Tag Archives: rheumatoid arthritis

Knowing Your Arthritis


Before we go any further, we must first distinguish the differences between these two types of Arthritis:

1) Osteoarthritis?

2) Rheumatoid Arthritis?

I hope the very brief summary below should be enough to take us through in understanding them!

What is Osteoarthritis?

If osteoarthritis had been with us from the beginning of time,one should wonder why in today’s advances in Medical technologies we still can not find the cure?
While the exact cause of OA is unknown, joint damage can be due to repetitive movement (also known as “wear and tear”). It can also begin as the result of an injury. Either way, with OA there’s erosion of the cartilage, the part of the joint that covers the ends of the bones.

Some factors that may increase your risk of developing OA:
Age
Gender
Obesity
Joint Alignment
Heredity
What is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is an autoimmune disease where the body’s immune system attacks normal joint tissues, causing inflammation of the joint lining.

Symptoms of Rheumatoid Arthritis

If you experience some of these symptoms, you may want to talk to your doctor:
Pain and stiffness lasting for more than 1 hour in the morning or after a long rest
Joint inflammation in the joints closest to the hand, such as wrist and fingers, although the neck, shoulders, elbows, hips, knees, ankles, and feet can also be affected
Symmetrical pattern of inflammation, meaning both sides of the body are usually affected at the same time
Fatigue, an occasional fever, and a general sense of not feeling well (called malaise)

Effects of rheumatoid arthritis

Rheumatoid arthritis can cause joint inflammation, which can affect the ability to go about your daily activities. If left untreated, RA can worsen and destroy joints. After the onset of the disease, some of the effects of RA are as follows:
Tendons become inflamed and may rupture (tear apart).
Swelling can severely damage or destroy ligaments that hold joints together. It can also damage joint cartilage and bone.
Erosion of the bones of the joint can occur, causing pain and deformity.

Rheumatoid arthritis diagnosis:

Persistent discomfort and swelling in multiple joints on both sides of your body, make an appointment to see your doctor. Early diagnosis and treatment can help slow disease progression.

 

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Rheumatoid Arthritis


Rheumatoid Arthritis:  6 Common Mistakes To Avoid.

Most people with rheumatoid arthritis can live full, active lives despite their disease. But living a good life with RA often means you need to work at managing your disease and get the help you need. Take care to avoid these six common mistakes.

Mistake 1: Not Seeing a Rheumatologist

If you’re like most people with RA, the first doctor you saw for your joint symptoms was a primary care physician. But a specialist has more training in treating RA.

Just 20 years ago, RA was often treated with medications that relieved pain but didn’t stop ongoing joint damage. Today, there are many new, effective — and highly complex — treatments for rheumatoid arthritis that do both. It’s important to see a rheumatologist, who has the training and experience to prescribe and monitor those medications.

If you haven’t seen a rheumatologist, your primary care doctor should be able to refer you to one. The American College of Rheumatology (ACR) also lists rheumatologists in your area.

Mistake 2: Becoming a Couch Potato

When you have joint pain and fatigue, it’s hard to get up and get moving. But regular exercise is one of the best things that you can do for your health. While rest is also important for managing your disease, too much inactivity can make pain, fatigue, and stiffness worse.

Even when your RA is flaring, you can — and should — do gentle range-of-motion exercises. Range-of-motion exercises help maintain joint movement and flexibility by taking joints through their full span of movements. No weights are used.
You may also be able to gently exercise in water during flares.

When your disease is less active, you should be more active. Add exercises to build muscle strength and joint stability and improve aerobic fitness.

Talk to your rheumatologist or a physical or occupational therapist about the best and safest exercises for you. Walking can be a good exercise for people with RA, and it doesn’t even require going to a gym! Warm-water aerobic exercise may be another choice to consider — the water gives sore joints some additional support.

Mistake 3: Skipping Doctor Appointments

While you may not feel the need to see your rheumatologist when your RA is less active, keeping your appointments is still important.

During regular visits, your doctor will:

Monitor the course of your disease
Determine how well your treatment is working.
Look for harmful side effects
Adjust your treatment, if necessary
In addition to seeing your doctor, you also may need periodic lab tests or X-rays. It’s important that keep those appointments, too.

