Posts Tagged ‘rheumatoid’
Wednesday, December 30th, 2009
Know your Pain Relief Options
The term “arthritis” refers generally to an inflammation of the joints and is typically associated with stiffness and joint pain. The different forms of arthritis vary in terms of cause, severity and potential pain relief treatments.
Management of arthritis pain depends not only upon the specific condition, but also upon your age, lifestyle, and unique response to different treatment methods.
Osteoarthritis and Rheumatoid Arthritis
The two most common forms of arthritis are osteoarthritis and rheumatoid arthritis. Together these conditions affect approximately 40 million people in the United States alone.
* Osteoarthritis is a degenerative condition involving deterioration of the cartilage in the joints, resulting in joint pain or stiffness.
* Rheumatoid arthritis is an inflammatory disease affecting the lining of the joints. While osteoarthritis is far more common, rheumatoid arthritis is often a much more severe form of the disease.
Before assessing your arthritis pain relief options, it is important to consult with a physician to determine whether you have arthritis, and if so, which type since treatment options differ.
Common Causes of Arthritis Pain
The joint pain associated with arthritis may be caused by a variety of factors. Most commonly, arthritis pain originates from:
* Inflammation of the tendons, ligaments or lining of the joints. This inflammation may be accompanied by swelling or redness, which results in joint pain.
* Joint tissue damage, which may be related to an injury or excess pressure on the joints.
* Fatigue, which is sometimes a result of arthritis and can make the joint pain seem more intense and the condition more difficult to cope with.
Arthritis Pain Treatment Options
There are a variety of ways to treat arthritis pain and other joint pain. It’s essential to be aware that people respond differently to different treatments. An individual’s response to pain and pain relief treatments is affected by the particular disease or condition he/she suffers from, the severity of the pain, and a range of psychological and emotional factors.
Short Term Pain Relief
One of the most important considerations when evaluating arthritis pain relief treatment options is to be clear about whether you are focusing on short or long term pain relief.
For short term relief from arthritis pain, many people use hot or cold therapy, depending on the type of pain and the specific condition. Cold therapy in the form of an ice pack can sometimes provide pain relief by reducing swelling, but may not be a good option for patients with poor circulation. Heat therapy, either moist or dry, acts as a muscle relaxant, and can also provide short term pain relief.
Certain drugs can also give quick, short term relief from the joint pain associated with arthritis. Depending on the amount of inflammation, doctors will often recommend a pain relief medication such as acetaminophen or a non-steroidal anti-inflammatory drug (NSAID) like aspirin or ibuprofen.
Another non-drug alternative that provides some patients with short term relief from arthritis pain is TENS, or transcutaneous electrical nerve stimulation. A TENS unit delivers electrical pulses to nerves in the affected area. The pulses block pain messages that the nerves would normally deliver to the brain, thereby bringing pain relief to the patient.
TENS therapy may also raise the level of endorphins produced by the brain. Endorphins are substances that are produced naturally in the body and contribute to feelings of well-being and pain relief.
Long Term Pain Relief
Because both rheumatoid arthritis and osteoarthritis are chronic conditions, sufferers often need to look for long term options to deal with their joint pain.
Drugs such as NSAIDs provide some level of pain relief. In the case of rheumatoid arthritis, disease-modifying antirheumatic drugs (DMARDs) target the immune system and are helpful for some patients. Corticosteroids are hormones that are sometimes prescribed for treatment of the joint pain and inflammation that typically accompany arthritis.
For many people with arthritis pain, exercise and physical therapy can help reduce stiffness and joint pain. Depending on the severity of the condition, walking, swimming, and a variety of strengthening and/or aerobic activities may be helpful, not only in pain relief but also from the standpoint of improving patients’ self-confidence and psychological and emotional well-being.
Overweight people suffering from arthritis pain are frequently advised to lose weight, since additional weight places an added burden on the joints.
In a small minority of cases, medication and lifestyle changes do not provide the desired pain relief and doctors may recommend surgery. Surgical procedures can remove tissue within the joint, or else realign or replace the joint.
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Monday, October 26th, 2009
* Rheumatoid arthritis (RA) is a condition in which the body’s immune system mistakenly attacks joints.
* People usually begin to develop RA between the ages of 30 and 50.
* About 2.1 million Americans have RA (about 0.5 to 1 percent of the U.S. adult population), according to the National Institutes of Health. More than 70 percent of them are women.
* The cause of this autoimmune disease is unknown.
* RA begins when immune system cells attack normal body cells in the joints. This causes inflammation, pain and damage in the joints, frequently in the same joint on both sides of the body.
* The first symptoms of RA are often pain, swelling or stiffness in a few joints.
