In treating rheumatoid arthritis, the aim is to reduce pain, retain the maximum mobility, and slow the progress of the disease. At the same time, those who treat RA patients must bear in mind that medications used in the treatment of this disorder often cause serious health problems by themselves. Risks must be carefully and precisely weighed against benefits. Patients should, in particular, take the minimum medication needed to control pain and inflammation, taking care, not to overdose.
To slow down the progress of rheumatoid arthritis, doctors prescribe disease-modifying antirheumatic drugs (DMARDS). There are two classes of such drugs. First generation DMARDS are hydroxychloroquine, sulfasalazine, methotrexate, and leflunomide. Newer drugs, called “biologic agents,” include abatacept, adalimumab, anakinra, certolizumab, etanercept, and several others. A typical treatment regime will pair a biologic agent with one of the first generation DMARDS.
Non-steroidal anti-inflammatory drugs (NSAIDS) are the preferred medications for day-to-day pain management. Many of these drugs are available without a prescription. The Mayo Clinic recommends ibuprofen (available as Advil and Motrin) and naproxen sodium (available as Aleve) in the daily treatment of pain association with RA. Patients who take ibuprofen on a daily basis must be monitored for signs of kidney, liver, and heart failure.
To reduce swelling and loss of mobility, most physicians will prescribe some kind of corticosteroid, like prednisone. These medications are most frequently taken as pills, but may also be injected. Steroids are notorious for their side effects which may include weight gain, bone loss, vulnerability to diabetes, and mood swings.
Effective treatment of rheumatoid arthritis aims to keep the patient moving and preserve his or her range of motion. To that end, physicians will encourage RA patients to engage in a moderate amount of low-impact exercise. Any low-impact exercise is suitable, but some evidence points to Tai Chi as the best exercise for rheumatoid arthritis. Patients should stop the exercise they are doing at the point that they feel pain.
A physical therapist may also be extremely useful in teaching patient exercises that will minimize loss of hand and foot movements. Also useful to the RA patient is a range of tools that make the movement more pain-free. Buttonhooks can be used to make getting dressed in the morning much easier. For patients who like to cook, a kitchen knife can be outfitted with a saw handle that protects the wrist and finger joints. Reaching sticks can be helpful when shopping for groceries. RA patients whose hands have become badly swollen or distorted may also benefit from doors that are equipped with handicap buttons that open the door automatically when pushed.
At the point that a patient’s joints are substantially damaged, the provider may decide that surgical intervention to save the joint and the patient’s mobility is in order. The loose or ruptured tendons around a joint can be repaired surgically. In other cases, a joint can be entirely replaced with a prosthetic joint made of plastic or metal. Other surgical interventions include joint fusion and synovectomy, in which a surgeon removes an inflamed joint lining on the hip, finger, wrist, elbow, or knee.
Diet Maintenance Goals
The goal of any RA patient is to regain lost mobility, prevent future loss of mobility, and manage pain. Diet plays little role in the treatment of rheumatoid arthritis. RA patients, like all patients, should strive to eat a balanced, healthy diet rich in vegetables, fruits, whole grains, and lean proteins. They should avoid excessive amounts of fried foods, red meat, processed sugars, and fast foods.
Studies have been conducted to see if maintaining a low-protein diet inhibits the progress of rheumatoid arthritis, but the results of these studies are not conclusive. There is some evidence that adding fish oil and/or plant oils such as are extracted from evening primrose, borage, and black currant, will alleviate stiffness and pain. These oils can have side effects for some people, however. If a patient experiences nausea, gas, or diarrhea when taking these alternative medicines, he or she should discontinue their use immediately.