Treatment of Rheumatoid Arthritis is customized to the disease activity based
on diagnostic testing. Rheumatoid arthritis is an immune disease where the
body is somehow triggered to attack itself. There is no known cause but the
outcome is the same.
The first step in identification of the disease is to do a physical exam for
telltale rheumatoid nodules in areas of pressure as the elbow and fingers;
examination also looks for redness, tenderness, swelling and heat in the
joints. Doctors also use a thorough history, blood tests and some x-rays.
Once the diagnosis is suspected or confirmed a referral to a Rheumatologist
is standard practice. The Rheumatologist is a physician who has received
special training and education and has taken and passed certification board
exams. Some doctors will say they are board eligible but this only means
that they have passed their initial tests to be a doctor but haven’t taken
the testing to be a Rheumatologist.
A Rheumatologist will complete the diagnosis, evaluate the progression of the
disease, prescribe a treatment plan and follow up with the patient.
Symptoms of Rheumatoid Arthritis are usually symmetrical so if there is
inflammation of only one or two joints the diagnosis may be more difficult.
The doctor may use arthrocentesis to rule out an infection or gout. The
presence of nodules around the elbows or fingers will also make the diagnosis
easier.
Doctors use blood tests including a Rheumatoid Factor (antibody in the blood)
to rule out Rheumatoid Arthritis. RF is present in only 60-80% of patients
with RA. Most patients with RA also have Citrulline antibody in the blood.
It is used in the diagnosis of patients who otherwise have unexplained
inflammation and is felt to be present during the early stages of RA.
AntiNuclear Antibodies (ANA) are also thought to be present in the early
stages.
Sedimentation rate (sed rate) is the rate at which the blood cells fall to
the bottom of the test tube. The rate is faster during flares and when the
inflammation is higher and slower when the disease is in relapse. C-reactive
protein will also measure the amount of inflammation in the body.
Rheumatoid factor, C-reactive protein, Sed rate and ANA can be abnormal in
other autoimmune diseases so doctors use these tests in combination with
others to diagnose RA
At this time there is no cure. The goals of treatment for Rheumatoid
Arthritis is to reduce the inflammation and pain as well as maximize the
function of the patient. Studies have shown that early aggressive treatment
will improve function and decrease the progression of the disease.
Optimal treatment of Rheumatoid Arthritis involves medications, exercise,
rest, joint strengthening, joint protection, and patient and family
education. Treatment is customized according to the progression of the
disease, the types of joints involved, age of the patient, occupation,
general health and the cooperation of the family and patient.
There are two types of medications used to treat Rheumatoid arthritis. First
line drugs are anti-inflammatory such as aspirin, ibuprofen (Advil) and
corticosteroids. These are fast acting drugs and are used to decrease
inflammation, pain, swelling and discomfort.
Second line drugs are Disease Modifying AntiRheumatic Drugs (AMADs) and are
slow acting. They are used to promote remission of the disease and decrease
the progression such as methotrexate, gold and hydroxycholoquine.
Other treatments of Rheumatoid Arthritis include fish oil, which has
anti-inflammatory effects. Acetominophen (Tylenol) gives some quick pain
relief. Recent research has also shown some promising results using
antibiotics. Exercise is also important to strengthen the muscles that
support the joints while heat or cold packs after exercise can help decrease
the discomfort.
Although this disease has varying degrees of severity in patients treatment
of Rheumatoid arthritis has improved significantly over the past several
years. As research continues to move treatment plans forward we are getting
closer to finding the trigger that initiates the immune cascade that results
in Rheumatoid Arthritis.
Vanessa Youngstrom, a nurse practitioner, enjoys writing and educating on
health and wellness topics. You’ll find more articles at
http://www.PathToYourHealth.com
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