After all of the information that WebMD has provided on Rheumatoid Arthritis, including the drugs and surgical interventions, there are home remedies that people with this painful inflammatory disease can utilize to diminish their pain to a tolerable level. As I’ve told you before, check with your medical provider before implementing anything you read on this or any other blog or website.

Natural Treatments for Rheumatoid Arthritis

Looking for some natural treatments for RA? Natural therapies are popular today as people seek to control their health and healing. For those with RA, natural therapies may let you have greater control of your pain and activities.

Self-Assessment: Are You Doing All You Can to Manage Your Rheumatoid Arthritis?

What are some natural treatments for RA?

According to the National Center for Complementary and Alternative Medicine (NCCAM), natural treatments for RA may range from moist heat, magnets, and massage to herbs, natural supplements, and relaxation remedies.

Although some of these natural treatments may help RA, none of these therapies is fully grounded in science. Before you use any unprescribed remedy, always talk to your doctor.

How are heat and cold used to relieve RA symptoms?

Many doctors recommend heat and/or cold treatments to reduce RA symptoms.

Cold compresses reduce joint swelling and inflammation. You can apply a cool compress or ice pack to the affected joint during an RA flare-up to help ease inflammation and pain.

You don’t want to overdo cold treatments. Apply the cold compress for 15 minutes at a time with at least a 30-minute break in between treatments.

Heat compresses relax your muscles and stimulate blood flow.

To use heat therapy, you can try a moist heating pad or a warm, damp towel. Many people like using the microwavable hot packs. Don’t go too hot. Your skin should not burn.

You can also use heat therapy by standing in the shower. Letting the warm water hit the painful area on your body may help ease pain.

A hot tub is a good way to relax stiff muscles — and it’s enjoyable. (Caution: Avoid hot tubs or spas if you have high blood pressure, heart disease, or are pregnant.)

Can magnets improve RA symptoms?

Magnets are commonly said to be helpful alternative therapies for pain control. Found at most natural food stores, magnet therapies come in a variety of forms, such as bracelets, necklaces, inserts, pads, or disks.

Most research on magnets has been done in people with osteoarthritis, the wear and tear type of arthritis associated with aging.

In people with osteoarthritis, some preliminary studies have shown that magnets improved joint pain better than a placebo in people with knee or hip arthritis. Doctors do not understand exactly how magnets might relieve pain.

It’s unclear if magnets might also help those with rheumatoid arthritis.

What about mind/body therapies for RA?

Many studies have reviewed the use of mind/body therapies for pain. Mind/body therapies may be helpful when added to conventional treatments.

Mind/body therapies may help with stress management. They can help improve sleep and pain perception.

Deep abdominal breathing: Taking deep, slow breaths from the abdomen (not the chest) can help alter your emotional state. Deep breathing can make a stressful moment lessen in intensity.

What about mind/body therapies for RA?

With deep breathing, you can decrease stress hormones. Deep breathing also helps slow your heart beat during stressful moments.

Progressive muscle relaxation: Concentrating on different muscle groups, contract then relax all of the major muscle groups in the body.

Start with your head, neck, and arms. Then contract and relax your chest, back, and stomach. Finish by doing your pelvis, legs, and feet.

Along with muscle relaxation, use deep breathing. Breathe in while tensing the muscles. Breathe out or exhale while relaxing the muscles.

Visualization: Visualization can help reduce stress and pain. With this exercise, you close your eyes, breathe deeply, and imagine that you’re in quiet, peaceful place.

Using visualization during stressful times can be soothing and refreshing.

Meditation: Meditation brings about relaxation and stress reduction. It can slow the heart rate and breathing. Meditation reduces stress and helps with your pain perception.

Those who practice meditation tell of having decreased anxiety and depression. They also report increased concentration and resilience.

Tai chi: Studies are being done on tai chi for pain reduction. The movements of tai chi are gentle, graceful, and mystical.

For those with arthritis, tai chi is a safe way to relieve pain. Tai chi can help increase range of motion and joint strength.

