Health Topics A-Z

How Do I know If I Have It?

In addition to symptoms and a doctor's examination, blood tests and X-rays are commonly used to confirm rheumatoid arthritis. The majority of sufferers have antibodies called rheumatoid factors (RF) in their blood, although RF may also be present in other disorders.

X-rays are used to diagnose osteoarthritis, typically revealing a loss of cartilage and shrunken joints. Sometimes blood tests and joint aspiration (using a needle to draw a small sample of fluid from the joint for testing) are used to rule out other types of arthritis. If your doctor suspects infectious arthritis as a complication of some other disease, testing a sample of fluid from the affected joint will usually confirm the diagnosis.

What Are the Treatments?

Treatment generally includes occupational or physical therapy, exercise, drugs, and sometimes surgery to correct joint damage. Treatments for osteoarthritis generally can help relieve pain and stiffness, but the disease may continue to progress. The same was true for rheumatoid arthritis in the past. But treatments in recent years have been able to slow or stop progression of the arthritic damage.

The duration and intensity of pain and discomfort depend on the type of arthritis and the degree of severity.

Conventional Medicine

In the case of localized pain, stiffness and immobility, the typical three-stage treatment consists of medication to relieve pain and inflammation, rest to let injured tissues heal themselves, and exercise to rebuild mobility and strength.

Joint Protection

Learning to protect your joints is an important part of treatment. With the help of an occupational therapist, you can learn easier ways to do your normal activities, such as avoiding positions that strain your joints, using your strongest joints and muscles while sparing weaker ones, wearing braces or supports for certain joints and using grab bars in the bath, modified door knobs, canes or walkers, as well as using devices to help you with tasks such as opening jars or pulling up socks and zippers.

Your doctor may recommend pain relievers combined with regimens of heat, rest and exercise, physical therapy, and controlled application of deep heat to soothe affected joints.

Medication

To reduce pain and inflammation in mild cases of rheumatoid arthritis and osteoarthritis, your doctor will probably prescribe aspirin or another nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen. Your doctor may also suggest acetaminophen for osteoarthritis.

In more advanced cases, your doctor may recommend corticosteroid joint injections - strong anti-inflammatories - to ease the pain and stiffness of affected joints. Depending on the individual, results range from temporary relief to long-lasting suppression of symptoms. Doctors are also using hyaluronate gel like solutions in joint injections to further restore the cushion and lubricating properities of normal joint fluid thereby minimizing pain. Some examples are Hyalgan, Synvisc, Supartz and Orthovisc.

In the early 1900s, researchers discovered that certain compounds containing gold, given orally or by injection, gave relief to some people who have rheumatoid arthritis and caused total remission in others.

Note, however, that because the side effects of gold treatment can range from minor skin rash to severe blood and kidney disorders, this treatment is generally approached with caution. Newer treatments using low doses of chemotherapy medications (methotrexate) have produced dramatic improvements in severe rheumatoid arthritis, and these treatments show great promise of preserving joint function. Other strong medications that have come along since methotrexate are Arava, Azulfidine, Enbrel, Imuran, Neoral, Plaquenil, Remicade, Humira and Kineret. In general, they work by suppressing the overactive immune system. Apheresis is another treatment for rheumatoid arthritis that removes antibodies from the blood.

In cases of arthritis, specific treatment will depend on the nature and seriousness of the underlying condition. The major concern is for healing the affected area before more serious problems occur. Treatment of infectious arthritis typically involves large intravenous doses of antibiotics as well as drainage of excess fluid from the joints.

Surgery

Various forms of surgery may be needed to reduce the discomfort of arthritis or to restore mobility or joint function. Synovectomy is the removal of damaged connective tissue lining a joint cavity, and allows the body to regenerate new, healthy tissue in its place. This operation is most common in the knee. In cases of severe arthritic damage to the neck or foot, bones can be surgically removed or fused. Although movement is limited after such surgery, the operations relieve excruciating pain and help prevent further damage to nerves or blood vessels.

