Arthritis

 

Osteoarthritis is the pain and stiffness that results from normal wear and tear on your joints over time.

Rheumatoid arthritis, however, is caused by an immune disorder. Its symptoms are more generalized and usually more severe. The disease typically strikes your hands, feet and other joints. It causes painful swelling, inflammation and sometimes deformity.

Years ago, rheumatoid arthritis may have left you confined to a wheelchair. That's not as likely today. Doctors are finding that rest, exercise, more aggressive use of medications, and sometimes surgery, can help many people with rheumatoid arthritis lead nearly normal lives.

Joints most often affected by rheumatoid arthritis are those in your wrists, hands, feet and ankles. The disease can also invade your elbows, shoulders, hips, knees, neck and jaw. Occasionally, it can cause inflammation in membranes surrounding internal organs, such as your heart and lungs.

The disease affects about 2.5 million Americans and is three times more common in women than men. It generally strikes between ages 20 and 50, but can also affect very young babies and older people.

The most common signs and symptoms of rheumatoid arthritis are joint swelling, stiffness and pain. The pain may be similar to that of a headache or toothache. Affected joints may also feel warm to the touch, and the skin covering them may appear reddish. On days when the disease is more active, you may actually feel "sick." Symptoms may include fatigue, loss of appetite, fever, sweats and difficulty sleeping. About one-fifth of people with rheumatoid arthritis also develop rheumatoid nodules -- lumps of tissue under your skin, often over bony areas such as your elbows. The disease varies from person to person. Some people experience symptoms that come and go. These episodes are called flares and remissions. Others may have continuous symptoms that generally worsen with time.

The cause of rheumatoid arthritis is unknown. Many researchers believe an infection triggers the disease among people who carry a genetic susceptibility. Researchers believe that you can't actually inherit the disease, but that you can inherit a tendency to develop it. But this hasn't been proven.

If you have rheumatoid arthritis, you may wonder about:

Diet -- Some people claim that particular foods help their symptoms or make them worse. A few studies suggest benefits from low-calorie, low-fat and low-protein diets. Other studies indicate that eating large amounts of omega-3 fatty acids from cold-water fish (salmon, mackerel, herring) and plant oils may reduce joint tenderness. But check with your doctor before taking omega-3 fatty acid supplements (fish oil capsules). They can result in loose stools and abdominal discomfort, and possibly even increase your risk of stroke.

Climate -- People often wonder if moving to a different climate will ease symptoms. In most cases, a change doesn't make a big difference.

Alternative therapies -- There are many alternative treatments available -- everything from antioxidants to copper bracelets. Two popular therapies are the dietary supplements glucosamine and chondroitin sulfate. A few small studies have suggested benefits. But no long-term, controlled studies have been done to prove safety and effectiveness. The Arthritis Foundation and most physicians don't recommend their use. Be careful when considering alternative therapies. Many are expensive and some may be harmful.

Medications

There is no treatment that can cure or reverse rheumatoid arthritis. However, there are medications that can relieve its symptoms and slow or halt its progression. The four types of drugs are:

Nonsteroidal anti-inflammatory drugs (NSAIDs) -- This group of medications, which includes aspirin, helps relieve pain and inflammation. Side effects may include stomach upset and stomach bleeding. Therefore, NSAIDs should always be taken with food.

Cox-2 inhibitors -- Similar to NSAIDs, this new class of medications may be less damaging to your stomach. Like NSAIDs, cox-2 inhibitors suppress an enzyme called cyclooxygenase (cox) that triggers joint inflammation and pain. Researchers believe that NSAIDs work against two versions of cox that are present in your body (cox-1 and cox-2). However, there is evidence that in suppressing cox-1 NSAIDs may cause stomach and other problems because cox-1 is the enzyme that protects your stomach lining. Cox-2 inhibitors work selectively, suppressing only cox-2, the enzyme involved in inflammation. There are a number of pharmaceutical companies developing cox-2 inhibitors and none has yet received final approval from the Food and Drug Administration.

Corticosteroids -- These medications (cortisone, prednisone and others) reduce inflammation and slow joint damage. In the short term, corticosteroids can make you feel dramatically better. However, when used for many months or years, they may become less effective and also cause serious side effects. Side effects may include easy bruising, thinning of your bones, cataracts, weight gain, a round face, diabetes and high blood pressure. Doctors will often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering you off the medication.

Disease-modifying antirheumatic drugs (DMARDs) -- These medications have been shown to slow or halt the progression of rheumatoid arthritis. In the past, they were used only if you had more severe rheumatoid arthritis and noticeable joint destruction. Today, DMARDs are prescribed early to try to prevent destruction. When taken in proper doses, the drugs aren't as toxic as once believed. Depending on the drug used, side effects can range from blurry vision to increased susceptibility to infection. Three of the most commonly prescribed DMARDs are methotrexate (Rheumatrex), hydroxychloroquine (Plaquenil) and gold (Myochrysine, Solganal). Sometimes, a combination of DMARDs may be used if one alone isn't effective. Because they don't relieve symptoms, DMARDs are taken in addition to an NSAID, a corticosteroid, or both. The drugs are slow-acting, so it may take months before you notice benefits.

Rest and exercise are also key parts of treatment. During times when your joints are more warm, swollen and painful, rest helps. You should continue to do range-of-motion exercises to keep your joints mobile, but don't get overly tired or aggravate your joints with unnecessary walking, housework or other activities. Schedule a time to lie down and rest at midday, even if you don't sleep.

Increase exercise when your joints feel better and when you have less fatigue and morning stiffness. Weight-bearing exercises, such as walking and lifting weights, were once forbidden. But studies have found they can strengthen weakened muscles without additional joint damage. If exercise produces more pain or joint swelling, next time do less.

For about one-third of people with rheumatoid arthritis, treatment can't prevent joint destruction. When this occurs, surgery can often help restore joint function, reduce joint pain or correct a deformity. You may need to have the entire joint replaced with a metal or plastic prosthesis. Surgery may also involve tightening tendons that are too loose, loosening home due to age or disability.