Mistake 4: Not Taking Prescribed Medications

Pain relievers and nonsteroidal anti-inflammatory drugs (NSAIDs) may help your joints feel better. But they do nothing to stop the joint damage that is going on inside. That requires a more powerful disease-modifying antirheumatic drug (DMARD) or biologic response modifier, or both.

Years ago, doctors started RA treatment with aspirin and other pain relievers. If the disease got worse, they then prescribed a DMARD. Today, doctors are likely to prescribe a DMARD or a biologic (or both) early on, particularly for aggressive RA.

In fact, ACR guidelines recommend that all people diagnosed with RA be given a DMARD, regardless of how active or severe their RA is. Studies have shown that starting powerful drugs earlier may be more effective in reducing or preventing joint damage.

If your rheumatologist recommends a DMARD or biologic and you don’t take it, you may be risking serious joint damage that cannot be repaired. If you have active RA and your doctor has not recommended one of these drugs, ask if you need one.

Mistake 5: Skipping Medication When You Feel Good

You may be tempted to skip your medications on days when you’re feeling better. But failing to take your medications could cause the pain — or even your rheumatoid arthritis — to get worse.

If you take medication for pain and inflammation, you should take it consistently. Missing a dose could cause the pain to return, and it may be more difficult to relieve. The same is true for joint inflammation. It’s better to keep it under control than allow it to flare and try to get it under control again.

To control your RA, some medications need to stay in your bloodstream at therapeutic levels. If you miss a dose of medication, you should take it as soon as you remember (but don’t take a double dose). If you miss a dose often — even if you are feeling better at the time — blood levels of the drug may drop and could cause a flare of your RA.
Mistake 6: Accepting Depression

Living with RA isn’t easy. It can be painful and unpredictable and make it hard to do the things you enjoy. It’s understandable that you may become sad at times, but you don’t have to accept depression as a part of your disease.

Ask your doctor to refer you to a mental health professional who works with people with chronic diseases. Counseling may help you develop better skills for coping with RA. Attending a support group, such as those offered by the Arthritis Foundation, may also help.

If you still experience feelings of depression, let your doctor know. Some people with rheumatoid arthritis benefit from taking antidepressants. Simply accepting depression can take the joy out of life and make it more difficult to manage your disease.

10 Serious RA Symptoms to Never Ignore


There’s more than joint pain to watch out for.

Painful, swollen joints are a hallmark of rheumatoid arthritis. But for people with RA, it’s not the only thing to watch out for.

A result of the body’s immune system attacking its own tissues, rheumatoid arthritis requires more than just managing the pain. Other symptoms that might even seem unrelated to the condition may pose a threat.
“This is a disease process, not just something that happens in the joints,” rheumatologist Joan Bathon, MD, says. “It can be in all your tissues, causing problems wherever inflammation occurs,” says Bathon, who is chief of the rheumatology department at New York-Presbyterian Hospital/Columbia University Medical Center.

People with more severe rheumatoid arthritis are more likely to have other complications. But it can also happen in milder cases.

Here are the top 10 symptoms rheumatoid arthritis patients should never ignore.

1. Shortness of breath or chest pain

Because rheumatoid arthritis can affect the blood vessels and muscle of the heart, people with the condition are at a greater risk for heart attacks and heart failure.

“Chest pains or shortness of breath are big red flags,” says rheumatologist Brian Mandell, MD, PhD, of Cleveland Clinic’s Arthritis and Musculoskeletal Center.

If you’re getting winded easily, you could also have a lung infection. Or you could have some form of interstitial lung disease, which causes lungs to become inflamed and scarred, Mandell says. Fluid might also be surrounding the lungs, which would require drugs and drainage to treat.

Seek medical attention immediately if you’re having these problems, even if you’ve never had heart or lung issues before.

2. Numbness or tingling

Rheumatoid arthritis can cause connective tissues in the hand or foot to become inflamed and push up against a nerve causing numbness and tingling. As a result, you might experience weakness or clumsiness, or even nerve damage.

This type of swelling can happen in tissues throughout the body. But it most commonly occurs around the wrist area, causing carpal tunnel syndrome, Mandell says.

If you experience numbness or tingling, you need to be evaluated by your rheumatologist or another health care provider as soon as possible to determine the cause.

