by Janet Kim, Rheumatologist
Rheumatoid arthritis can be a sneaky disease. At first, you may just think you have the flu, with fatigue, a low fever or muscle aches.
Then you may develop telltale signs: stiffness that begins in your fingers or hands, feeling stiff after sitting for a while, and redness, pain, swelling or warmth in the lining of a joint, which is where two bones meet.
The disease has three stages. First, the lining becomes swollen, then inflamed cells cause the lining to thicken. Finally, the inflamed cells release enzymes which can damage the joint, leading to increased pain and, ultimately, decreased movement in the joint.
Rheumatoid arthritis is a chronic disease, so it may last for an extended period of time. For most people, the disease is not constantly painful, but frequent flare-ups can cause increased discomfort and difficulty in movement.
Rheumatoid arthritis also can affect other organs, such as the lungs, heart or eyes. It most often strikes between ages 30 and 50, and women make up about 70 percent of people with the disease. Women also tend to develop it at a higher than usual rate in the year following pregnancy.
What causes rheumatoid arthritis? No one knows for sure. We do know that it is an autoimmune disease, which means that the immune system has gone awry.
Normally, the immune system fights off germs and disease that threaten healthy tissue. In rheumatoid arthritis, for some reason, the immune system perceives healthy tissue as a threat and attacks it.
The pain can begin in any joint, but it usually starts in the smaller joints of the hands and wrists. What’s more, if a joint hurts on the right hand, the same joint usually will hurt on the left hand as well.
Symptoms vary, but they may include fatigue, flu-like symptoms, a low fever, muscle pain, weight loss and cold or sweaty hands and feet. In addition, people with rheumatoid arthritis may notice that they feel stiff in the morning or after sitting for a long time, and may develop dry eyes or mouth.
If you notice any of these symptoms, call your doctor. He or she may use your medical history, a physical exam, blood tests and/or X-rays to make a diagnosis. The earlier rheumatoid arthritis is diagnosed, the easier it is to treat. Early treatment can help limit damage to the joints and help you stay healthy.
There are a number of ways to treat rheumatoid arthritis, including a variety of over-the-counter and prescription medications.
Some people get relief through non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs help reduce pain and swelling, but do not prevent damage to the joint.
Some NSAIDs are available over the counter, such as aspirin or ibuprofen (for example, Advil or Motrin). Others require a prescription. NSAIDs can upset your stomach, so use them carefully.
Oral corticosteroids, such as prednisone, are man-made steroids that may be used in low doses to reduce severe inflammation and stiffness and help prevent damage to the joints.
However, they too can have side effects, such as thinning of the bones, cataracts, high blood pressure, problems sleeping and a greater susceptibility to infection.
That’s why the goal is to work with your doctor to find the lowest effective prednisone dose that will help your symptoms. After six months or so, your doctor may slowly reduce the dose until you no longer need it.
One of the most widely used drugs is methotrexate, which is in a class of medications known as disease-modifying antirheumatic drugs (DMARDs). DMARDs help slow joint damage caused by rheumatoid arthritis and have been the drug of choice when inflammation lasts for more than six weeks or affects many joints at once.
DMARDs target the cells that cause inflammation, but do not reverse joint damage. Mild side effects may include mouth sores, diarrhea and nausea. Your doctor may order regular blood and urine tests to check for more serious side effects, such as liver damage or changes in your blood cell count.
We’re finding that DMARDs used in combination with another type of drug, biologic response modifiers (BRMs), may be most effective in the treatment of rheumatoid arthritis. BRMs block specific hormones which contribute to inflammation and can help reduce symptoms.
Finally, many people find that exercise helps reduce the discomfort of rheumatoid arthritis and prevents further damage to the joints. Strengthening exercises help to build the muscles around the joint, which can lessen the amount of pain you feel.
Stretching reduces stiffness and helps maintain flexibility and range of motion. Finally, low-impart cardiovascular exercises, such as swimming, walking or bicycling can help reduce pain and increase your energy and sense of well-being.
Moreover, cardiovascular exercise can help you maintain a healthy weight, which puts less stress on your joints. Ask your doctor for an exercise program, or contact a physical therapist.
This Scripps Health and Wellness information was provided by Janet Kim, MD, a rheumatologist at Scripps Memorial Hospital La Jolla.