Arthritis-Rheumatoid
Rheumatoid Arthritis
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Arthritis is the name given to a group of related diseases which include osteoarthritis (degenerative
arthritis), rheumatoid arthritis, juvenile arthritis, psoriatic arthritis, ankylosing spondylitis, lupus and fibromyalgia.
In its various forms, arthritis affects the young and old, both sexes and all races. Although
there are over 100 kinds of arthritis, they share one thing in common: they all rob otherwise
healthy people of their quality of life by making even the simplest of movements painful.
This pain is caused by inflammation of the lining of the body’s joints.
WHAT IS RHEUMATOID ARTHRITIS?
Rheumatoid arthritis is a painful condition where the lining of the joints becomes inflamed.
This inflammation is particularly common in the hands and feet. Unlike osteoarthritis, the
condition does not result from prolonged “wear and tear.” Rather, it is precipitated
by an improper immune response, which causes the body to attack its own healthy tissue. Rheumatoid
arthritis may also affect the eyes, lungs and heart. As it progresses, the disease results
in damage to the cartilage, bone, tendons and
ligaments.
HOW COMMON IS RHEUMATOID ARTHRITIS?
Rheumatoid arthritis affects one in 100 in the USA and Canada. It is twice as prevalent
among women than men and most common among people aged 25 to 50.
WHAT ARE THE WARNING SIGNS?
The following signs frequently signal rheumatoid arthritis:
- Swelling, heat or redness in a joint, often accompanied by tenderness or pain.
- Morning stiffness that persists beyond 30 minutes.
- Persistent pain in a joint, often lasting the whole night.
- Pain that occurs in three or more joints at the same time.
- Pain that occurs in the same joints on both sides of your body.
- Low energy or fatigue. (This can be symptomatic of many diseases. If you are fatigued
beyond two weeks, see your doctor or other health care provider.)
- Fever and weight loss usually combined with one or more of the above symptoms.
The early symptoms of rheumatoid arthritis differ from person to person. They may start
gradually or as a sudden attack of flu-like symptoms. Once established, rheumatoid arthritis
may produce consistent pain, or have a pattern of “flare-ups” and remission.
The earlier rheumatoid arthritis is diagnosed and treated, the better your chances of controlling
the disease and preventing severe joint damage. If you experience any of the above symptoms,
you should see your doctor as soon as possible. He or she will develop a plan of action based
on your individual condition and needs.
HOW DOES RHEUMATOID ARTHRITIS PROGRESS?
If left untreated, rheumatoid arthritis can cause severe joint damage. The resulting pain
can hamper the ability to walk and to use the hands for performing normal tasks.
In addition to causing painful, inflamed joints, rheumatoid arthritis may cause inflammation
in other body tissues and organs. In 20 percent of cases, lumps known as rheumatoid nodules
develop underneath the skin, often over bony areas. While these are most common over the elbow,
they may be found elsewhere on the body, including the internal organs.
Occasionally, people with rheumatoid arthritis develop inflammation of the membranes that surround
the heart and lung. Inflammation may also occur in the
tear glands and salivary glands, resulting in dry eye and dry mouth. In rare occasions, rheumatoid
arthritis causes inflammation of the blood vessels, in turn
affecting the nerves, skin, and other organs.
WHAT CAUSES INFLAMMATION?
Inflammation is the body’s natural response to being injured. It is characterized
by redness, swelling, heat and pain. When your joints become inflamed, you may experience
any or all of these symptoms. Inflammation can prevent the normal use of the joint and cause
it to lose the ability to function properly. The key to reducing the pain of arthritis, and
to halting its progression, is controlling the inflammation that precedes the condition.
Drugs developed to manage arthritis normally work by curbing the inflammatory process.
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UNDERSTANDING ARTHRITIS MEDICATIONS
If you have been diagnosed with rheumatoid arthritis, your doctor will review the best
course of treatment and pain management. This will likely include medication. Here are the
most commonly used arthritis medications, and how they work.
MEDICATIONS THAT CONTROL SYMPTOMS
These include non-steroidal anti-inflammatory drugs (NSAIDs). They help you to feel better
by reducing the amount of discomfort that you experience but they do not inhibit the disease
process itself. For this reason, they cannot prevent the damage associated with arthritic
conditions, such as bone and joint impairment. These formulations typically take a few days
to a few weeks to control pain effectively. Corticosteroids inhibit the disease process to
a degree but cannot be taken over the long-term due to their side effects.
- NSAIDs
Pronounced “ensayds,” these drugs help reduce
pain and swelling in the joints while decreasing stiffness.
When a low dose is taken, NSAIDs control pain, but higher
doses are required to reduce inflammation. The problem with
NSAIDs is their side effects. Taking more than one NSAID
at a time increases the possibility of heartburn and severe
side effects such as ulcers and bleeding. NSAIDs inhibit
the blood’s ability to clot properly and may therefore
interact with blood-thinning medications such as coumadin.
Kidney disease has also been reported as a side effect.
Most NSAIDs require a prescription, including naproxen (Naprosyn®),
nabumetone (Relafen®), indomethacin (Indocid®),
diclofenac (Voltaren®), piroxicam (Feldene®) and
sulindac (Clinoril®). Other NSAIDs are available over-the-counter;
these include ASA (Aspirin®, Anacin® and others),
and ibuprofen (Motrin IB®, Advil® and others.)
- COX-2 Inhibitors
This sub-class of NSAID has recently been introduced to
the North American marketplace. The most frequently prescribed
Cox-2 inhibitors are celecoxib (Celebrex®), rofecoxib
(Vioxx®), valdecoxib (Bextra®) and meloxicam (Mobicox®).
Unlike standard NSAIDs, Cox-2 inhibitors do not inhibit
proper blood clotting. Recent evidence, however, strongly
suggests that Cox-2 inhibitors have the same degree of negative
side effects as standard NSAIDs—including contributing
to kidney failure—and may increase the risk of heart
attack and other cardiovascular problems.
*Important News Release September 2004
Vioxx®, the cox-2 inhibitor made by Merck, has been
pulled from the market because of severe lethal side effects
due to heart attack and stroke.
- CORTICOSTEROIDS
Oral corticosteroid drugs are frequently used to treat extreme
inflammation, pain and stiffness. They are also prescribed
to help control systemic rheumatoid arthritis (affecting
the internal organs, nerves, blood vessels, etc.).The most
commonly used oral corticosteroid is prednisone. Long-term
use of this drug may give rise to cataracts, high blood
pressure, problems sleeping, muscle loss, bruising, osteoporosis
(thinning of the bones), weight gain, immune suppression
and increased susceptibility to infection. If you are prescribed
a corticosteroid, your doctor will give you the lowest possible
dose to begin with, slowly reducing this after six months
use.
Cortisone may be injected directly into the joint to relieve
severe inflammation and swelling. Cortisone mimics the anti-inflammatory
effects of cortisol—a hormone produced naturally in
the body. A cortisone injection can provide almost immediate
relief for a tender, swollen or inflamed joint. However,
since corticosteroids can weaken cartilage and remove
minerals from the bone, they should only be used rarely.
Chronic use of corticosteroids may result in immune suppression
and increase the risk of infection.
SUBSTANCES THAT MAY HELP MODIFY THE DISEASE PROCESS
These include DMARDs (disease–modifying anti-inflammatory drugs) and a relatively
new class of drugs known as Biologics. They help to prevent the joint damage that can increase
discomfort and lead to deformities.
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