3. Inability to move or raise your hand or foot

Compared to numbness or tingling, suddenly not being able to raise or move a hand or foot is a much more severe complication to result from rheumatoid arthritis.

It’s also a much more rare occurrence, involving damage to nerves that are connected to muscles.

“It’s like having a heart attack for the nerves,” Bathon says.

Seek emergency treatment for this symptom. Bathon says not doing so could lead to permanent paralysis.

4. Spots on or around your fingertips

Little red or black spots on or around the fingernails may mean that the tissue in those areas has died from inflamed small blood vessels.

Although very uncommon, the spots can signal an advanced form of inflammation, says Bathon, who suggests promptly seeing a rheumatologist.

If the symptom goes untreated, it may ultimately lead to losing fingers or toes.

5. Red, inflamed eyes

Blood vessels in the eyes are another common target of rheumatoid arthritis, especially among people with more serious forms of the disease.

If the outer layer of your eye feels dry or irritated, eye drops can usually treat the problem, Mandell says.

However, sudden severe pain and redness of the eyes could mean deeper parts of the eye are affected. That’s a very serious complication, so see a doctor immediately if that happens, Mandell says.

6. Tummy troubles

If you take a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen or naproxen to treat your rheumatoid arthritis, you are at risk for stomach problems.

These drugs can cause stomach ulcers, which could in turn make the stomach bleed or form a hole in its wall.

When taking an NSAID, report any tummy pain, black or bloody bowel movements, or nausea to your doctor.

7. High fever and other signs of infection

Another problem from rheumatoid arthritis treatment is infection related to biologic drugs such as Cimzia, Enbrel, Humira, Remicade, and Simponi.

The most telling sign of an infection is high fever (greater than 101 or 102 degrees Fahrenheit), Bathon says. Others are an unexplained cough, or an area of the skin that is extremely hot, red, swollen, or more painful than usual.

This type of infection can spread very quickly and is usually tough to control since rheumatoid arthritis patients have compromised immune systems to begin with. That gives them a lower tolerance for fever, Bathon says.

If you suspect an infection, see a doctor immediately, even if it means a trip to the ER, she says.

 

8. Feeling blah

Symptoms that just make you feel not well could also signify infection. So don’t ignore your body when it’s telling you something isn’t right, Mandell says.

Specifically, things like loss of energy, night sweats, sudden weight loss, unexplained fatigue, or a low-grade fever might mean it’s time to re-evaluate your treatment regimen.

Be sure to discuss any of these symptoms with your doctor.

 

9. Bone fracture

A bone fracture in someone with rheumatoid arthritis may reveal underlying osteoporosis, especially among women.

Because of its inflammatory nature, rheumatoid arthritis can cause bone loss. On top of that, the risks of fracture can skyrocket if you’re taking prednisone, a common treatment for rheumatoid arthritis.

In addition to exercising and following a diet rich in calcium and Vitamin D, people with rheumatoid arthritis should consider having a bone density test to detect osteoporosis soon after their RA diagnosis.

 

Rheumatoid Arthritis Drug Guide


 

Rheumatoid arthritis (RA) is a progressive inflammatory disease that affects the joints. It gets worse over time unless the inflammation is stopped or slowed. Only in very rare cases does rheumatoid arthritis go into remission without treatment.

Arthritis medications play an essential role in controlling the progression and symptoms of rheumatoid arthritis. Starting treatment soon after diagnosis is most effective. And the best medical care combines rheumatoid arthritis medications and other approaches.

You may take rheumatoid arthritis medications alone, but they are often most effective in combination. These are the main types of RA medications:

Disease-modifying anti-rheumatic drugs (DMARDs)
Biologic response modifiers (a type of DMARD)
Glucocorticoids
Nonsteroidal anti-inflammatory medications (NSAIDs)
Analgesics (painkillers)
In the past, doctors took a conservative, stepwise approach toward treating rheumatoid arthritis. They started first with NSAIDs such as ibuprofen. Then, they progressed to more potent RA drugs for people who showed signs of joint damage.

Today, doctors know that an aggressive approach is often more effective; it will result in fewer symptoms, better function, less joint damage, and decreased disability. The goal, if possible, is to put the disease into remission.

