Managing Rheumatoid Arthritis

Rheumatoid arthritis (RA) affects 1.3 million Americans. Treatment programs are tailored to meet each individual's needs, taking into account the severity of the condition, other medical problems, and the person's lifestyle.

"We now have highly effective drug treatments for rheumatoid arthritis, and people with the disease who take the right medications and do appropriate self-care have the most improvement," says Dr. Hayes Wilson, a rheumatologist and medical advisor for the Arthritis Foundation (AF). "Because the treatment is complex, being a proactive patient and being aware of what self-care steps you should do can help."

Managing RA

The symptoms of RA include pain, stiffness, warmth, redness, and swelling of the affected joints. The treatment goals include reducing joint swelling, relieving stiffness, preventing joint damage, and maintaining joint function.

There is no cure for RA, but many drugs are available to manage the pain and slow the progression of this disease. New medications may help prevent damage to the joints by reducing inflammation.

Most people with RA take several medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids to help reduce joint pain, stiffness, and swelling. Other medications often prescribed are called disease-modifying antirheumatic drugs (DMARDs), which slow the progression of RA. Also, drugs called biologic response modifiers (or "biologics"), which block inflammation, include abatacept, adalimumab, etanercept, infliximab, and rituximab.

Treatment also includes a combination of exercise, rest, joint protection, hot/cold therapy, and physical and occupational therapy. Surgery, including joint replacement, can also reduce pain and improve the function of damaged joints.

"Regular exercise is a very important part of treatment," says Dr. Wilson. "A recent study found people who exercised 150 minutes a week had a significant improvement in their ability to be active on a daily basis."

Being proactive

The following guidelines from the AF can help you work with your doctor to find the best treatment.

• Folic acid. If you take methotrexate, your doctor also should prescribe a folate supplement to help reduce the drug's side effects.

• Exercise. If you can work out, your doctor should prescribe a supervised muscle-strengthening or aerobic exercise program and should review it with you at least once a year.

• Assistive devices. If you're having difficulty walking, your doctor should evaluate you to determine whether you need any assistive devices, such as a cane, insoles, or orthotics. Likewise, if you're having difficulty with daily living tasks, such as brushing your teeth or dressing, your doctor or a therapist should evaluate you to determine whether you need assistive devices to help with the tasks, or splints for your hands or wrists.

• Vaccines. If you're taking immunosuppressant therapy and/or steroid therapy, you shouldn't be given the live oral polio, live typhoid, yellow fever, MMR, or BCG vaccines. If you're taking immunosuppressive therapy, you should have the following vaccines: influenza (annually), pneumococcal, meningococcal, haemophilus B, hepatitis B and tetanus.

• If your doctor has discussed giving you one of the new biologic response modifiers such as infliximab, you should be tested for tuberculosis (TB) and have a chest x-ray before starting treatment. If you had a positive TB test in the past, let your doctor know.

"There is no cure for rheumatoid arthritis," says Dr. Wilson. "But with proper medication, exercise, weight loss, and other self-care steps, people with this disease can reduce their symptoms, increase their functioning and live fuller lives."