Rheumatoid Arthritis
Initial Treatment for Rheumatoid Arthritis
Courtesy: Medicinenet
The aim of rheumatoid arthritis treatment is to control a patient's signs and symptoms, and to maintain their quality of life and ability to function. Joint damage caused by rheumatoid arthritis generally occurs within the first two years of diagnosis, and it is difficult to predict which individuals will develop long-term complications. Therefore, the initial treatment of RA aims to eliminate or minimize inflammation.
Initial Treatments
Nonpharmacologic therapies include treatments other than medications, and are the foundation of treatment for all people with rheumatoid arthritis. There are a wide variety of nonpharmacologic therapies available.
Education and counseling — Education and counseling can help you to better understand the nature of rheumatoid arthritis and cope with the challenges of this condition. You and your healthcare providers can work together to formulate a long-term treatment plan, define reasonable expectations, and evaluate both standard and alternative treatment options.
Nonpharmacologic measures such as biofeedback and cognitive behavioral therapy can be very effective for controlling rheumatoid arthritis symptoms. These measures can reduce pain and disability and improve self-esteem. Programs on topics such as self-management skills, social support, biofeedback, and psychotherapy are offered by the Arthritis Foundation and by many hospitals and clinics.These programs have been shown to reduce pain, depression, and disability in people with arthritis and to allow them to gain some control over their illness.
Rest — Fatigue is a common symptom of rheumatoid arthritis. Resting inflamed joints by taking naps often helps restore energy. You can alternate rest with activity, when possible.
Exercise — Pain and stiffness often prompt people with rheumatoid arthritis to become inactive. Unfortunately, inactivity can lead to a loss of joint motion, contractions, and a loss of muscle strength. Weakness, in turn, decreases joint stability and further increases fatigue.
Regular exercise can help prevent and reverse these effects. Several different kinds of exercises can be beneficial, including range of motion exercises to preserve and restore joint motion, exercises to increase strength (isometric, isotonic, and isokinetic exercises), and exercises to increase endurance (walking, swimming, and cycling).Exercise programs for people with rheumatoid arthritis should be designed by a physical therapist and tailored to the severity of your condition, your build, and your former activity level.
Physical therapy — Physical therapy can relieve pain, reduce inflammation, and help preserve joint structure and function for patients with rheumatoid arthritis.
Specific types of physical therapy are used to address specific effects of rheumatoid arthritis:
· The application of heat or cold can relieve pain or stiffness
· Ultrasound may reduce inflammation of the sheaths surrounding tendons (tenosynovitis)
Specific types of physical therapy are used to address specific effects of rheumatoid arthritis:
· The application of heat or cold can relieve pain or stiffness
· Ultrasound may reduce inflammation of the sheaths surrounding tendons (tenosynovitis)
- Passive and active exercises can improve and maintain range of motion of the joints
- Rest and rest splinting can reduce joint pain and improve joint function
- Finger splinting can prevent deformities and improve hand function
- Relaxation techniques can relieve secondary muscle spasm
Nutrition and dietary therapy — People with active rheumatoid arthritis sometimes lose their appetite or are unable to eat an adequate amount of food. Dietary therapy helps to ensure that you eat an adequate amount of calories and nutrients. However, weight loss may be recommended for overweight and obese people to reduce stress on inflamed joints
People with rheumatoid arthritis have a higher risk of developing coronary artery disease. High blood cholesterol is one risk factor for coronary disease that can respond to changes in diet. A nutritionist can recommend specific foods to eat or avoid to achieve a desirable cholesterol level.
Changes in diet have been investigated as treatments for rheumatoid arthritis. The addition of fish oils and some plant oils, such as borage seed oil, have modestly improved arthritis pain and in joint swelling in one study. However, there is no diet that can cure rheumatoid arthritis. No herbal or nutritional supplements, such as cartilage and collagen, can cure rheumatoid arthritis; these treatments can be dangerous and are not usually recommended.
Measures to reduce bone loss — Rheumatoid arthritis causes bone loss, which can lead to osteoporosis. Bone loss is more likely in people who are inactive. The use of glucocorticoids, such as prednisone, further increases the risk of bone loss, especially in postmenopausal women.
Several measures can minimize the bone loss associated with steroid therapy:
· Use the lowest possible dose of glucocorticoids for the shortest possible time, when possible, to minimize bone loss.
· Consume an adequate amount of calcium (1000 to 1500 mg/day) and vitamin D (400 to 800 IU/day), either in the diet or by taking supplements.
· Medications called bisphosphonates, such as alendronate (Fosamax®), risedronate (Actonel®), ibandronate (Boniva®) and etidronate (Didronel®), can reduce bone loss. Use of calcitonin in the form of a nasal spray (Miacalcin®) can also reduce bone loss caused by glucocorticoids.
People with rheumatoid arthritis have a higher risk of developing coronary artery disease. High blood cholesterol is one risk factor for coronary disease that can respond to changes in diet. A nutritionist can recommend specific foods to eat or avoid to achieve a desirable cholesterol level.
Changes in diet have been investigated as treatments for rheumatoid arthritis. The addition of fish oils and some plant oils, such as borage seed oil, have modestly improved arthritis pain and in joint swelling in one study. However, there is no diet that can cure rheumatoid arthritis. No herbal or nutritional supplements, such as cartilage and collagen, can cure rheumatoid arthritis; these treatments can be dangerous and are not usually recommended.
Measures to reduce bone loss — Rheumatoid arthritis causes bone loss, which can lead to osteoporosis. Bone loss is more likely in people who are inactive. The use of glucocorticoids, such as prednisone, further increases the risk of bone loss, especially in postmenopausal women.
Several measures can minimize the bone loss associated with steroid therapy:
· Use the lowest possible dose of glucocorticoids for the shortest possible time, when possible, to minimize bone loss.
· Consume an adequate amount of calcium (1000 to 1500 mg/day) and vitamin D (400 to 800 IU/day), either in the diet or by taking supplements.
· Medications called bisphosphonates, such as alendronate (Fosamax®), risedronate (Actonel®), ibandronate (Boniva®) and etidronate (Didronel®), can reduce bone loss. Use of calcitonin in the form of a nasal spray (Miacalcin®) can also reduce bone loss caused by glucocorticoids.
