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Rheumatoid Arthritis (cont.)

RA Diet and Other Therapy

There is little scientific research on the role of herbs, natural products, and nutritional supplements in the treatment of rheumatoid arthritis. High-dose fish oil (omega-3 fatty acids) has been shown in small studies to reduce rheumatoid arthritis disease activity, and in some cases, fish oil supplementation may allow patients to discontinue NSAIDs. People with rheumatoid arthritis are using turmeric with varying degrees of success in reducing inflammation.

Other dietary changes that some people with rheumatoid arthritis can find helpful including increasing hydration for the dry mouth of Sjögren's syndrome, increasing fish intake (especially salmon) for fish oil supplementation to reduce inflammation, and taking anti-inflammatory medications with food to avoid stomach irritation (gastritis and dyspepsia). As described above, some research has suggested that a fish-grain diet can decrease the chances of developing rheumatoid arthritis while a Western high-fat diet might increase the chances of developing rheumatoid arthritis. There are currently no particular foods that are universally recommended that people with rheumatoid arthritis avoid, but dietary discretion is individualized based on patients' own experiences.

A variety of complementary approaches may be effective in relieving pain. These include acupuncture and massage.

When Is Surgery Needed for Rheumatoid Arthritis?

Some people with rheumatoid arthritis need several operations over time. Examples include removal of damaged synovium (synovectomy), tendon repairs, and replacement of badly damaged joints, especially the knees or hips. Surgical fusion of damaged rheumatoid wrists can alleviate pain and improve function. Sometimes rheumatoid nodules in the skin that are irritating are removed surgically.

Some people with rheumatoid arthritis have involvement of the vertebrae of the neck (cervical spine). This has the potential for compressing the spinal cord and causing serious consequences in the nervous system. This is important to identify prior to anesthesia intubation procedures for surgery. These people with serious spinal involvement occasionally need to undergo surgical fusion of the spine.

Follow-up for Rheumatoid Arthritis

A specialist or primary-care physician should regularly monitor the patient's condition, response to treatment, and side effects and other problems related to the rheumatoid arthritis or treatment. The best way to monitor the condition is to see if there is any disability (loss of function) and, if so, how much.

The frequency of these visits depends on the activity of the rheumatoid arthritis. If the treatment is working well and the patient's condition is stable, the visits can be less frequent than if the rheumatoid arthritis is getting worse, there are complications, or if the patient is having severe side effects of treatment. Each person's situation must be decided individually.

Can RA Be Prevented?

There is no known way to prevent rheumatoid arthritis, although progression of the disease usually can be stopped or slowed by early, aggressive treatment.

What Is the Prognosis of Rheumatoid Arthritis?

As a rule, the severity of rheumatoid arthritis waxes and wanes. Periods of active inflammation and tissue damage marked by worsening of symptoms (flares) are interspersed with periods of little or no activity, in which symptoms get better or go away altogether (remission). The duration of these cycles varies widely among individuals.

Outcomes are also highly variable. Some people have a relatively mild condition, with little disability or loss of function. Others at the opposite end of the spectrum experience severe disability due to pain and loss of function. Disease that remains persistently active for more than a year is likely to lead to joint deformities and disability. Approximately 40% of people have some degree of disability 10 years after their diagnosis. For most, rheumatoid arthritis is a chronic progressive illness, but about 5%-10% of people experience remission without treatment. This is uncommon, however, after the first three to six months.

Rheumatoid arthritis is not fatal, but complications of the disease shorten life span by a few years in some individuals. Although generally rheumatoid arthritis cannot be cured, the disease gradually becomes less aggressive and symptoms may even improve. However, any damage to joints and ligaments and any deformities that have occurred are permanent. Rheumatoid arthritis can affect parts of the body other than the joints.

The early treatment and use of DMARDs and biologic response modifiers in rheumatoid arthritis has resulted in patients experiencing more profound relief of symptoms and less joint damage and less disability over time. So the prognosis is best when treatment is started early. New treatments are on the horizon.

Medically Reviewed by a Doctor on 9/11/2017

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The eMedicineHealth doctors ask about Rheumatoid Arthritis (RA):

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Read What Your Physician is Reading on Medscape

Rheumatoid Arthritis »

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown cause that primarily affects the peripheral joints in a symmetric pattern.

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