Rheumatoid Arthritis Drugs: DMARDs

If you’ve been diagnosed with rheumatoid arthritis, your doctor may recommend that you begin treatment with one of several types of DMARDs within a few months of diagnosis. One of the most important drugs in the arsenal for treating rheumatoid arthritis, DMARDs can often slow or stop the progression of RA by interrupting the immune process that promotes inflammation. However, they may take up to six months to be fully effective.

DMARDs have greatly improved the quality of life for many people with rheumatoid arthritis. These RA drugs are often used along with NSAIDs or glucocorticoids; however, with this type of medication, you may not need other anti-inflammatories or analgesics.

Because DMARDs target the immune system, they also can weaken the immune system’s ability to fight infections. This means you must be watchful for early signs of infection. In some cases, you may also need regular blood tests to make sure the drug is not hurting blood cells or certain organs such as your liver, lungs, or kidneys.

Examples of DMARDs:

 

Name Brand Name(s) Precautions Potential Side Effects
auranofin
(oral gold) Ridaura
Limit exposure to sunlight and tell your doctor if you have had:
• Any adverse reactions to gold-containing medications
• A history of blood-cell problems
• Inflammatory bowel, kidney, or bowel disease

• Diarrhea
• Low blood counts
• Metallic taste
• Mouth ulcers

• Skin rash or itching
azathiaprine

Imuran
Tell your doctor if:
• You use allopurinol
• You have kidney or liver disease

• Fever or chills
• Loss of appetite
• Liver problems
• Low blood counts
• Nausea or vomiting
• Extreme fatigue

Rare:

Azathiaprine is associated with certain cancers, such as lymphoma.
cyclosporine

Sandimmune, Neoral
Tell your doctor if you have:
• Liver or kidney disease
• Active infection
• High blood pressure

• Headache
• High blood pressure
• Hair growth
• Kidney problems
• Loss of appetite
• Nausea

Increased risk of infection and certain cancers.
gold sodium thiomalate (injectable gold)
Myochrysine

Tell your doctor if you have:
• Lupus
• Skin rash
• Kidney disease
• Colitis

• Irritated, sore tongue
• Irritated, bleeding gums
• Metallic taste
• Skin rash or itching
• White spots on mouth or throat

Joint pain may occur for a few days after first few injections.

hydroxychloroquine sulfate Plaquenil Tell your doctor if you have vision problems; vision may be damaged with high doses or long-term use.
• Blurry vision or increased light sensitivity
• Headache
• Abdominal cramps or pain
• Loss of appetite, nausea, vomiting, or diarrhea
• Itching or rashes

leflunomide Arava
Tell your doctor if you have:
• Active infection
• Liver or kidney disease
• Cancer

Stop taking leflunomide before trying to conceive.
• Dizziness
• Hair loss
• Headache
• Heartburn
• High blood pressure
• Gastrointestinal or liver problems
• Low blood cell count
• Neuropathy
• Skin rash

methotrexate Rheumatrex, Trexall Tell your doctor if you have:
• Abnormal blood counts
• Liver or lung disease
• Alcoholism
• Active infection or hepatitis
• Abdominal pain
• Chills or fever
• Dizziness
• Hair loss
• Headache
• Light sensitivity
• Itching
• Liver problems
• Low blood counts

Rare, but serious:

Dry cough, fever, or trouble breathing, which may result from a blood disease.

Rheumatoid Arthritis Drugs: Biologic Response Modifiers

Biologic response modifiers are a type of DMARD. They target the part of the immune system response that leads to inflammation and joint damage. By doing this, they can improve your condition and help relieve symptoms.

These RA medications can’t cure rheumatoid arthritis. If the drugs are stopped, symptoms may return. But just as with other DMARDs, biologic response modifiers may slow the progression of the disease or help put it into remission. If your doctor prescribes one of these RA drugs, you will likely take it in combination with methotrexate. Biologic response modifiers are taken by injection and are expensive. Their long-term effects are unknown.

NOTE: Before taking biologics, it’s important to get appropriate vaccinations and to be tested for tuberculosis and hepatitis B and C.

 

Examples of biologic response modifiers:

Name Brand Name Precautions Potential Side Effects
abatacept Orencia
• Tell your doctor if you have a serious infection, such as pneumonia or COPD.
• Do not take live vaccines.
• Get tested for TB before starting treatment.

