There’s no cure for rheumatoid arthritis, but there are numerous treatments that can alleviate symptoms.
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Rheumatoid arthritis can turn life’s simple tasks–such as moving a pot on the stove or squeezing a tube of toothpaste–into painful and difficult chores. A disease of the joints, rheumatoid arthritis (RA) is a chronic condition that develops when the immune system goes awry, attacking the body’s own tissues and setting up a cycle of pain and inflammation.
RA can occur at any age but most often develops between 30 and 50 years of age. It affects about two million Americans, and women are three times as likely as men to be affected.
RA targets the synovium, the cell layer that lines and lubricates joints. The immune system mistakenly attacks these cells causing the synovium to become red and swollen, making the joint painful and misshapen.
RA is characterized by morning stiffness that lasts at least an hour, swelling and redness in joints, and fatigue. It usually occurs on both sides of the body and tends to affect the joints we move most: shoulders, wrists, ankles and finger and toe joints.
The symptoms can develop slowly or the disease can strike suddenly, leaving a previously active adult incapacitated by pain and stiffness virtually overnight. Regardless of how quickly symptoms appear, it’s important to seek medical attention promptly. The inflammation typical of RA creates irreversible joint damage and physicians now know that serious joint damage occurs in the first two years of the disease. Early diagnosis and treatment can limit joint damage and bone loss and possibly moderate the course of the disease. Once RA is suspected or diagnosed most patients are referred to a rheumatologist, an arthritis specialist.
Although there’s no cure for RA, there are numerous treatment options that alleviate symptoms, including many newly-developed drugs. In the past, early treatment focused on nonsteroidal antiinflammatory drugs (NSAIDs) to treat pain and inflammation, but more aggressive, early therapy is now favored.
The drugs of choice, known as disease modifying antirheumatic drugs (DMARDs), act in different ways. They include methotrexate, sulfasalazine, gold salts, hydroxychloroquine and infliximab. Early treatment with DMARDs can limit joint destruction.
For more than a decade methotrexate has been the most commonly prescribed DMARD, and it’s considered to have a good safety profile. It may be used alone, but, because no single drug is effective for even a majority of patients, the trend today is to use DMARDs in varying combinations.
All of the DMARDs have potentially serious side effects and patients have to be monitored for toxicity with regular blood screening and checks of kidney and liver function.
Glucocorticoids, including prednisone, are often used to treat the pain and inflammation of RA. Although they can be effective in relieving symptoms, they have serious side effects when used long-term, including a higher risk of diabetes, weight gain, glaucoma, and osteoporosis. A recent Scottish study found that women who used prednisone long-term increased their risk of a heart attack three-fold. The American College of Rheumatology recommends using glucocorticoids as a bridge therapy while waiting for the slower-acting DMARDs to take effect.
Although exercise can be difficult, it is important to keep joints moving and flexible. Exercise can also help control weight, maintain cardiovascular fitness and improve mood. Fitness plans often include swimming and water exercises in heated pools, walking, riding a stationary bike and light work on weight machines.
A number of studies have shown the power of diet in controlling some of the symptoms of RA. Diets high in omega 3 fatty acids from salmon, sardines and other fatty fish produce a small but measurable decrease in inflammation and pain.
The Mediterranean diet, emphasizing olive oil, fish, poultry, fruits and vegetables has reduced pain and improved mobility in RA patients who followed the diet for three months.
Managing RA is an ongoing challenge. It’s important to maintain an active dialogue with your treatment team and to stay abreast of new treatment options. For those newly diagnosed there is a sense of urgency about beginning therapy as researchers believe that the first two years after diagnosis offer a window of opportunity to alter the course of the disease.
Act Early with RA
Serious joint damage can occur in the first two years of rheumatoid arthritis. Starting treatment early with disease modifying antirheumatic drugs (DMARDs) can slow the progression of the disease and limit joint damage.
In one study comparing two treatment approaches, one group of subjects used the drug auranofin, a DMARD, early; the second group waited for eight months before beginning DMARD therapy. At a five-year followup the patients who had been treated early had better outcomes and less joint damage compared with those who started DMARD therapy late.
[SOURCE: Ted Mikuls and James O’Dell, “Managing RA in the Primary Care Setting,” The Journal of Musculoskeletal Medicine, January 2003]
Breastfeeding Lowers RA Risk
Data from the Nurses’ Health Study indicated that women who breastfed their babies for a lifetime total of 12 months or more had a lower risk of developing rheumatoid arthritis than women who breastfed for a short time or not at all.
The study showed a strong protective trend. The longer a woman nursed, the lower her overall risk of RA.
Researchers aren’t sure of the exact mechanism at work but believe it has to do with changing levels of female hormones related to breastfeeding.
