Rheumatoid arthritis (RA) is an immune disease characterized by inflammation of the lining of the joints (synovium).
By Margaret Jaworski
The persistent inflammation leads to painful stiffness, redness, and swelling in the joints that over time can cause long-term damage to the joints resulting in decreased dexterity, mobility and other problems. According to the Arthritis Foundation, 70 percent of the 2.1 million Americans with RA are women. In adults, RA usually appears between the ages of 30 and 50.
RA feels as though your joints have gone a few rounds in the boxing ring: You’re likely to experience aches, dull throbbing, tenderness and stiffness in the affected areas that may be worse in the morning or after long periods of inactivity. Some people with RA have occasional or enduring episodes of flu-like symptoms, irritability and depression.
Treatment
While there’s no cure for RA, over the past fifteen years managing and mitigating the effects of the disease has become more sophisticated and holistic. Drugs combined with lifestyle changes such as improved nutrition, appropriate exercise and the use of adaptive devices (e.g., easy grip door handle covers, long handled brushes, elastic shoelaces) all help reduce inflammation and relieve pain, maintain mobility and simplify the tasks of daily living.
Drugs
Medications for RA are prescribed to reduce pain and to thwart, interfere with or suppress immune processes that cause inflammation.
- DMARDs (non-biologic disease-modifying anti-rheumatic drugs) such as methotrexate and sulfasalazine (Azuldifine) work by curbing the underlying inflammatory disease process. Methotrexate is the most widely used first line drug. (For more information about living with RA, please read the following Pain Resource article.)
- Corticosteroids are taken orally, usually to quell acute flares or active episode of RA or injected locally to reduce swelling and inflammation.
- Biologics (genetically engineered drugs) are a relatively new class of drug that came on the market in 1998. According to the American College of Rheumatology (ACR), these drugs copy the effects of substances made naturally by your body’s immune system. In February 2013, the ACR issued a recommendation that doctors use biologics only after trying methotrexate and other non-biologic interventions
- Analgesics such as acetaminophen and prescription opioid pain medications are commonly used for pain relief.
Nutrition
Eating well is always important, but there are no definitive studies that prove that any the specific food or vitamin hugely impacts RA, says Gary R. Feldman, MD, a board-certified rheumatologist and medical director of Pacific Arthritis Care Center and the Osteoporosis Diagnostic Medical Center and an assistant clinical professor of medicine at the David Geffen School of Medicine at UCLA. Dr. Feldman advises his patients to follow a healthy, balanced diet, take a daily dose of 1 gram of omega-3 fatty acids and 1000 to 1200 IUs of vitamin D. Omega-3 has an anti-inflammatory effect and vitamin D is critical for the health of bone, cartilage, muscles, and the neurological system [in patients with RA], he explains. In addition, Dr. Feldman gives folic acid supplements to his patients on methotrexate, a chemotherapy drug that can cause a deficiency in this vital B vitamin.
Exercise
While specialists may disagree about the best combination of drugs or diet, no one disputes that exercise is essential to maintaining flexibility, muscle tone, and strength. However, it’s equally important that those with RA adjust their exercise program when joints are swollen or inflamed. Avoid weight-bearing exercises that put pressure on the joints, especially during flare-ups, cautions Doreen M. Stiskal, PT, PhD., associate professor and chair of the department of physical therapy at Seton Hall University, in South Orange, New Jersey. During times when your arthritis is not active, daily exercise should include range-of-motion and flexibility workouts, says Dr. Stiskal.
Recommended workouts for RA
- Isometric exercise is joint friendly training done in a stationary position (think of standing and pressing your palms together). In isometrics, you alternately contract and relax the muscle without lengthening it or changing the position of the joint.
- Water exercise allows movement without joint stress.
- Walking on a flat surface or treadmill. Avoid inclines or going up and down steps, step classes, Stairmasters and exercises that put added stress on knee and ankle joints.
- Tai Chi is a series of gentle movements and postures designed to improve coordination and relieve stress. This ancient Chinese discipline combines stretching and range-of-motion exercises and also improves balance and stability
- Pilates is an exercise system designed to strengthen core muscles (abdominal and lower back) and improve muscle strength and control, flexibility, coordination, alignment and breathing. It’s important to find a certified Pilates instructor with a thorough understanding of RA and with the expertise to adapt and modify exercises to accommodate your individual problems.
Take a breather
People with rheumatoid arthritis need to find a balance between rest and exercise, with more rest when the disease is active and more exercise when it is not. According to the National Institute of Arthritis, Musculoskeletal, and Skin Diseases (NIAMS) resting helps to reduce active joint inflammation and pain and fight fatigue. The length of down time you need may vary, but in general, it’s better to take shorter, more frequent rest breaks than to spend long periods sitting or staying in bed. (For more useful tips on how to reduce stress, read the following Pain Resource article.)