• Cough
• Dizziness
• Headache
• Serious infection
• Infusion reaction
adalimumab

Humira
• Tell your doctor if you have a serious infection, such as pneumonia.
• Do not take live vaccines.

Get tested for TB before starting treatment.

• Redness, pain, itching, or bruising at injection site
• Upper respiratory infection

anakinra

Kineret • Tell your doctor if you have a serious infection or a history of it.
• Do not take live vaccines. • Redness, swelling, pain, or bruising at injection site
• Low white blood cell count
• Upper respiratory infection
etanercept
Enbrel

Do not take if you have congestive heart failure, and tell your doctor if you have:
• A serious infection
• Been exposed to TB
• A serious nervous system disorder
• Do not take live vaccines.

• Redness, pain, itching, swelling, or bruising at injection site
• Headache
• Sinus infection

Rare complications:
• Lupus
• Multiple sclerosis
• Seizures

infliximab Remicade Tell your doctor if you have:
• A serious infection, especially hepatitis B
• Been exposed to TB
• A serious nervous system disorder
• Do not take live vaccines.
• Chest pain
• Hives and trouble breathing
• Changes in blood pressure
• Redness, pain, swelling, or itching at the injection site
• Sinus infection

Rare complications:
• Lupus
• Multiple sclerosis
• Seizures

rituximab Rituxan
• Tell your doctor if you have a serious infection, or heart or lung disease.
• Do not take live vaccines.

• Abdominal pain
• Chills or fever
• Headache
• Infection
• Itching

Serious side effects:
• Infusion reactions
• Tumor lysis syndrome
• Severe skin reactions

golimumab Simponi
• Tell your doctor if you have any infections or health conditions, like heart disease, MS, or diabetes.
• Get tested for TB before starting treatment.
• Do not take live vaccines.
• See your doctor right away if you develop signs of infection while taking this drug.

• Redness at the injection site
• Upper respiratory infections
• Nausea
• Abnormal liver tests

Rare complications:
• Serious infections, like TB, fungal infections, and reactivation of a previous hepatitis B infection
• Lupus
• Multiple sclerosis
certolizumab pegol Cimzia
• Tell your doctor if you have an infection or are being treated for an infection, or if you have diabetes, HIV, hepatitis B, cancer, or TB.

• Heart failure
• Nerve problems such as MS
• Allergic reactions
• Autoimmune problems like lupus
• Reactivation of hepatitis B

tocilizumab Actemra
• Tell your doctor if you have a serious infection, history of gastrointestinal perforation, or if you are pregnant or plan on becoming pregnant.
• Do not take live vaccines.

• Upper respiratory tract infection
• Inflammation of the nose or throat
• High blood pressure
• Headache
• Abnormal liver enzyme level
• Serious infections, like TB, and infections from bacteria, viruses, or fungi

tofacitinib Xeljanz • Xeljanz adds to risk of serious infections, cancers, lymphoma.
• May increase cholesterol levels and liver enzymes.
• May lower blood count.
• Upper respiratory tract infection
• Headache
• Diarrhea
• Inflammation of the nasal passage and the upper part of the throat

Rheumatoid Arthritis Drugs: Glucocorticoids

Glucocorticoids are steroids. They are strong anti-inflammatory drugs that can also block other immune responses. These rheumatoid arthritis medications help relieve symptoms and may stop or slow joint damage. You receive these RA drugs by pill, or by injection.

Because of the risk of side effects, you should only use these RA drugs for brief periods, for example, when disease flares up or until DMARDs reach their full effectiveness. If your side effects are severe, don’t stop taking the drug suddenly. Talk first with your doctor about what to do.

