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What can I do about Rheumatoid Arthritis?
Being diagnosed with a chronic disease like RA can be a little scary. The first thing is don’t panic. Take a deep breath. Although you might have been diagnosed with RA, you are not alone. Luckily, there are effective treatments available. Even if they don’t cure RA, they can make living with the condition much more comfortable.
If you have RA or think you may have RA, your family doctor should refer you to a rheumatologist. A rheumatologist is a specialist doctor who is an expert in treating arthritis. This type of doctor is in the best position to help you manage your condition. Many people with inflammatory types of arthritis who see their rheumatologist regularly benefit from the highest level of care.
Here are some recommendations on what you should do:
- Learn as much as you can about this disease. Education is very powerful and we’ve aimed to develop this RheumInfo website to be accessible and easy to understand for everyday people living with RA and other forms of inflammatory arthritis
- Attend your rheumatologist appointments regularly
- Get your blood tests done as suggested by your rheumatologist
- Learn about the medications used to treat RA. The RheumInfo website has many interactive and valuable tools to help you understand these medications and their impact on your disease
Treatment of Rheumatoid Arthritis
Now is probably the best time in history to get RA. The approach to treatment has changed and the medicines available today are much more effective than in the past.
People with RA can lead active and productive lives with the right kinds of treatment. Whatever treatment approach you choose it is essential to remember two key points: treat RA early and treat it aggressively. Don’t wait. There is great treatment available that can help get you back to leading a full life.
Why is it important to treat Rheumatoid Arthritis early?
Research has shown us if you treat RA early you are much more likely to get into remission. Even a few months can make a difference. Here’s an analogy. Imagine you are sitting in your living room enjoying a nice cup of coffee. You look over to the kitchen and see a fire burning on the stove. What do you think you’ll do? One option is to just sit there and wait until the fire gets worse and spreads to the walls or the ceiling. The second option is to grab the phone, dial the fire department, and grab the fire extinguisher.
You can think of RA like a fire in your joints. You want to get that fire put out as quickly as possible so it doesn’t damage your body. Once the damage from RA is done it cannot be reversed. We want to stop RA before it damages your joints.
Why is it important to treat Rheumatoid Arthritis aggressively?
Using the same fire analogy, we’ve decided to call in the fire department. Now we need to make sure we have the right tools to put out the fire. We don’t want a bucket and water. We want a fire truck with a big hose. We might even want more than one fire truck. The faster we can get that fire out the better things will be in the long run.
That said, sometimes we call three fire trucks right off the bat. Sometimes rheumatologists use three medications right off the bat. This is called triple therapy. That strategy will be covered under the “Medications for RA” section.
Medications for Rheumatoid Arthritis
Medications for RA fall into two broad groups. The first includes medications that help control the symptoms of RA. The second group of medications control the disease and prevent long-term joint damage.
Medications that Control Symptoms
Corticosteroids (prednisone), NSAIDs, and Analgesics are groups of medications that help control RA symptoms. These drugs can help make it easier to live with the disease.
Medications that Control RA and Prevent Long-term Damage
Disease Modifying Anti-Rheumatic Drugs (DMARDs) and Biologics are “two-for-one” medications that help control your symptoms and prevent long-term damage. Biologics are often prescribed with DMARDs to maximize the effect of treatment.
For more information about specific medications used to treat RA, refer to the “pictopamphlets” in the Medications Section of this website.
Non-Steroidal Anti-Inflammatory Drugs or NSAIDs are medications that reduce the inflammation of joints caused by RA. They also help to reduce symptoms such as pain. Luckily there are about 20 different anti-inflammatory medications available. So if one doesn’t work for you, try another.
Medications like prednisone can help control inflammation. They may also prevent long-term damage in some people. Prednisone is a very effective medication to control the symptoms of RA. In the short-term, prednisone works very well to control symptoms. When used for long periods of time, prednisone can have side effects. You should to discuss the risks and benefits of using prednisone with your rheumatologist. Some patients also benefit from cortisone injections directly into a joint. This should be discussed with your rheumatologist.
Analgesic medications only control pain. They do nothing to control the disease or to prevent further joint damage. Analgesics can range from simple things like acetaminophen (Tylenol) to more potent narcotics like morphine.