Some believe that tai chi has a spiritual modality. Tai chi allows people to practice mindfulness as they focus in the moment and away from the pain.

Acupuncture: With acupuncture, the practitioner uses stainless steel needles to stimulate the major pathways — called “meridians” — in the body. The goal is to stimulate various points targeted at specific areas of the body.

Traditional Chinese medicine practitioners believe acupuncture can heal imbalances of energy, or “qi.” The practitioner tries to restore balance to the sick body and boost the immune system. Good health happens when qi flows unrestricted throughout the body.

Some doctors believe acupuncture needles decrease pain by triggering pain-blocking chemicals called endorphins. Endorphins are known as the body’s natural opioid. Other theories suggest that acupuncture may block pain signals.

Although little research has been done on people with rheumatoid arthritis, studies do show an improvement in pain, particularly in people with back pain. Some studies have also shown a decrease in pain in people with osteoarthritis.

Biofeedback: With biofeedback, you learn to control automatic responses such as heart rate and blood pressure.  By placing electric sensors on the body, information is sent to a monitor. You then have to react to stimuli such as thoughts, pictures, or sounds.

Working with a therapist, you’ll study your body’s reactions to the stimuli. The therapist will help you recognize feelings of increased tension and learn ways to calm yourself.

There is insufficient medical evidence to determine how well biofeedback helps pain from arthritis.

Are there safe supplements for RA?

There are a few studies showing some benefit for certain supplements and natural remedies. However, the research is preliminary, so the true impact these supplements may have on RA is uncertain.

Keep in mind that even natural supplements can interact with medicines. Be sure your doctor is aware of all medicines and supplements you are taking.

Supplements for RA that have the best medical research to back them up include:

Borage. Some studies show that borage seed oil along with anti-inflammatory painkillers can reduce RA symptoms. These findings show reduced tender and swollen joints of RA after six weeks. Borage seed oil appears to be safe but may cause soft stools, diarrhea, and bloating. Borage seeds and other plant parts, such as the leaf or flower, may contain substances that are potentially harmful to the liver. Borage seed oil does not contain these harmful substances.

Fish oil. Studies show that omega-3 fatty acids in fish oil have an anti-inflammatory effect in the body. Several studies have shown that fish oil supplements may help reduce morning stiffness with RA. In addition, the omega-3 fatty acids in fish oil help protect against heart disease. People with RA are at a higher risk of developing heart disease. Fish oil appears to be safe when used appropriately. Doses greater than 3 grams per day may increase the chance of bleeding.

Thunder god vine. A few studies have shown a decrease in pain and tender joints in people with RA. A larger government-funded study is under way comparing thunder god vine with traditional medicine for rheumatoid arthritis. Thunder god vine appears to be safe. However, pregnant women should not take this supplement as it may cause birth defects.

Can Your Diet Help Relieve Rheumatoid Arthritis?

If you suffer from rheumatoid arthritis, you may have heard that a specific diet or certain foods can ease your pain, stiffness, and fatigue. Someday, food may be the medicine of choice for those with arthritis and related inflammatory diseases. For now, though, here’s information that may help you separate the facts from the myths about diet and rheumatoid arthritis.

Eating certain foods or avoiding certain foods may help your rheumatoid arthritis symptoms. However, according to the Arthritis Foundation, there is no scientifically substantiated “arthritis diet.” On the other hand, if you find certain foods worsen your rheumatoid arthritis symptoms and others help your symptoms to improve, it makes sense to make some adjustments in your diet.

A recent study showed that 30% to 40% of people with rheumatoid arthritis may benefit from excluding “suspect” foods that are identified with an elimination diet. An elimination diet guides you in removing suspected “trigger” foods from your daily diet. Then, after a period of time, you slowly add the suspect foods back into your diet and watch for increased pain and stiffness. For some people, eliminating those foods that seem to trigger pain and stiffness may help decrease rheumatoid arthritis symptoms.

Can some fats increase the inflammatory response in people with rheumatoid arthritis?