Examples of glucocorticoids:

 

Name Brand Name(s) Precautions Potential Side Effects
betamethasone

injectable

Celestone Tell your doctor if you have:
• Fungal infection
• History of TB
• Underactive thyroid
• Diabetes
• Stomach ulcer
• High blood pressure
• Osteoporosis • Bruising
• Cataracts
• Increased cholesterol
•Atherosclerosis
• High blood pressure
• Increased appetite or indigestion
• Mood swings or nervousness
• Muscle weakness
• Osteoporosis
• Infections
prednisone

Deltasone, Meticorten, Orasone Tell your doctor if you have:
• Fungal infection
• History of TB
• Underactive thyroid
• Diabetes
• Stomach ulcer
• High blood pressure
• Osteoporosis • Bruising
• Cataracts
• Increased cholesterol
•Atherosclerosis
• High blood pressure
• Increased appetite or indigestion
• Mood swings or nervousness
• Muscle weakness
• Osteoporosis
• Infections

Rheumatoid Arthritis Drugs: NSAIDs

NSAIDs work by blocking an enzyme that promotes inflammation. By reducing inflammation, NSAIDS help reduce swelling and pain. But they are not effective in reducing joint damage. These drugs alone are not effective in treating the disease. They should be taken in combination with other rheumatoid arthritis medications.

As with glucocorticoids, you should use them for brief periods — they can cause severe digestive tract problems. Which type, if any, your doctor prescribes may depend upon your medical history. If you have a history of liver, kidney, heart problems or stomach ulcers, it’s best to not take these drugs. Ask your doctor whether any new NSAIDS producing fewer side effects are available.

Examples of NSAIDs:

Name Brand Name(s) Precautions Potential Side Effects
celecoxib Celebrex • Tell your doctor if you have had a heart attack, stroke, angina, blood clot, or high blood pressure or if you have sensitivity to NSAIDS or sulfa drugs.
• Do not take with other NSAIDS.
• Do not take late in pregnancy. • Indigestion, diarrhea, and stomach pain
• Serious skin reactions
diclofenac sodium

Voltaren
Tell your doctor if you:
• Drink alcohol
• Use blood thinners
• Take ACE inhibitors, lithium, warfarin, or furosemide
• Have sensitivity to aspirin; kidney, liver, or heart disease; asthma; high blood pressure; ulcers
• Do not take with other NSAIDs.

• Abdominal cramps, diarrhea
• Dizziness or drowsiness
• Heartburn, indigestion, nausea, vomiting, ulcer, or bleeding
• Increased risk of blood clots, heart attacks, and stroke

Greater risk of complications for people with cardiovascular disease
ibuprofen Motrin, Advil
Tell your doctor if you:
• Drink alcohol
• Use blood thinners
• Take ACE inhibitors, lithium, warfarin, or furosemide
• Have sensitivity to aspirin; kidney, liver, or heart disease; asthma; high blood pressure; ulcers
• Do not take with other NSAIDS.

• Abdominal cramps, diarrhea
• Dizziness or drowsiness
• Heartburn, indigestion, nausea, vomiting, ulcer, or bleeding
• Increased risk of blood clots, heart attacks, and stroke

Greater risk of complications for people with cardiovascular disease

Rheumatoid Arthritis Drugs: Analgesics

Analgesics reduce pain but they do not reduce swelling or joint damage.

There are a variety of over-the-counter and prescription analgesics. Narcotics are the most powerful type of analgesic. Use these carefully and be sure to let your doctor know if you have any history of alcoholism or drug abuse.

Examples of analgesics:

Name Brand Name(s) Precautions Potential Side Effects
acetaminophen Tylenol, Faverall, Tempra • Tell your doctor if you have 3 or more drinks of alcohol daily.
• Avoid taking more than one product with acetaminophen.
Side effects uncommon if taken as directed.

tramadol

Ultram
• Tell your doctor if you use central nervous system depressants, tranquilizers, sleeping medications, muscle relaxants, or narcotic pain medications or if you have a history of drug or alcohol abuse.
• Do not stop suddenly or increase the dose on your own.

• Do not drive or use heavy machinery until you know how your body reacts to the drug. • Constipation
• Diarrhea
• Drowsiness
• Increased sweating
• Loss of appetite
• Nausea
oxycodone OxyContin, Roxicodone
Tell your doctor if you use central nervous system depressants, tranquilizers, sleeping medications, muscle relaxants or narcotic pain medications or if you have a history of drug or alcohol abuse.
• Never chew or cut tablets; a high dose can be fatal if released rapidly.

• Constipation
• Dizziness
• Drowsiness
• Dry mouth
• Headache
• Increased sweating
• Itchy skin
• Nausea or vomiting
• Shortness of breath

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