The Disease Modifying Anti-Rheumatic Drugs (DMARDs) are medications that control symptoms and prevent long-term damage. Examples include methotrexate, sulfasalazine, hydroxychloroquine (Plaquenil), leflunomide (Arava), gold (Myochrisine), and azathioprine (Imuran).
DMARDs have been around for a long time and can work very well to control RA. Using two or three DMARDs together is called combination therapy. Today, we know that combination therapy works better than using a single DMARD alone. Common combinations include triple therapy with methotrexate, sulfasalazine and hydroxychloroquine.
Most DMARDs take some time before they begin to work (about 6-12 weeks). Some people might not feel any effect when they first start taking DMARDs. Even if this happens, it’s important to keep taking DMARDs to help put out the fire in the joints.
Biologics are the newest class of medications that have been around for about a decade. These medications were specifically designed to treat RA. They are very effective and can make a big difference for people living with RA. Like DMARDs, biologics control symptoms and prevent long-term joint damage.
Biologics are often given in combination with DMARDs. The most common combination is with methotrexate. This is because combination therapy has been shown to work better than treatment with either medication alone.
There are now 9 biologics available including Humira, Remicade, Enbrel, Cimzia, Simponi, Rituxan, Orencia, Acemtra, and Kineret. With 9 different biologics to choose from, if one doesn’t work, your rheumatologist may suggest another.
Exercises for Rheumatoid Arthritis
Exercise is important to overall health. The level and amount of exercise you can do depends on the activity of your arthritis. A trained arthritis physiotherapist can help design an exercise program tailored to you and your needs.
Below are some useful articles on exercising with arthritis:
Exercise and Arthritis: An article by arthritis physiotherapist, Marlene Thompson
Exercising in a Flare: Another excellent article written by Marlene Thompson on how to cope with flares through your exercise routine.
Natural or Home Remedies for Rheumatoid Arthritis
There are no known natural remedies or complementary therapies that have been proven to help RA in any significant way. However, it’s important to check with your rheumatologist to make sure that nothing interacts with your medication if you choose to use natural remedies or complementary therapies.
Surgery for Rheumatoid Arthritis
In the most severe cases of RA, the joints can become so badly damaged that they no longer function. If this happens, surgery might help. Surgery usually involves replacing a damaged joint with an artificial joint. Surgery can help people with severe, advanced RA by reducing pain, improving their mobility and restoring their functioning.
Diet for Rheumatoid Arthritis
Questions about diet and arthritis are very common. We all want to know what we can do to help ourselves. Can we change our diet to improve our immune system and help our arthritis? Changing our diet gives us a sense of control over a disease which often seems to have a mind of its own.
Unfortunately, there is no diet that has been proven to significantly alter the course of RA or other types of arthritis. Following the basics of healthy eating can help improve health and well-being in everyone, including those with RA. Keeping a healthy weight can help reduce the load on your weight-bearing joints including the spine, hips, and knees.
Alcohol and Rheumatoid Arthritis
Many of us like to share a glass of wine, a beer, or a spirit from time to time. Unfortunately, due to the nature of RA, some people may turn to alcohol to help cope with the pain and distress. Alcoholic beverages are not an effective treatment for RA. They can also interact with some medications. Examples include the DMARDs methotrexate, leflunomide, and azathioprine.
Besides, there are so many effective treatments available for RA, you don’t need to try to manage your illness with alcohol.
Smoking and Rheumatoid Arthritis
Cigarette smoking, whether you have RA or not, has no positive effects on any aspect of your health.
Did you know that people who smoke have a higher chance of developing RA? The good news is that the chances decrease in those who stop smoking.
Smoking also makes RA worse and more difficult to treat. The reasons for this are not clear. But it’s thought that chemicals in the cigarettes may interfere with medications for RA. Smoking can also make RA nodules worse.
So if you are a smoker with RA, quitting could be one of the best things you can do to improve your overall health.
You want to keep looking good for a long time!
It’s important to keep your joints looking good. Think of it like this – imagine you want to keep your face looking good for a long time. Putting on lipstick will help from day to day. But to make the wrinkles go away a facelift does a better job. The same is true with RA. DMARDs and biologic medications are like getting a face lift. They’ll protect your joints over the long run and keep them looking good for a long time. For day-to-day pain and discomfort then NSAIDs, prednisone, and analgesics can be used. They’re like lipstick – some days you need them and some days you feel pretty good without them. Of course, this analogy applies more to women than to men!