Six savvy facts about rheumatoid arthritis and treatment
An orthopaedic surgeon and rheumatologist reveal new advances that may make arthritis pain a thing of the past.
1. Rheumatoid arthritis affects more women than men.
Rheumatoid arthritis (RA) affects women twice as often as men. RA is caused by inflammation in the lining of joints, and is usually symmetrical, occurring on both sides of the body. The disease does the most damage in the first year or two. So, early diagnosis and aggressive treatment is very important.
2. Rheumatoid arthritis is not osteoarthritis.
Osteoarthritis, the most common form of arthritis, is the result of "wear and tear" and affects people as they age. RA is an auto-immune disease that affects one percent of the population. The body's immune system mistakenly attacks the body itself. This results in painful joint inflammation.
3. A personal pain management plan puts patients in control.
It's important to devise a plan to take positive and proactive action against pain. Dr. Hollander advises patients to take pain medication on a schedule versus taking it to "catch up." She also suggests trying meditation techniques like controlled breathing, joining a support group and meeting with a mentor, friend or counselor on a consistent basis to keep spirits lifted.
Another idea is to put together a basket of favorite things to choose from when RA symptoms worsen. Examples are: bath salts, a special robe or towel, scented candles, heating pad, tea, books or DVDs.
4. New medications are combined with old for more effective treatment.
Traditional disease-modifying antirheumatic drugs, or DMARDs, work to change the immune system and stop the processes that cause certain forms of inflammatory arthritis like RA. They also can slow down progressive joint destruction.
According to Virtua Health rheumatologist,
Adrienne Hollander, MD, DMARDs are helpful, but they don't control RA in some patients. "Medications called biologics target a specific component of the immune system. Combining biologics and DMARDs allows RA to be attacked from multiple pathways." Patients who take both medications report a reduction in long-term effects like disabilities or deformities.
There are a number of medications available for treatment. Your doctor will consider your health and risk factors before making a recommendation.
5. Physical and occupational therapies promote mobility.
Physical therapists often do gentle strengthening exercises with patients with RA to help them maintain mobility. One example is an aquatic-exercise class that incorporates gentle range-of-motion, mild endurance exercises and relaxation techniques. These exercises stimulate muscles, bones, and joints and increase strength, tone and overall fitness. "Exercise is especially important for patients with rheumatoid arthritis since these patients have an increased risk for heart disease," says Dr. Hollander.
Occupational therapists (OTs) help on many levels. For example, an OT might create a tool or device to help patients get dressed, cook or open a door if they have difficulty using their hands. They may also help patients identify if joints are stressed unnecessarily and teach them easier ways to perform tasks.
6. Joint replacement relieves pain in knees and hips.
Patients in early stages of RA will often take a daily over-the-counter pain medication and progress to heavier doses of prescribed pain medication over time. Virtua Health orthopaedic surgeon,
Rajesh Jain, MD, advises patients to exhaust these conventional treatments before undergoing a surgery like knee or hip replacement.
"Patients who have no other serious medical conditions are considered good candidates for total joint replacement," says Dr. Jain. "For most patients, we can replace the affected joint with a minimally invasive technique using smaller incisions and causing less tissue damage. Patients are in less pain, and are mobile within a day."
However, patients who are obese or very muscular may not be candidates for minimally invasive surgery. For these patients, open surgery is usually the best option. No matter how the surgery is performed, the goal is to increase a patient's mobility and relieve pain. Patients who have minimally invasive joint replacement surgery at Virtua see a physical therapist while they are still in the hospital, and continue therapy at home.
PHYSICIAN PROFILES
Adrienne Hollander, MD, is board certified in rheumatology and graduated from Temple University Medical School, completing her residency at Temple University Hospital. She is the medical director of Virtua Health's Bone Health and Osteoporosis Center and belongs to several medical organizations, including the American Medical Association, American College of Physicians, American College of Rheumatology, and Philadelphia Rheumatism Society.
Rajesh K. Jain,MD, MPH, orthopaedic surgeon, earned a master of public health in epidemiology from the University of Michigan and graduated from SUNY University Hospital where he also completed his residency in orthopaedic surgery. Dr. Jain completed his fellowship in adult reconstructive surgery at New England Baptist Hospital in Boston.
To find out about arthritis support groups, programs and water-exercise classes, or to speak with a Virtua physician, call 1-888-Virtua-3.