If arthritic pain and inflammation become truly unbearable, or arthritic joints simply refuse to function, the answer may lie in surgical joint replacement. Today, hip and shoulder joints — as well as smaller joints in elbows, knees and fingers — can be replaced with reliable artificial joints made of stainless steel and plastic. This type of surgery can dramatically improve function and mobility.

Pain Management

Because one of the most trying aspects of arthritis is learning to live with pain, many doctors recommend training in pain management, including cognitive therapy. The National Institutes of Health has found that cognitive behavioral therapy, using education and behavior modification alongside relaxation techniques, is better than routine care for relieving pain associated with arthritis. Such programs focus on improving patients' emotional and psychological well-being by teaching them how to relax and conduct their daily activities at a realistic pace. Learning to overcome mental stress and anxiety can be the key to coping with the physical limitations that may accompany chronic rheumatoid arthritis and osteoarthritis. Cognitive therapy may include various techniques for activity scheduling, imaging, relaxation, distraction, and creative problem-solving.

Alternative Medicine

A variety of alternative therapies are used for arthritis. Let your doctor know if you're considering them.

Some studies suggest that glucosamine and chondroitin supplements are as effective as NSAIDs for reducing pain, swelling, and stiffness in osteoarthritis. Recent studies in 2001 show some promise that they may slow the progression of osteoarthritis. More studies are underway to further investigate this. Typical doses are 1500mg for glucosamine and 1200mg for chondroitin daily. Glucosamine can raise blood sugar, so be sure to talk to your doctor before taking it, especially if you have diabetes. The antibiotic doxycycline may also show some potential in delaying the progression of osteoarthritis by inhibiting enzymes that break down cartilage. More research is needed to confirm these results.

The National Institutes of Health considers acupuncture an acceptable alternative treatment for osteoarthritis. Studies have shown that acupuncture helps reduce pain, may significantly lessen the need for painkillers, and can help increase range of motion in affected joints.

Available over-the-counter since 1999, the supplement SAMe has been shown in some studies to be as effective against osteoarthritic pain as NSAIDs, with the added benefit of fewer side effects.

Homeopathy may improve pain, joint tenderness, stiffness, and grip strength, especially when used in conjunction with nonsteroidal anti-inflammatory drugs (NSAIDs)

Fish oil has been shown to reduce inflammation, lessen the need for painkillers, and possibly decrease joint stiffness. A diet low in animal and dairy fats may have similar effects. Excellent sources of fish oil include EPA/DHA capsules and oily fish such as salmon and mackerel.

At least a dozen different herbs have been used to ease the symptoms of both osteoarthritis and rheumatoid arthritis; most are considered anti-inflammatories. Ask your doctor about using any herbs, since they can interact with each other or with medication you are taking. In most cases, lack of careful studies means little is known about long-term effects. Herbs that have been used are powdered ginger, borage seed oil, or devil's claw to reduce pain and swelling. Stinging nettles or turmeric may also lessen pain, stiffness and inflammation.

Ayurvedic medicine uses herbal compounds internally and externally for symptom relief. Topical curcumin may help relieve the inflammation of rheumatoid arthritis; if taken in capsule form, it can reduce morning stiffness and boost endurance. In one study, a combination of Withania somnifera, Boswellia serrata, and Cucurma longa caused a significant drop in pain and disability for people with osteoarthritis.

At-Home Remedies:

Heat and rest — traditional remedies for arthritic pain — are very effective in the short run for most people with the disease. Overweight sufferers should lose weight, especially when arthritis affects the lower back, knees, and legs. Consult a registered dietician who can help you plan a healthy weight-loss program.

In addition to treatments recommended by your doctor, you can use dry heat from a heating pad or moist heat in the form of a hot bath or a hot-water bottle wrapped in a towel to help relieve pain and stiffness. Regular exercise is important to keep the joints mobile. People with weakened, badly deformed fingers from rheumatoid arthritis benefit from specially designed utensils and door and drawer handles; people suffering weakness in the legs and arms can use special bathroom fixtures, especially tub rails and elevated toilet seats.

Though arthritis is not preventable, many people are able to prevent disability with a well-designed treatment program, including medications, exercise, and physical therapy when needed.