Controlling Symptoms of Rheumatoid Arthritis
- Rheumatoid arthritis is a potentially debilitating chronic disease
- Early identification of symptoms is crucial
- New treatment protocols can put the disease in remission
Rheumatoid arthritis (RA) is a vexing disease. There's no known cause and no known cure, and if you don't catch symptoms early it can lead to joint damage and severe disability. But people with rheumatoid arthritis have more reason than ever to be optimistic, thanks to recent advances in diagnosis and treatment.
Unlike osteoarthritis, which results mainly from wear and tear on the joints and equally affects both sexes later in life, rheumatoid arthritis usually strikes between ages 30 and 50, and is three times more likely to occur in women than men. It is an autoimmune disease, in which the immune system attacks normal body tissue as if it were a foreign invader, like bacteria or a virus.
The target of this attack is the synovial membrane, a thin layer of tissue that lines your joints. It becomes inflamed and can erode cartilage, ligaments, tendons and bones; about 20 percent of patients develop rheumatoid nodules, lumps of tissue that form under the skin. Untreated, the damage can lead to severe pain, joint deformity and disability. It also poses an elevated risk of diabetes and heart disease due to systemic inflammation.
Although the exact cause of rheumatoid arthritis is unknown, researchers have identified some factors that may increase the likelihood of developing the diseaseincluding specific genetic markers, bacteria or viruses.
There may be a link to certain hormones, given that it occurs more frequently in women. There is also a well-established connection between cigarette smoking and rheumatoid arthritis. One recent study concluded that heavy smoking accounts for more than a third of the most severe cases of RA.
Know the Symptoms of RA
As with many chronic diseases, symptoms of rheumatoid arthritis tend to wax and wane. When symptoms are active, it's called a flare; when disease activity is nonexistent, this is known as remission.
RA isn't currently preventable, but increasing evidence suggests that early detection along with aggressive medical treatment is critical. "It's clear that if you aggressively treat this disease right away, you increase your chances of inducing remission," says Patience White, M.D., public health officer at the Arthritis Foundation and professor of medicine and pediatrics at the George Washington University School of Medicine and Health Sciences in Washington, D.C.
Dr. White says you should be on the lookout for specific symptoms, such as morning stiffness (particularly in the small joints of the hands or feet) that doesn't dissipate within about 30 minutes after getting out of bed, joint pain on both sides of the body and warmth and redness around the joints.
But what does seeking treatment "right away" mean? The ideal window of opportunity is within six to 12 weeks of experiencing symptoms, says Uzma Haque, M.D., assistant professor of medicine at the Johns Hopkins Arthritis Center in Baltimore. "We want to catch the disease before it has established itself and then switch it off. Most studies are showing that treating rheumatoid arthritis early and aggressively can put 40 to 60 percent of patients into remission."
A diagnosis should involve an arthritis specialist, such as a rheumatologist, and will be based on your medical history and a physical examination that includes x-rays, MRI and blood tests.
Get Treated for RA Early
New treatment protocols for rheumatoid arthritis call for early intervention and aggressive drug combinations. Early, aggressive treatment with two types of powerful medications offers the best hope for putting people with rheumatoid arthritis into remission and avoiding serious joint damage.
One ongoing Dutch study found that patients who received a combination of infliximab (a "biologic") and methotrexate (a disease-modifying anti-rheumatic drug, or DMARD) from the very beginning were more likely to achieve remission than patients whose treatment was delayed or did not include infliximab.
This supports a "window of opportunity" hypothesis: The earliest possible treatment of rheumatoid arthritis with available drugs may stop the disease before joint damage begins. A small percentage of study participants even stayed in remission after discontinuing medication.
Drugs used to treat RA include nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen and naproxen to help ease pain, and corticosteroids like prednisone that are potent and quick-acting anti-inflammatory medications used to bring potentially damaging inflammation under control.
Disease-modifying anti-rheumatic drugs (DMARDs) can slow or stop the course of the disease and inhibit structural damage. (Methotrexate is the most commonly prescribed DMARD for RA.)
The newest category is biological response modifiers, or "biologics," each of which blocks a specific step in the inflammation process that leads to RA by targeting a particular protein or other cellular component.
The drawback of both DMARDs and biologics is that because these drugs work by suppressing the immune system, patients are more vulnerable to infection and possibly certain cancers. But overall, these treatments do more good than harm and shouldn't be avoided, says Andrew Ruthberg, M.D., director of the Rush Rheumatoid Arthritis Clinic at Rush University Medical Center in Chicago.
The hope for the future is that once remission is achieved, drug treatments could be withdrawn entirely without causing a recurrence. Dr. Haque notes that the prognosis for anyone with RA is better than ever before: "Rheumatoid arthritis is a chronic disease, but we are doing extremely well at managing it and the outcome for most patients is excellent."
From our sister publication, REMEDY (Summer 2011)