* Depending on the individual, these symptoms may stay the same for many years or progress to include other joints and areas of your body, such as the heart. Severe cases of RA can cause tendons and bones in the joints to become deformed and difficult, if not impossible, to use.
* Many people with RA experience periods of severe inflammation called flare-ups, followed by remission for long periods of time. It is also possible, though less likely, that you may experience one flare-up followed by remission.
* There is no definitive test for RA. However, a physician may use blood tests, a physical examination and a synovial fluid analysis to permit a diagnosis.
* Rheumatologists use four separate classes to classify your RA status, with each based on your ability to function. Class I indicates that you are completely able to perform usual activities of daily living. Class II means you are able to perform usual self-care and work activities but are limited in other activities, such as sports. Class III: able to perform self-care activities but limited in work and other activities. Class IV: limited in your ability to perform usual self-care, work and other activities.
* There is no known cure for RA. Treatment primarily focuses on relieving pain and other symptoms, maximizing function and slowing the progression of the disease.
* Your RA will most likely be treated with basic pain relievers such as acetaminophen or anti-inflammatory drugs. Other drugs modify the disease’s progress or work on parts of the immune system that malfunction to trigger RA.
* The course of RA is different for each patient, and different drug combinations may provide relief for individuals.
* No drugs can reverse damage inflicted on the joints, but there are drugs that can stop the progression of the disease. Some surgical procedures can remove parts of damaged joints or even replace an entire joint.
* There is a great deal of research being conducted about the causes of RA and possible ways to cure it.
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Monday, June 1st, 2009
Ankylosing spondylitis (AS) has a strong genetic component, but there is no known way to prevent the disease. However, patients who are aware of a family history of this disease can watch for signs and symptoms. Early detection of AS provides the best chance to treat the disease before it causes irreversible damage.
In addition, patients who are diagnosed with AS can help reduce the chance of further damage by quitting smoking. Patients with AS sometimes develop stiffness in the rib cage that reduces their ability to breathe fully. Damage to the lungs caused by smoking can worsen these symptoms. Researchers have also found smoking to be a risk factor for other forms of arthritis, including rheumatoid arthritis and osteoarthritis.
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Saturday, May 16th, 2009
The potential benefits of disease-modifying antirheumatic drugs (DMARDs) should be weighed against possible side effects. The condition being treated will influence the choice and dosage of DMARDs. A physician should be consulted regularly during any treatment program involving DMARDs.
Patients who regularly use DMARDs are often carefully monitored for side effects in several ways, such as blood tests, urine tests, eye exams and chest x-ray. Depending on the disease, the DMARDs prescribed and the overall condition of the patient, certain side effects may occur. They include:
* Stomach pain, diarrhea or constipation
* Nausea or vomiting
* Headache
* Joint pain or swelling
* Skin rash
* Increased sensitivity to sunlight
* Mouth or throat sores
* High blood pressure
* Increased vulnerability to infection, including in the eyes
* Cold or flu-like symptoms, such as fever
* Hair loss
* Low blood count, low white blood cell count
Rheumatoid arthritis (RA) has been linked to increased risk of developing lymphoma. Some studies have suggested that this could be due to use of certain DMARDs, but recent research indicates that the inflammation of RA may account for the cancer risk and that the medications do not appear to be a factor, with the possible exception of azathioprine, which is seldom used to treat RA.
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Friday, May 15th, 2009
Disease-modifying antirheumatic drugs (DMARDs) each have different chemical properties. Accordingly, DMARDs may respond differently depending on the condition being treated, the drug being used, the dosage and characteristics of the patient.
In general, patients are encouraged to drink a lot of fluids to increase urine output. Prolonged exposure to sunlight should be avoided when DMARDs are prescribed, including the use of a highly protective sunscreen. In addition, because DMARDs may affect the immune system, proper oral hygiene will help prevent mouth infections from occurring.
Potentially serious side effects or reduced effectiveness of DMARDs may occur in patients with any of the following conditions:
* DMARD allergies
* Alcoholism
* Bone marrow or blood toxicities
* Pregnancy or breastfeeding
* Uncontrolled high blood pressure
* Dermatitis
* Kidney or liver damage, including hepatitis
* Uncontrolled diabetes
* Colitis
* Cancer
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Thursday, May 14th, 2009
Disease-modifying antirheumatic drugs (DMARDs) may be used independently or in combination with other drugs to treat various diseases, including:
* Rheumatoid arthritis (RA). A chronic, inflammatory disease that causes the body’s immune system to attack the joints. This is by far the most common disease treated with DMARDs.
* Psoriatic arthritis. A form of arthritis that develops in some people with the skin disease psoriasis.
* Felty’s syndrome. Associated with RA. Felty’s syndrome occurs when a person with RA also has an enlarged spleen (splenomegaly) and an unusually low white blood cell count.
