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Arthritis, Treatment, Rheumatoid arthritis, Osteoarthritis
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What is Arthritis?
Arthritis is one of the most pervasive diseases in the United States and is the leading cause of disability. According to the Centers for Disease Control and Prevention one out of every three Americans (an estimated 70 million people) is affected by one of the more than 100 types of arthritis.

For most people arthritis pain and inflammation cannot be avoided as the body ages. In fact, most people over the age of 50 show some signs of arthritis. Joints naturally degenerate over time. Fortunately, arthritis can be managed through a combination of medication, exercise, rest, weight-management, nutrition, and, in some cases, surgery. Your doctor can tell if you have arthritis through blood tests and x-rays. He or she will then be able to help you make a decision on the best treatment for your case.

Arthritis is a chronic disease that will be with you for a long time and possibly for the rest of your life. Your treatments will probably change over time and medication may be adjusted. Having a positive mental outlook and the support of family and friends will help you live with arthritis and be able to continue to perform your daily activities

Risk Factors for Rheumatoid Arthritis

A risk factor is something that increases your likelihood of getting a disease or condition. It is possible to develop rheumatoid arthritis with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing rheumatoid arthritis. If you have a number of risk factors, ask your health care provider what you can do to reduce your risk.

Risk Fectors:

Blood Transfusions You may have an increased risk of developing rheumatoid arthritis if you have received blood transfusions.

Age Although rheumatoid arthritis can develop at any age, you’re most likely to develop the condition between the ages of 25 and 45.

Gender Women are 2.5 to 3 times more likely to develop rheumatoid arthritis than men.

Genetic Factors You are more likely to develop rheumatoid arthritis if there are other people in your family with this condition or with other autoimmune disorders.

Ethnic Background You have a greater risk of developing rheumatoid arthritis if you are:

  • White
  • Native American (particularly belonging to the Yakima, Chippewa, or Inuit tribes)

Weight People who are overweight may have an increased risk of developing rheumatoid arthritis.

Coffee and Cigarettes Some studies have suggested that there is a connection between drinking coffee and developing rheumatoid arthritis. More work needs to done to confirm this association. Long-term smoking may be a risk factor for the development of rheumatoid arthritis.

Symptoms of Rheumatoid Arthritis Joint symptoms usually involve three or more joints. The most commonly affected joints are the wrists, fingers, knees, feet, and ankles.

  • Increased pain and stiffness in the morning and after inactivity
  • Morning stiffness and pain that lasts more than 30 minutes
  • Pain and stiffness symmetrically (that is, both feet or both hands are affected, as opposed to only one)
  • Red, swollen, warm joints
  • Deformed, misshapen joints
Other symptoms of rheumatoid arthritis include:
  • Intense fatigue, decreased energy
  • Muscle aches
  • Decreased appetite
  • Weight loss
  • Fever and sweats
  • Depression
  • Problems sleeping
  • Anemia
  • Bumps occurring under the skin (rheumatoid nodules)
  • Inflamed blood vessels
  • Bleeding stomach ulcers
  • Inflammation of the heart’s sac (pericarditis)
  • Inflammation of the heart muscle (myocarditis)
  • Lung problems
  • Eye Problem
Risk Factors for Rheumatoid Arthritis Diagnosis of Rheumatoid Arthritis:
There are no specific tests to completely confirm or eliminate the diagnosis of rheumatoid arthritis.

Your health care provider may begin to suspect rheumatoid arthritis after taking a careful history of your symptoms and performing a thorough physical exam.

According to The American Rheumatism Association, if you have four of the seven symptoms listed below you are considered to have rheumatoid arthritis:

  • Morning stiffness that lasts over an hour
  • Arthritis in at least three joints
  • Arthritis of the joints of the hand
  • Arthritis on both sides of the body (for example, involving both hands or both feet)
  • A positive blood test for rheumatoid factor (RF)
  • Presence of lumps under the skin, called rheumatoid nodules
  • X-rays that show signs of rheumatoid arthritis affecting the joints
Testing- If there are any questions about the diagnosis, your health care provider may recommend other tests to confirm the diagnosis or to evaluate whether your internal organs are also involved. Such tests may include the following:

Blood tests – a number of blood tests can point to the presence of an autoimmune disorder. These include:

  • Rheumatoid factor
  • Erythrocyte sedimentation rate
  • Antinuclear antibody
  • C-reactive protein
Imaging tests – to best view the joints and any destruction caused by rheumatoid arthritis, a specialized x-ray test called dual energy x-ray absorptiometry is used.

Other imaging tests may be used to visualize the internal organs, in order to see whether rheumatoid arthritis has affected them. Specific areas of the body to be examined with imaging tests may be chosen based on your symptoms. Imaging tests may include:

  • X-rays
  • CT scans
  • MRI scans
Arthrocentesis – removing some joint fluid for laboratory exam may reveal the presence of an enzyme called MMP-3. MMP-3 is associated with rheumatoid arthritis.

Medications for Rheumatoid arthritis The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your health care provider if you need to take any special precautions. Use each of these medications only as recommended by your health care provider, and according to the instructions provided. If you have further questions about usage or side effects, contact your health care provider.