Yes. Studies show that saturated fats may increase inflammation in the body. Foods high in saturated fats, such as animal products like bacon, steak, butter, and cream, may increase pro-inflammatory chemicals in the body called prostaglandins. Prostaglandins are chemicals that cause inflammation, pain, swelling, and joint destruction in rheumatoid arthritis.

In addition, some findings confirm that meat contains high amounts of arachidonic acid. Arachidonic acid is a fatty acid that’s converted to pro-inflammatory chemicals in the body. Some people with rheumatoid arthritis find that a vegetarian diet helps relieve symptoms of pain and stiffness. Other people with rheumatoid arthritis, however, get no benefit from eating a diet that eliminates meat.

Is omega-6 fatty acid linked to increased inflammation associated with rheumatoid arthritis?

Omega-6 fatty acids are in vegetable oils that contain linoleic acid. That includes corn oil, soybean oil, sunflower oil, wheat germ oil, and sesame oil. Studies show that a typical western diet has more omega-6 fatty acids compared to omega-3 fatty acids. Omega-3 fatty acid is a polyunsaturated fat found in cold-water fish.

Consuming excessive amounts of omega-6 fatty acids may promote illnesses such as cancer and cardiovascular disease. It may also promote inflammatory and/or autoimmune disease such as rheumatoid arthritis. Ingesting fewer omega-6 fatty acids and more omega-3 fatty acids, on the other hand, may suppress inflammation and decrease the risk of illness.

Many studies show that lowering the ratio of omega-6 fatty acids to omega-3 fatty acids contained in the diet can reduce the risk of illness.

How can omega-3 fatty acids help rheumatoid arthritis?

Omega-3 fatty acids, the polyunsaturated fats found in cold-water fish, nuts, and other foods, may have an anti-inflammatory effect in the body. The marine omega-3 fatty acids contain EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). These are substances that may decrease inflammation. Some studies show a positive anti-inflammatory effect of omega-3 fatty acids with rheumatoid arthritis. The same is true for cardiovascular disease. This is important because people with rheumatoid arthritis have a higher risk of cardiovascular disease.

Human studies with marine omega-3 fatty acids show a direct relationship between increased DHA consumption and diminished C-reactive protein levels. That means reduced inflammation.

Which foods have omega-3 fatty acids that might be good for rheumatoid arthritis?

For omega-3 fatty acids, select cold-water fish such as salmon, tuna, and trout. Some plant foods are also sources of omega-3 fatty acids. They include walnuts, tofu and soybean products, flaxseed and flaxseed oil, and canola oil.

Can fish oil supplements help rheumatoid arthritis?

According to the American College of Rheumatology, some patients with rheumatoid arthritis report an improvement in pain and joint tenderness when taking marine omega-3 fatty acid supplements. You may not notice any benefit at first from taking a fish oil supplement. It may take weeks or even months to see a decrease in symptoms. But studies do show that some people who have a high intake of omega-3 fatty acids benefit from decreased symptoms and less use of anti-inflammatory drugs.

The American College of Rheumatology reminds consumers that fish oil supplements may have high levels of vitamin A or mercury.

Can a Mediterranean-type diet help rheumatoid arthritis?

Many studies suggest that a diet high in fruits, vegetables, and vitamin C may be linked to a lower risk of rheumatoid arthritis. In fact, we know that rheumatoid arthritis is less severe in some Mediterranean countries such as Greece and Italy. In those countries, the main diet consists of large amounts of fruits, vegetables, olive oil, and fatty fish high in omega-3s. The Mediterranean-type diet may even protect against severe rheumatoid arthritis symptoms.

Fruits, vegetables, grains, and legumes are high in phytonutrients. These are chemicals in plants that have disease-fighting properties and immune-boosting antioxidants such as vitamin C, vitamin E, selenium, and the carotenoids. A plant-based diet is also high in bioflavonoids. These are plant compounds that reportedly have anti-viral, anti-inflammatory, and anti-tumor activities.