[SOURCE: Diana Mahoney, “Breast Feeding May Protect Against Rheumatoid Arthritis,” Family Practice News, December 15, 2002]
The Course of RA Varies
For some individuals, rheumatoid arthritis may cause pain and inflammation for a couple of months or years and then go into remission. For others, it’s a crippling disease that makes it impossible to work or enjoy many physical activities.
About 20 percent of patients experience relatively mild symptoms that then go into remission. The majority have chronic joint pain, swelling and flare ups triggered by other illnesses or stress. About five percent of RA patients develop a severe form of the disease and suffer extensive pain and disability as well as damage to other organs of the body.
[SOURCE: “Rheumatoid Arthritis,” Chemist and Druggist, February 15, 2003]
Methotrexate Extends Life
Methotrexate may help patients with rheumatoid arthritis live longer, according to researchers at the University of Manchester, England.
Researchers followed the progress of 197 patients from eight European countries over 10 years. All of the patients were treated only with methotrexate between 1979 and 1990, although not all patients received the same dose and some took methotrexate for only a short period.
At the 10-year followup 56 patients had died. Patients were grouped into four categories depending on the length of time they had taken methotrexate, ranging from less than a year to more than six years.
Those who had taken methotrexate for more than six years were 80 percent less likely to have died compared with those who had taken the drug for less than a year. Researchers concluded that those with the highest exposure to methotrexate had a mortality benefit of 6.7 years compared with those with the lowest exposure.
[SOURCE: Diana Mahoney, “Methotrexate May Help RA Patients Live Longer,” Internal Medicine News, January 15, 2003]
Therapy Can Help
Patients Adjust to RA
Cognitive-behavioral therapy can help rheumatoid arthritis (RA) patients deal psychologically with the disease, although it doesn’t change pain or disability, according to a study from the Netherlands.
A group of patients with RA and depression, anxiety or a passive coping style were treated with 10 individual therapy sessions plus a single booster session after six months.
At both six and twelve months, the patients reported less depression, less fatigue and said they perceived receiving more support. They also showed improvement related to feelings of helplessness and active coping skills.
[SOURCE: Robert Finn, “Behavioral Therapy Helps Arthritis Patients: No Effect on Pain,” Family Practice News, May 15, 2003]
RA Increases Heart Risk
Women with rheumatoid arthritis (RA) face a significantly higher risk of having a heart attack compared with women with no history of RA, according to data from the Nurses’ Health Study. Women who had RA for more than 10 years were more than three times as likely to suffer a heart attack. The risk of stroke was no higher for women with RA, however.
Women with RA need to be aware of this increased risk and to work with their physicians to ensure they follow a heart-healthy lifestyle.
[SOURCE: Jeff Bauer, “Women, Rheumatoid Arthritis and MI Risk,” RN, April 2003]
REFERENCES:
Amy Cannella and James O’Dell, “Use of Combination Therapy for RA,” April 2003.
Kathryn DeMott, “Options for Treating Rheumatoid Arthritis,” Internal Medicine News, January 15, 2003.
M. Hoekstra et al, “Factors Associated with Toxicity, Final Dose, and Efficacy of Methotrexate in Patients with Rheumatoid Arthritis,” Annals of the Rheumatic Diseases, May 2003.
Diane Mahoney, “Methotrexate May Help RA Patients Live Longer,” Internal Medicine News, January 15, 2003.
Ted Mikuls and James O’Dell, “Managing RA in the Primary Care Setting,” The Journal of Musculoskeletal Medicine, January 2003.
“Rheumatoid Arthritis,” Chemist and Druggist, February 15, 2003.
“Rheumatoid Arthritis: a New CAD Risk Factor,” Internal Medicine Alert, April 29, 2003.
“Rheumatoid Arthritis Help,” Better Nutrition, May 2003.
E. Saxne et al, “Ten Year Outcome in a Cohort of Patients with Early Rheumatoid Arthritis,” Annals of the Rheumatic Diseases, December 2002.
“Should Glucocorticoids Be Used To Treat Early Rheumatoid Arthritis?” Family Practice News, March 15, 2003.
“Successful RA Drugs Identified,” GP, February 3, 2003.
Diana Taibi and Cheryl Bourguignon, “The Role of Complementary and Alternative Therapies in Managing Rheumatoid Arthritis,” Family and Community Health, January-March 2003.
“Very Early “Therapeutic Window” for RA,” The Journal of Musculoskeletal Medicine, May 2003.
Nancy Walsh, “New Generation of Biologic Agents for Rheumatoid Arthritis Targets IL-1 (Cytokine Traps),” Internal Medicine News, May 1, 2003.
Nancy Walsh, “Patients on High-Dose Steroids Face Increased Risk of CVD,” Internal Medicine News, May 1, 2003.
