Rheumatoid Arthritis

Rheumatoid arthritis is the most common form of inflammatory arthritis, affecting approximately 1 in 100 Canadians.  RA causes swelling and pain in and around joints and can affect the body’s organs, including the eyes, lungs, and heart. While RA most commonly affects the hands and feet, other joints often affected include elbows, shoulders, neck, jaw, ankles, knees and hips. 
RA affects women two to three times more often than men, and like many forms of inflammatory arthritis, it tends to strike people in the prime of their lives. Most commonly, people are diagnosed between the ages of 20 and 50, although RA can strike at any time. People of every age have been diagnosed with RA, from toddlers to senior citizens.

Rheumatoid arthritis has several "hallmark" symptoms when the disease first presents. These include: 

Morning stiffness, lasting longer than 30 minutes
Pain and/or inflammation in the same joints on both sides of the body
Pain in three or more joints at the same time
Loss of motion in affected joints
Severe fatigue

If you experience two or more of these symptoms you should speak with your Doctor. Be sure to tell your Doctor about any history of RA in your family. While there is no known cause of RA, research indicates that heredity likely plays a role.

To confirm a diagnosis of RA, a Doctor may run a number of tests, including blood tests, x-ray imaging and joint fluid tests. Bone scans are used infrequently but can sometimes help check for joint swelling. 

Rheumatoid Arthritis Management and Treatment
While there is no known cure for RA, there are effective treatments available to help a person manage the symptoms and minimize joint damage.  Today specialists recommend a treatment plan that includes education, medication, social support, appropriate amounts of range-of-motion exercises, cardiovascular and muscle strengthening exercises, rest, vitamins and mineral supplements and a well-balanced diet.

Medications are a cornerstone of the treatment for RA. Early and aggressive medication therapy is used to stop or markedly reduce inflammation and prevent joint damage. There are five major medication groups used to treat the disease. These are: 

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, and diclofenac
COX-2 inhibitors, such as celecoxib 
Corticosteroids, such as prednisone
Disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate, sulfasalazine, hydroxychloroquine, leflunomide and azathioprine
Biologic response modifiers (or "biologics"), including abatacept (Orencia®), adalimumab (Humira®), anakinra (Kineret®), etanercept (Enbrel®), infliximab (Remicade®), and rituximab (Rituxan®)

These medications can work alone or in combination with one another. A person newly or recently diagnosed with moderate to severe rheumatoid arthritis is typically started on methotrexate, and possibly one or two other DMARDs in combination with methotrexate such as sulfasalazine and hydroxychloroquine (triple therapy). While waiting for the drugs to take effect, an NSAID or COX-2 inhibitor or in some cases prednisone, can be used to reduce inflammation quickly.

If a person does not respond to the above combination therapy, they may be a good candidate for a biologic response modifier medication. Biologics are usually used in combination with methotrexate.

Exercise is also a very important component of a successful treatment plan in rheumatoid arthritis. Appropriate stretching and strengthening of muscles and tendons surrounding affected joints can help to keep them stronger and healthier and is effective at reducing pain and maintaining mobility. In addition, moderate forms of aerobic exercise can help to maintain a healthy body weight and lessen unnecessary strain on joints. Swimming, walking, and cycling are often recommended but they must be done at a level which safely "challenges" a person's aerobic capacity. A physiotherapist trained in RA is the ideal person to recommend a safe and effective exercise program for people living with the disease.

Finally, maintaining a healthy lifestyle is also a critical part of any RA treatment plan. A nutritionally sound diet that includes appropriate levels of calcium, vitamin D and folic acid is important. Managing stress levels, getting appropriate amounts of rest and good old-fashioned relaxation lead to a higher quality of life.