Rheumatoid arthritis can turn life’s simple tasks–such as moving a pot on the stove or squeezing a tube of toothpaste–into painful and difficult chores. A disease of the joints, rheumatoid arthritis (RA) is a chronic condition that develops when the immune system goes wrong, attacking the body’s own tissues and setting up a cycle of pain and inflammation.
RA can occur at any age but most often develops between 30 and 50 years of age. It affects about two million Americans, and women are three times as likely as men to be affected.
RA targets the synovium, the cell layer that lines and lubricates joints. The immune system wrongly attacks these cells causing the synovium to become red and swollen, making the joint painful and distorted. It is characterized by morning stiffness that lasts at least an hour, swelling and redness in joints, and fatigue. It usually occurs on both sides of the body and tends to affect the joints we move most: shoulders, wrists, ankles and finger and toe joints.
The symptoms can develop slowly or the disease can strike suddenly, leaving a previously active adult debilitated by pain and stiffness virtually overnight. Regardless of how quickly symptoms appear, it is important to seek medical attention promptly. The inflammation typical of RA creates irreversible joint damage and physicians now know that serious joint damage occurs in the first two years of the disease. Early diagnosis and treatment can limit joint damage and bone loss and possibly slow down the course of the disease. Once RA is suspected or diagnosed most patients are referred to a rheumatologist, an arthritis specialist.
Although there is no cure for RA, there are numerous treatment options that ease symptoms, including many newer meds. In the past, early treatment focused on nonsteroidal antiinflammatory drugs (NSAIDs) to treat pain and inflammation, but more aggressive, early therapy is now preferred.
The drugs of choice for RA, known as disease modifying antirheumatic drugs (DMARDs), act in a different way. They include methotrexate, sulfasalazine, gold salts, hydroxychloroquine and infliximab. Early treatment with DMARDs can limit joint damage.
For more than a decade methotrexate has been the most commonly prescribed DMARD, and it is considered to have a good safety profile. It may be used alone, but, because no single drug is effective for even a majority of people, the trend today is to use DMARDs in different combinations. All of the DMARDs have potentially serious side effects and patients have to be monitored for toxicity with regular blood screening and checks of kidney and liver function.
Glucocorticoids, including prednisone, are often used to treat the pain and inflammation of RA. Although they can be effective in relieving symptoms, they have serious side effects when used long-term, including a higher risk of diabetes, weight gain, glaucoma, and osteoporosis. A recent Scottish study found that women who used prednisone long-term increased their risk of a heart attack three-fold. The American College of Rheumatology recommends using glucocorticoids as a bridge therapy while waiting for the slower-acting DMARDs to take effect.
Although exercise can be difficult, it is important to keep joints moving and flexible. Exercise can also help control weight, maintain cardiovascular fitness and improve mood. Fitness plans often include swimming and water exercises in heated pools, walking, riding a stationary bike and light work on weight machines. In addition, to excerse, a number of studies have shown the power of diet in controlling some of the symptoms of RA. Diets high in omega 3 fatty acids from salmon, sardines and other fatty fish produce a small but measurable decrease in inflammation and pain. The Mediterranean diet, emphasizing olive oil, fish, poultry, fruits and vegetables has reduced pain and improved mobility in RA patients who followed the diet for three months.
Managing RA is an ongoing challenge. It is important to talk with your treatment team and to stay on top of new treatment options. For those newly diagnosed there is a sense of urgency about beginning therapy as researchers believe that the first two years after diagnosis offer a window of opportunity to alter the course of the disease.
By: Kerri Musselman, Pharm.D.
