What Ails You: Rheumatoid arthritis requires committed treatment

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What Ails You: Rheumatoid arthritis requires committed treatment

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Our bodies have one response to injury, illness, foreign bodies (whether it's

bullets or pollen): the inflammation brought on by our immune response. Our

immune system is amazing both in its simplicity and sophistication. It is

not, however, a perfect system and does sometimes run amok. Such is the case

with rheumatoid arthritis (RA).

While osteoarthritis is the result of long-standing wear and tear, RA

describes the immune system ravaging the joints causing chronically

progressive and, sometimes, crippling, pain and dysfunction. Another

significant difference between osteoarthritis and RA is that, unlike

osteoarthritis, RA can affect other organs of the body, including the heart

and lungs.

Medication is the single best defense against the ravages of RA. Initially,

medication is used to reduce your symptoms. NSAIDs (ibuprofen, naproxen

sodium) or aspirin is used to reduce inflammation. If that doesn't work, you

may be prescribed steroids. Unfortunately, steroids can become a part of

daily life for patients with RA. This is an important consideration because

the side effects of long-term steroid use are many. It is important that

your doctor monitor you carefully while you are using these stronger

medications.

Another group of drugs called disease-modifying antirheumatic drugs (DMARDs)

addresses the underlying disease rather than just the symptoms. Methotrexate

has long been the standard drug prescribed, but it is only effective in one

third of those who take it. Lately, a new drug called Enbrel has been used.

If you have tried methotrexate and it has not worked, talked with your

doctor about Enbrel.

Exercise, heat, cold and physical therapy can also be helpful. The rules of

exercise change for patients with RA. It is important that you talk honestly

with your physical therapist so that you can be instructed in a program of

exercise specific to your needs.

Eventually, as the disease progresses, it may be necessary to replace the

joints. Joint replacement surgeries are available for almost every joint

that can be involved including the knuckles of the hands, shoulders, hips

and knees. These are involved procedures often with long recoveries. You

will need to shop carefully for an orthopedic surgeon and prepare yourself

for the ordeal ahead. In the long run, though, joint replacement can restore

the quality to your life.

More than two million Americans, more than half of whom are women, are

living with RA. There is no cure. Osteoarthritis tends to be constant. The

pain you have today will be the pain you have tomorrow though the intensity

of the pain may vary. With RA, the pain you have today may be completely

gone in a few weeks when you go into a remission. You may believe that you

have been cured, but your symptoms have simply receded for a time. The enemy

will return.

A remission from the pain and dysfunction of RA is marked by a notable

reduction in symptoms. The clinical signs of the inflammation have

disappeared: you have morning stiffness that lasts less than 15 minutes

(rather than the half-hour or more you experience during a flare-up), no

fatigue, no joint pain, no tenderness during motion, no swelling of the

joints or surrounding tendons.

Thirty percent of RA patients will experience one or more remissions during

the course of their disease. You are not cured. The disease has not

magically gone away. You must continue to take your medication. Ninety-five

percent of RA patient will take their medications the rest of their lives.

Even in remission, you will need to take your medication to maintain the

remission. The longer the disease stays in remission, the less likely it

will become active again. For this reason, discontinue your arthritis

medication only when your doctor says so.

In the end, there is no cure for RA, but it is possible, through the use of

appropriate medication and physical therapy, to control your symptoms and

reduce the pain and swelling that accompanies it. The earlier you receive

treatment, the better.