Note that I’m not a doctor. Just sharing what I’ve learned about basic RA treatment.
Treat RA early and aggressively!
While there is currently no cure for rheumatoid arthritis, there are promising treatments. Treatment should be two-pronged: medication and lifestyle.
A rheumatologist will prescribe medication. The individual is responsible for taking the medication as prescribed.
Exercise is extremely important for people with RA. Some people also find that diet affects their disease.
It is not enough to faithfully swallow a zillion pills every day. To do the most effective job of controlling RA, we must also exercise.
The most effective pain relief is not found in a bottle. Exercise is the best thing that you can do for pain relief. Exercise is more effective than anti-depressants in helping with the depression that can accompany chronic illness. Exercise is also one of the best remedies there is for combatting the fatigue of RA.
Low-impact exercise is best. After all, you need to protect those joints and treat them with TLC. Swimming is the best for low-impact exercise. Most of us, however, don’t have our own private, heated swimming pool. Cross-country ski machines are very low impact. Elliptical trainers and exercise bikes are also good for low-impact exercises. Experiment to see what works best for you. The Arthritis Foundation’s Guide to Good Living with Rheumatoid Arthritis has a chapter with suggested stretches and exercises.
A physical therapist or occupational therapist can suggest exercises to strengthen specific areas.
Some people find that their RA symptoms are helped by dramatic dietary changes. Some people are helped by a vegetarian diet. Others find that a gluten-free diet helps.
Paraffin baths can help sore feet, hands, and elbows. Available from a physical therapist, these can be done at home for a lot less money. I found a $30 kit at WalMart; wax refills are $8 — much more economical than PT (however, if you have big feet, you might need to shop around for a larger one than I have)
TENS is another thing that can be done by a physical therapist. If it is helpful for your situation, sometimes these machines can be purchased for home use.
Talk of NSAIDs, DMARDS, and BRMs is common. Add to that the TCAs or SSNRIs that many people with RA also take, and you might feel like you’ve spilled your alphabet soup.
First, the inflammation of RA must be controlled. This is typically done with anti-inflammatory medications. Anti-inflammatories can be divided into two types. These are 1) corticosteroids such as prednisone, and 2) non-steroidal anti-inflammatory drugs (NSAIDs). Long-term use of steroids is not good; doctors prescribe prednisone to quickly reduce inflammation, but the goal is to slowly taper off of steroids and rely on NSAIDs to control inflammation. Long-term NSAID use can also have undesirable side effects, so doctors will carefully monitor your blood work so that problems can be detected, and treatment modified if necessary. There are many different NSAIDs, so if one is too hard on your stomach, let your doctor know so that you can try a different one. Ibuprofen, mobic, naprosyn, lodine, celebrex, daypro, feldene…
It is not enough to just control inflammation. Disease modifying anti-rheumatic drugs can slow or halt progression of the disease. Doctors often prescribe more than one DMARD; this is called combination therapy. DMARDS can affect your liver, so doctors will carefully monitor your blood work so that problems can be detected, and treatment modified if necessary. Methotrexate, plaquenil, sulfasalazine…
Biologic response modifiers are “strong” DMARDs. People who don’t respond enough to DMARDs often find BRMs helpful. Again, blood work will be carefully monitored. humira, enbrel, remicade, rituxan, kineret, orencia…
Although NSAIDs provide some pain relief, more is sometimes needed for successful RA treatment. Acetaminophen (Tylenol) is an over-the-counter (OTC) analgesic. Opiods can be prescribed if needed. These, too, require careful monitoring of blood work. Vicodin, tramadol, tylenol3, percocet…
Many people with chronic illnesses become depressed, and find that an anti-depressant can help improve mood, and also help to control pain. There are many different types, and they all have their own side-effects.
TCA: Tricyclic Anti-Depressants (Elavil, Norpramin, and Pamelor)
SSRI: Selective Serotonin Reuptake Inhibitors (Prozac, Paxil, and Zoloft)
SSNRI: Selective Serotonin and Norepinephrine Reuptake Inhibitors (Effexor, Cymbalta)
NDRI: Norepinephrine and Dopamine Reuptake Inhibitors
CRIRB: Combined Reuptake Inhibitors and Receptor Blockers
MAOI: Monamine Oxidase Inhibitors
There are probably others, too.
For those who prefer not to take anti-depressants, take hope in knowing that exercise is supposed to be more effective than medication for relieving depression.
With early, aggressive treatment, remission is a possibility. Don’t lose hope!