares simple range of motion exercises can be done to preserve joint mobility. Aquatic exercise may also be helpful because water protects the joints and facilitates motion.

When flares subside, exercise can be increased. Exercise that works the cardiovascular system is important for building endurance. Range of motion exercises and exercises that strengthen muscles but don't stress joints are also important.

Physical and/or occupational therapy

Physical and occupational therapists can provide valuable guidance for RA patients. They can help patients learn to protect their joints with special exercises, applications of heat or cold, splints or other joint protection devices, and by teaching ways to reduce strain in everyday work and home activities. Therapists can also help with rehabilitation after joint replacement surgery.

Diet

There is no diet that can prevent or cure RA. However, a nutritious, balanced diet is important because RA patients need to stay close to their appropriate body weight. Extra pounds place excessive stress on joints. In addition, overweight people are less likely to be active, which contributes to joint stiffening. At the other extreme, RA flares may cause some patients to lose their appetites.

Maintaining adequate caloric intake and balanced nutrition is especially important during flares. If the person is on steroids, calcium and vitamin D supplements are needed. A diet high in Omega 3 fatty acids may benefit RA patients by reducing inflammation. Omega 3 fatty acids are found in cold water fish like herring or salmon and are also available in capsule form.

Emotional support

When many joints are involved, RA can be emotionally distressing and sometimes depressing as well. Stress and depression make it even harder to cope with RA. Arthritis support groups and counseling sessions are designed to help diminish emotional stress. These groups provide forums for discussing problems, learning more about RA, and building supportive relationships. Sometimes medication for depression is helpful too.

Surgery

Patients whose joints are severely damaged by RA may opt for repair or replacement surgery. Orthopedic surgeons, doctors who specialize in joint surgery, can perform several procedures that benefit RA patients. Sometimes a joint is so badly destroyed that it cannot be repaired, and must be replaced instead. The most common replacement procedures are done on hip, knee and hand joints.

References

First published September 1, 1999
Last updated December 16, 2002
Copyright © 1999 Accordant Health Services, Inc. All Rights Reserved.

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