Rheumatoid Arthritis Slideshow Pictures Take the RA Quiz Understanding Lupus Slideshow Pictures

Medical Author:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Surgery

Surgery is generally reserved for those patients with arthritis that is particularly severe and unresponsive to the conservative treatments. Surgical procedures can be performed to relieve pain, improve function, and correct deformity. Occasionally, joint tissue is surgically removed for the purpose of biopsy and diagnosis. Doctors who specialize in joint surgery are orthopedic surgeons.

Joint surgery using a viewing tube with a cutting instrument is called arthroscopy. Osteotomy is a bone-removal procedure that can help realign some of the deformity in selected patients, usually those with knee disease. Removal of inflamed joint lining tissue is called synovectomy. In some cases, severely degenerated joints are best treated by fusion (arthrodesis) or replacement with an artificial joint (arthroplasty). "Total joint replacement" is a surgical procedure whereby a destroyed joint is replaced with artificial materials. For example, the small joints of the hand can be replaced with plastic material. Large joints, such as the hips or knees, are replaced with metals. Total hip and total knee replacements are now commonplace. These can bring dramatic pain relief and improved function.

Other Therapy

Patients with arthritis may benefit from conservative measures such as rest, exercise, weight reduction, physical and occupational therapy, and mechanical support devices. These measures are particularly important when large, weight-bearing joints are involved, such as the hips or knees. In fact, even modest weight reduction can help to decrease symptoms of osteoarthritis of the large joints, such as the knees and hips. Medications are used in combination with the physical measures.

Resting sore joints decreases stress on the joints, and relieves pain and swelling. Patients are asked to simply decrease the intensity and/or frequency of the activities that consistently cause joint pain.

Exercise usually does not aggravate arthritis when performed at levels that do not cause joint pain. Exercise can be helpful in several ways. First, it strengthens the muscular support around the joints. It also prevents the joints from "freezing up" and improves and maintains joint mobility. Finally, it helps with weight reduction and promotes endurance. Applying local heat before and cold packs after exercise can help relieve pain and inflammation. Swimming is particularly suited for patients with osteoarthritis because it allows patients to exercise with minimal impact stress to the joints. Other popular exercises include walking, stationary cycling, and light weight training.

Physical therapists can provide support devices, such as splints, canes, walkers, and braces. Toilet seat raisers and jar grippers can assist daily living. These devices can be helpful in reducing stress on the joints. Occupational therapists can assess daily activities and determine whether additional devices may help patients at work or home. Finger splints can support individual joints of the fingers. Splints are commonly used in the treatment of wrist arthritis. Paraffin wax dips, warm water soaks, and nighttime cotton gloves can help ease hand symptoms. Spine symptoms can improve with a neck collar, lumbar corset, or a firm mattress, depending on what areas are involved.

Next Steps

It should be noted that both before and especially after the diagnosis of arthritis, communication with the treating doctor is essential for optimal health. This is important from the standpoint of the doctor, so that he/she can be aware of the vagaries of the patient's symptoms as well as their tolerance to and acceptance of various treatment options. It is also important from the standpoint of patients, so that they can be assured that they have an understanding of the diagnosis and how the condition does and might affect them. It is also crucial for the safest use of medications.