Nutrition researchers who test the antioxidant activity of foods believe that certain foods may reduce the risk of some degenerative diseases associated with aging. These diseases include arthritis, heart disease, diabetes, and cancer. More recent findings show that the higher intake of omega-3 fatty acids with the Mediterranean diet may be linked to the improvement in rheumatoid arthritis symptoms.

What vitamins and minerals are important for people with rheumatoid arthritis?

Folic acid, or folate, is a B vitamin found in food. It can also be obtained by supplementation. It is important to you if you take methotrexate, a commonly prescribed medication for rheumatoid arthritis. Your body uses folic acid to manufacture red blood cells. Supplementing with folic acid may allow people with rheumatoid arthritis to stay on methotrexate longer. That way they can benefit from relief of pain and inflammation without suffering the medication’s side effects.

Selenium helps to fight free radicals that cause damage to healthy tissue. There are some studies that indicate people with rheumatoid arthritis have reduced selenium levels in their blood. Current findings are preliminary and so no recommendations have been made for selenium supplementation. One 3.5-ounce serving of tuna gives you a full day’s requirement of selenium.

Supplementing your diet with bone-boosting calcium and vitamin D is important, especially if you take corticosteroids (like prednisone) that can cause bone loss. The risk of bone loss is higher in people with rheumatoid arthritis. So check with your doctor to see how much calcium and vitamin D you need to get daily through foods, supplements, and sunlight.

What about alcohol and rheumatoid arthritis?

A recent study published in the Annals of Rheumatic Diseases (2008) concluded that drinking alcohol may be linked to a significantly reduced chance of getting rheumatoid arthritis. While the researchers did not know how alcohol protects against rheumatoid arthritis, they believed the data should encourage further study on how arthritis may be prevented through diet and lifestyle measures. Talk to your doctor about drinking alcohol if you take any rheumatoid arthritis medication. Avoid alcohol if you take methotrexate because liver damage could be a serious side effect.

Can weight loss help my rheumatoid pain and stiffness?

Yes. Studies show that dropping extra pounds is important for your joints and overall health. Excess pounds put extra strain on knees, hips, and other weight-bearing joints, not to mention your heart. Being overweight or obese actually worsens the joints — making them stiffer and more painful — and can exacerbate rheumatoid arthritis flares.

Rheumatoid Arthritis and Exercise

Learn about the importance of exercise for rheumatoid arthritis. Arthritis exercises can safely provide pain relief and build muscle strength.

When joints are stiff and painful, exercise might be the last thing on your mind. Yet when you have rheumatoid arthritis, exercising regularly is one of the best things you can do to take care of yourself and your joints. Here is why exercise is so important:

• People who exercise live longer, with or without rheumatoid arthritis.
• Regular exercise can actually reduce overall pain from rheumatoid arthritis.
• Exercise can keep your bones strong. Thinning of the bones can be a problem with rheumatoid arthritis, especially if you need to take steroids. Exercise helps bones keep their strength.
• Exercise maintains muscle strength.
• Regular exercise improves functional ability and lets you do more for yourself.
• People with rheumatoid arthritis who exercise feel better about themselves and are better able to cope with problems.

Is Exercise Safe If You Have Rheumatoid Arthritis?

Is exercise safe? Yes — certain kinds of exercise are proven to be safe for people with rheumatoid arthritis. There are three types you can do: stretching, strengthening, and conditioning.

• Stretching exercises are the simplest and easiest. They consist of stretching and holding different joint and muscle groups for 10 to 30 seconds each. Stretching improves flexibility, and daily stretching is the basis for any exercise program.
• Strength exercises involve working the muscle against resistance. This can be either with or without weights. Resistance training strengthens the muscle and increases the amount of activity you can do pain-free.
• Conditioning exercise, also called aerobic exercise, improves cardiovascular fitness. There are countless benefits to aerobic exercise! Among them, it makes your heart and blood vessels healthier, prevents disability, and improves mood and well-being. Good conditioning exercises for people with rheumatoid arthritis include low-impact activities like walking, swimming, bicycling, or using an elliptical machine. Any of these will get your heart pumping.

