Understanding and treating rheumatoid arthritis

Painful, tender joints can make even the simplest activities difficult for those with rheumatoid arthritis (RA). Read on to better understand this inflammatory disease and how to cope with it.

• In healthy joints, the surfaces of your bones and the cartilage that cushions them glide smoothly against one another, allowing for easy, pain-free movement. But for the 300,000 Canadians with RA, the cartilage becomes inflamed and breaks down, causing pain, stiffness and swelling
• If the disease progresses, bones and ligaments can permanently wear away. The heart, lungs, muscles and skin can become damaged, and there’s an increased risk for blood or lymph cancers
• Unlike the simple joint wear and tear of its common cousin, osteo­arthritis, rheumatoid arthritis arises from an immune system gone awry, which mistakenly attacks healthy joint tissue. Nobody knows what triggers this, although scientists speculate it may be the result of an infection, perhaps combined with genetic factors that make you susceptible to the disease
• During a flare-up, white blood cells collect in your joints and mount an inflammatory attack, secreting substances called cyto­kines that join the battle. One form of cytokine is a destructive protein called tumour necrosis factor (TNF); another is interleukin-1. In response, cells in the besieged joint release defensive chemicals called prostaglandins, which cause the joint to become red, sore and swollen
• This is the basic inflammatory process, although there are different forms of RA, some milder than others

• Anti-inflammatories, such as NSAIDs (including COX-2 inhibi­tors) to ease pain
• Steroids, such as prednisone, to control more serious cases of inflammation
• Early treatment with a DMARD drug, such as methotrexate, to slow the disease’s progression
• Biologic response modifiers, such as Enbrel or Remicade, alternatively or in combination with other drugs, to halt the disease’s progression.
• Lifestyle measures such as low-impact exercise or water aerobics, as well as plenty of rest

• Assemble a medical team.  A rheumatologist (a physician who specializes in arthritis) may be particularly valuable in tailoring a state-of-the-art treatment program that’s right for you. You also need a primary-care physician to monitor your overall health, a physical therapist to help keep your joints flexible and an occupational therapist to offer tips on making the most of your life at home or at work
• Be careful about drug combos. Don't take prednisone and an NSAID together — this can increase your risk of developing a stomach ulcer
• Start treatment early. A study in the Journal of Rheumatology found that those with early rheumatoid arthritis who delayed treatment by nine months continued to feel worse (even three years later) than those who began therapy promptly. Early treatment is key to reducing damage and the need for more invasive treatments, including surgery
• If you smoke, quit. Studies show that smoking can make symptoms worse. If you undergo joint replacement surgery, smoking can prolong your recovery
• Salmon and other oily fish are rich in omega-3 fatty acids that have anti-inflammatory properties and may help to relieve symptoms of rheumatoid arthritis. Eat fish twice a week or try fish oil capsules

• The Arthritis Society is a non-profit organization devoted to funding and promoting Canadian arthritis research, programs and patient care
• It has offices in every province and nearly 1,000 community branches throughout Canada
• Its website has in-depth facts and treatment options for both rheumatoid arthritis and juvenile rheumatoid arthritis

Recently, pharmaceutical breakthroughs have revolutionized treatment, enabling many to again lead active and productive lives.