* Palindromic rheumatism. Intermittent episodes of arthritis. Individuals with this rare disease have repeated arthritic attacks but without producing irreversible changes in the joints.
* Ankylosing spondylitis. A rare, painful form of arthritis that affects the spine, causing bones to grow together. DMARDs may be prescribed to treat Anatomy of the spine includes the cervical spine, thoracic spine, lumbar spine and sacral region.pain and inflammation.
* Scleroderma. A rare disease that causes hardening and tightening of skin and connective tissues. DMARDs may be used to treat symptoms of scleroderma, such as joint pain or stiffness, curling and pain or numbness in fingers.
* Systemic lupus erythematosus. A chronic autoimmune disorder in which natural antibodies attack several systems of the body. DMARDs may help treat and alleviate pain and inflammation from attacks of lupus. DMARDs can also address the kidney damage that can result from lupus or other conditions.
* Colitis. Inflammation of the colon with symptoms that include abdominal pain and cramps. DMARDs may help treat this condition.
* Cancer pain. DMARDs can help treat and alleviate pain associated with some cancers, including leukemia and lymphoma. And the primary use of some DMARDs is to fight the cancer itself.
As immunosuppressants, DMARDs are also used to prevent rejection of transplanted organs.
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Tuesday, May 12th, 2009
Disease-modifying antirheumatic drugs (DMARDs) decrease or stop joint damage caused by rheumatoid arthritis (RA) and other conditions and diseases and can often preserve use of joints. Some DMARDs were developed to treat RA, but others originated as drugs to treat cancer or malaria or to prevent rejection of organ transplants.
DMARDs work by suppressing the body’s immune and/or inflammatory systems to slow down or stop the progression of the condition being treated. However, how exactly this is accomplished is not known. DMARDs are usually taken orally but can also be injected.
Because of the potential for serious side effects, in the past this group of drugs was used as a second option against RA when less potent drugs, such as aspirin or other NSAIDs, had proven ineffective. However, research has shown that people with RA treated earlier with DMARDs tend to have better long-term results, greater mobility and a smaller risk of premature death. As a result, today DMARDs are often prescribed early in the course of the disease. Research has also shown that the combination of DMARDs started earlier has been beneficial in reducing joint damage, pain and swelling in patients with rheumatoid arthritis.
Treatment for RA usually begins within about three months of the onset of the disease to help prevent joint damage before it begins. DMARDs often help prevent much of this damage while also reducing pain, inflexibility and helping maintain physical mobility. Because their effectiveness may diminish over time, patients may be prescribed several different DMARDs over the course of the disease.
DMARDs are not designed for immediate relief and may not work for everyone. They often take several weeks or months of treatment before the effects are noticeable. Therapy with DMARDs may cause arthritis to go into remission, but the disease often recurs once treatment is stopped. As a result, patients may be encouraged to continue the use of DMARDs even if the progression of RA has ceased. Recent research suggests that patients who respond poorly to a DMARD initially can have better results when retrying the drug later.
Patients are often prescribed DMARDs in combination with other immunosuppressives, such as tumor necrosis factor (TNF) inhibitors or other biologic response modifiers (BRMs). Other medicines, such as NSAIDS, corticosteroids or other analgesics, may be used along with DMARDs to help alleviate symptoms, though DMARDs may make the need for their use less frequent. Combinations of DMARDs may be used over the long term, with adverse effects being no more common than when only one DMARD is used for treatment.
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Monday, May 11th, 2009
Disease-modifying antirheumatic drugs (DMARDs) decrease or stop joint damage caused by Lupus is a chronic autoimmune disease that can cause joint pain and inflammation (arthritis). Conditions including rheumatoid arthritis (RA), lupus, psoriatic arthritis and ankylosing spondylitis. DMARDs reduce swelling and pain, slowing or sometimes stopping the progression of the condition being treated.
Some DMARDs are used mainly to treat cancer or prevent rejection of an organ transplant.
Exactly how DMARDs work is not completely understood, but they appear to help suppress the immune system. RA, the condition for which DMARDs are most often prescribed, is an autoimmune disease, in which the body mistakenly attacks its own tissues. This causes joint inflammation that can cause irreparable damage.
Many physicians prescribe DMARDs early in the diagnosis of RA. Research has shown that DMARDs can prevent or delay damage to joints. However, they have some potentially serious side effects, such as headache, cold or flu-like symptoms and stomach pain. Patients who have been prescribed DMARDs are monitored regularly by a physician.
DMARDs do not provide immediate relief and may take months to be effective. Treatments may involve multiple DMARDs or a combination of DMARDs and other medicines, such as NSAIDs (nonsteroidal anti-inflammatory drugs). As a result, numerous drug combinations involving DMARDs are possible.
