Rheumatoid Arthritis Pictures Slideshow (cont.)
A blood test called the sedimentation rate (sed rate) is a measure of how fast red blood cells fall to the bottom of a test tube. The sed rate is used as a crude measure of inflammation of the joints. The sed rate is usually faster from inflammation such as during disease flares and slower during remissions. Another blood test that is used to measure the degree of inflammation present in the body is the C-reactive protein. The rheumatoid factor, ANA, sed rate, and C-reactive protein tests can also be abnormal in other systemic autoimmune and inflammatory conditions. Therefore, abnormalities in these blood tests alone are not sufficient for a firm diagnosis of rheumatoid arthritis
RA Diagnostic Test: Joint X-rays
Joint X-rays may be normal or only show swelling of soft tissues early in the disease. As the disease progresses, X-rays can show bony erosions typical of rheumatoid arthritis in the joints. Joint X-rays can also be helpful in monitoring the progression of disease and joint damage over time. Bone scanning, a radioactive test procedure, and MRI scanning can demonstrate inflamed or eroded joints.
RA Diagnostic Test: Arthrocentesis
The doctor may elect to perform an office procedure called arthrocentesis. In this procedure, a sterile needle and syringe are used to drain fluid out of the joint for study in the laboratory. Analysis of the joint fluid can help to exclude other causes of arthritis, such as infection and gout. Arthrocentesis can also be helpful in relieving joint swelling and pain. Occasionally, cortisone medications are injected into the joint during the arthrocentesis in order to rapidly relieve joint inflammation and further reduce symptoms.
How Is Rheumatoid Arthritis Treated?
There is no known cure for rheumatoid arthritis. To date, the goal of treatment in rheumatoid arthritis is to reduce joint inflammation and pain, maximize joint function, and prevent joint destruction and deformity. Early medical intervention has been shown to be important in improving outcomes. Aggressive management can improve function, stop damage to joints as seen on X-rays, and prevent work disability. Optimal treatment for the disease involves a combination of medications, rest, joint-strengthening exercises, joint protection, and patient (and family) education. Treatment is customized according to many factors such as disease activity, types of joints involved, general health, age, and patient occupation. Treatment is most successful when there is close cooperation between the doctor, patient, and family members.
What Medications Are Used to Treat Rheumatoid Arthritis?
Two classes of medications are used in treating rheumatoid arthritis: fast-acting "first-line drugs" and slow-acting "second-line drugs" (also referred to as disease-modifying antirheumatic drugs or DMARDs).
The first-line drugs, such as aspirin and cortisone (corticosteroids), are used to reduce pain and inflammation.
The slow-acting second-line drugs, such as methotrexate (Rheumatrex, Trexall), and hydroxychloroquine (Plaquenil), promote disease remission and prevent progressive joint destruction, but they are not anti-inflammatory agents. Some newer "second-line" drugs for the treatment of rheumatoid arthritis include leflunomide (Arava) and the "biologic" medications etanercept (Enbrel), infliximab (Remicade), anakinra (Kineret), adalimumab (Humira), rituximab (Rituxan), and abatacept (Orencia).
Other Treatments for Rheumatoid Arthritis
There is no special diet for rheumatoid arthritis. Fish oil may have anti-inflammatory beneficial effects. Likewise, the benefits of cartilage preparations remain unproven. Symptomatic pain relief can often be achieved with oral acetaminophen (Tylenol and others) or over-the-counter topical preparations, which are rubbed into the skin.
Other Treatments for Rheumatoid Arthritis (cont.)
The areas of the body, other than the joints, that are affected by rheumatoid inflammation are treated individually.
- Sjogren's syndrome (described above, see symptoms) can be helped by artificial tears and humidifying rooms in your home or office. Medicated eyedrops, cortisporine ophthalmic drops (Restasis), are also available to help the dry eyes in those affected. Regular eye check-ups and early antibiotic treatment for infection of the eyes are important.
- Inflammation of the tendons (tendinitis), bursae (bursitis), and rheumatoid nodules can be injected with cortisone.
- Inflammation of the lining of the heart and/or lungs may require high doses of oral cortisone.
Why Are Rest and Exercise Important?
A balance of rest and exercise is important in treating rheumatoid arthritis. During flare-ups (worsening of joint inflammation), it is best to rest joints that are inflamed. When joint inflammation is decreased, guided exercise programs can be helpful to maintain flexibility of the joints and to strengthen the muscles that surround the joints.
- Range-of-motion exercises should be done regularly to maintain joint mobility.
- Swimming is particularly helpful because it allows exercise with minimal stress on the joints.
- Physical and occupational therapists are trained to provide specific exercise instructions and can offer splinting supports. For example, wrist and finger splints can be helpful in reducing inflammation and maintaining joint alignment.
- Devices, such as canes, toilet seat raisers, and jar grippers can assist daily living.
- Heat and cold applications can ease symptoms before and after exercise.
Is Surgery an Option for Rheumatoid Arthritis?