There are a variety of medications available to treat the pain and inflammation of rheumatoid arthritis. You may have to try different medicines before you find the one that works best for you with the least number of side effects.

Prescription Medications Nonsteroidal anti-inflammatory drugs (NSAIDs)

  • Naproxen (Naprosyn, Anaprox, Aleve)
  • Ketoprofen (Orudis)
  • Ibuprofen (Motrin, Advil, Nuprin)
  • Indomethacin (Indocin)
  • Sulindac (Clinoril)
  • Meclofenamate (Meclomen)
  • Ketorolac (Toradol)
  • Piroxicam (Feldene)
  • Diclofenac sodium (Voltaren)
  • Diclofenac (Voltaren, Cataflam)
Cyclooxgenase-2 or COX-2 inhibitors
  • Celecoxib (Celebrex)
  • Rofecoxib (Vioxx)
  • Meloxicam (Mobic)
  • Valdecoxib (Bextra)

Disease-modifying antirheumatic drugs (DMARDs)

  • D-penicillamine (Cuprimine, Depen)
  • Hydroxychloroquine sulfate (Plaquenil)
  • Sulfasalazine (Azulfidine)
  • Methotrexate (Rheumatrex)
  • Cyclophosphamide (Cytoxan)
  • Cyclosporin
  • Prednisone (Deltasone, Cortan)
  • Methylprednisolone (Medrol)
Immunosuppressant medications
  • Azathioprine (Imuran)
  • Chlorambucil (Leukeran)
Biologic response modifiers
  • Etanercept (Enbrel)
  • Infliximab (Remicade)
Interleukin-1 receptor inhibitors
  • Anakinra (Kineret)
Over-the-counter Medications Acetaminophen Common brand names include:
  • Actamin
  • Banesin
  • Tylenol
Acetaminophen can be helpful in relieving some of the pain associated with rheumatoid arthritis. Do not take a larger dose than is recommended by your health care provider. Do not drink alcoholic beverages while you are taking acetaminophen.

Capsaicin Cream Common brand name: Zostrix Capsaicin cream is rubbed on the skin of an affected joint to relieve the pain and inflammation of rheumatoid arthritis.

It’s made using the active ingredient of hot chili peppers. Some people prefer to wear rubber gloves while applying the cream. If you don’t, be sure to wash your hands very thoroughly with soap and water after using the cream. Be very careful not to get the cream near your eyes, as it will burn and sting. If you do get some in your eyes, flush them thoroughly with cool water.

Possible side effects include burning, stinging, or warm sensation when first applied to the skin.

Special Considerations Whenever you are taking a prescription medication, take the following precautions:

  • Take them only as directed, not more, not less, not at a different time.
  • Do not stop taking them without consulting your health care provider.
  • Don’t share them with anyone else.
  • Know what effects and side effects to expect, and report them to your health care provider.
  • If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
  • Plan ahead for refills so you don’t run out.
Treatments for Rheumatoid Arthritis: The following treatments can help to manage pain, inflammation, stiffness, and decreased functioning:

Application of Heat Heat improves blood circulation to the treated area. Applying heat via warm soaks, whirlpools, paraffin, or heating pads can be very soothing. Most health care providers recommend that you apply the heat for about 10 minutes at a time, 3-4 times a day.

Application of Cold Cold can help decrease inflammation in an affected joint, thereby relieving pain and improving stiffness and movement. Apply an ice pack for 20-30 minutes at a time, several times each day.

Intra-articular Corticosteroid Injections In this therapy, the affected joint is injected with a solution containing a corticosteroid medication.
The steroids can help decrease inflammation and therefore pain in the joint. Sometimes, your health care provider will remove excess joint fluid from the joint just before injecting the steroid medicine.
Steroid injections often have to be repeated every several months. Most practitioners believe that you shouldn’t get more than three or four such injections in a year; more injections may cause damage to the cartilage.

Physical Therapy Physical therapy can help you decrease pain and stiffness, increase muscle strength, develop flexibility, and improve stamina. Physical therapists can teach you exercises to do on your own, or you can attend regular physical therapy sessions.

Assistive Devices If you are having trouble getting around, a cane or walker may help. In addition, a variety of devices are available to help you with tasks that rheumatoid arthritis can make difficult or impossible, such as buttoning or zipping your clothing, opening jars, opening doors, and other activities of daily living. Talk to your health care provider about the kinds of assistance you need; he or she may recommend a consultation with an occupational therapist.

Apheresis (Prosorba Column) This is a new treatment that involves filtering your blood through a medical device that removes antibodies. The rest of the blood is then returned to you. The procedure takes about 2 hours, and is usually done weekly for 12 weeks. Most patients don’t notice improvement of their symptoms until around the 12-week mark. Side effects may include:

  • Fatigue
  • Achy muscles
  • Weakness
  • Fever and chills
  • Nausea
Seek Support Some people with rheumatoid arthritis become depressed and anxious. Consider finding a support group where you can meet other people who have learned to cope with the challenges of rheumatoid arthritis. Sharing your own experiences, and learning from the struggles and triumphs of others can be very helpful

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