They are usually taken by mouth but can also be injected, usually in the physician’s office or in a hospital. DMARDs are available only by prescription.
Some medical conditions (e.g., alcoholism) make the use of DMARDs less effective or even dangerous, depending on the medication being used and the condition itself. Pregnant or breastfeeding women are generally discouraged from taking DMARDs in most circumstances. Children can take DMARDs for certain conditions, such as juvenile rheumatoid arthritis, but are monitored closely for side effects.
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Monday, May 4th, 2009
Most joints with pseudogout deposits revealed by x-ray do not cause any pain. When painful attacks do occur, however, pseudogout may manifest itself in ways similar to a variety of other disorders, such as:
* Gout. It is difficult to clinically differentiate between gout and pseudogout. Because gout and pseudogout crystals are composed differently, it must be established which crystal type is causing the joint inflammation. Crystal deposits associated with pseudogout are made primarily of calcium, unlike gout crystals, which are made of uric acid. Furthermore, attacks of gout typically occur in joints of the toes and feet, whereas pseudogout typically occurs in the knees.
Awareness of these patterns alone is insufficient in making a distinction between gout and pseudogout; further testing is required. Usually, the only difference is the type of crystal in the joint. Pseudogout crystals extracted in an arthrocentesis are positively birefringent (able to split a ray of light in two) under a polarized light microscope, but gout crystals are negatively birefringent. Trauma, surgery or illness may cause attacks of gout, pseudogout or a combination of the two.
* Osteoarthritis. Many people with pseudogout exhibit degeneration of one or more joints in ways similar to osteoarthritis (deterioration of cartilage in the joints). Calcium pyrophosphate Osteoarthritis is the most common type of arthritis and is caused by joint cartilage deterioration.dihydrate (CPPD) crystal deposits, which cause attacks of pseudogout, are often present in osteoarthritic joints. CPPD crystal deposits are thought to play a role in the progression of osteoarthritis in some cases, although the reason for this is uncertain.
* Rheumatoid arthritis. People with rheumatoid arthritis experience inflammation of multiple joints. Certain symptoms of pseudogout may closely resemble rheumatoid arthritis, such as stiffness, fatigue and persistent restricted range of motion in joints. Furthermore, pseudogout may worsen the damage caused by rheumatoid arthritis if both are present in the same joint.
* Neuropathic joint disease. Diseases that can cause one or more joints to deteriorate and lose sensation (e.g., diabetes, tabes dorsalis and syringomyelia) may be accompanied by CPPD deposits. The affected joint is known as a Charcot joint. In these instances, the underlying cause of Charcot joint may be strengthened by the presence of a CPPD deposit.
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Saturday, April 25th, 2009
Psoriatic arthritis (PA) can be difficult to diagnose because in adults, psoriasis and arthritis rarely occur at the same time. In addition, PA also mimics other conditions, such as:
* Rheumatoid arthritis (RA). Occurs when an autoimmune response causes inflammation in the lining of the joints, especially those in the hands and feet.
* Gout. Arthritis characterized by sudden, severe attacks of pain, redness and tenderness in a single joint, usually at the base of the big toe.
* Reiter’s syndrome. Form of reactive arthritis that inflames the joints, eyes, genitals, and urinary or digestive tract.
* Infection. An infection of the joint can mimic arthritis as it causes a red, swollen and inflamed joint. Psoriasis patients can have an episode of infectious joint without any evidence of arthritis related to the psoriasis.
In attempting to diagnose PA, a physician will review the patient’s medical history and perform a physical examination.
Additional tests that may be used to diagnose PA include:
* X-rays. Can reveal changes in the joints that occur in PA. In severe disease, the distal interphalangeal (DIP) joints of the fingers or toes give a distinctive “pencil-in–cup” appearance on an x-ray.
* Arthrocentesis. A small sample of fluid is removed from a joint, typically in the knee, for laboratory analysis. A physician can use this test to rule out gout, which is indicated by the presence of uric acid crystals.
* Erythrocyte sedimentation rate (ESR). Blood test that checks ESR, or “sed rate,” by measuring how far from the top of a glass tube red blood cells (erythrocytes) fall in a given time. Generally, blood cells fall when inflammation is present. However, this test alone cannot confirm the presence of PA as inflammation can be caused by many factors.
* Rheumatoid factor (RF) test. Lupus is a chronic autoimmune disease that can cause joint pain and inflammation (arthritis). RF is an antibody (protein made by the immune system) present in the blood of people with RA, lupus or certain other diseases. This test can help determine if a patient’s symptoms are due to PA or another condition.
* Skin biopsy. This may be needed to rule out other conditions, such as fungal infection.
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