  After being cleared by your doctor, you should try to do 20 to 30 minutes of low-impact conditioning exercise on as many days as you feel you can. More is better, but any amount is better than none at all!

Exercises to Avoid if You Have Rheumatoid Arthritis

Are there any kinds of exercise you should avoid if you have rheumatoid arthritis? In general, you should be careful about activities that put a lot of stress on a joint, or are “high-impact,” such as:

• Jogging, especially on paved roads
• Heavy weight lifting

That’s not to say that these activities are totally off-limits. If you’re interested in trying them, talk to your doctor first.

Your rheumatologist can help you create an exercise program that is right for you. This may also involve meeting with a physical therapist. Physical therapists can identify what areas you need to work on, choose the right exercises for you, and tell you how vigorously you should exercise.

There are also community exercise programs designed just for people with arthritis. People with Arthritis Can Exercise (PACE) and the Arthritis Self Help Course (ASHC) are offered by the Arthritis Foundation (www.arthritis.org).

You should work with your treatment team to design the right plan before starting to exercise, especially if you have other medical problems.

As you start to exercise regularly, you’ll realize the benefits, and you’ll know you’ve taken control of your rheumatoid arthritis. Soon, not only will your joints feel better — you’ll feel better too.

Hand Exercises for Rheumatoid Arthritis

You need your hands to cook, clean, type, and do just about everything else. But you probably don’t think much about how important manual dexterity is unless you have rheumatoid arthritis (RA) or another type of arthritis that attacks your hand and finger joints.

RA is a disease in which the body’s immune system engages in friendly fire against the joints. It often starts in your hands before spreading to the other joints.

“The hands and the feet are usually hit first, and these are the joints that are predominantly involved in everyone with RA,” says Eric Matteson, MD, a professor of medicine at the Mayo Clinic in Rochester, Minn. Hand exercises can help maintain range of motion, flexibility, and strength in your hands.

There is not a one-size-fits-all hand exercise prescription for people with RA, but a rheumatologist, physical therapist, or occupational therapist can help design a program especially for your hands. Here are seven hand exercises your program may include.

• Hand Exercise for Rheumatoid Arthritis: No. 1: Start by holding your hand upright and pointing your wrist, fingers, and thumb upward. This also serves as the neutral starting position for many of the hand exercises that follow. Hold for 5 to 10 seconds.
• Hand Exercise for Rheumatoid Arthritis: No. 2: Keep your wrist straight in the neutral starting position and bend the base joints of your fingers, which connect the fingers to the palm. Keep your middle and end joints and your wrist straight. “This is already a big effort for people with RA,” Matteson says. Hold for 5 to 10 seconds. Repeat twice daily on each hand.
• Hand Exercise for Rheumatoid Arthritis: No. 3: Keep your wrist and the base joints straight, and bend your middle and end joints of your fingers toward your palm, one at a time. Hold each position for five seconds. Repeat on all 10 fingers twice a day.
• Hand Exercise for Rheumatoid Arthritis: No. 4: Bend each finger from the base joint downward using your other hand to move your fingers. Repeat this movement using the second row of knuckles in your finger. Repeat this exercise on the third row of joints in your fingers, closest to the fingertips. Hold for 10 seconds. Repeat on all 10 fingers twice a day.
• Hand Exercise for Rheumatoid Arthritis: No. 5: With your hand straight and fingers pointing upward, bend your fingers downward so they are touching your palm. Do not make a fist. Instead, your fingertips should be touching the palm of your hand. Hold for five seconds. Repeat on both hands twice a day.
• Hand Exercise for Rheumatoid Arthritis: No. 6: Starting with your wrist, fingers, and thumb pointing upward, make an “O” by touching your index finger to your thumb. Hold this for at least 5 and up to 20 seconds. Repeat two to 10 times twice a day.
• Hand Exercise for Rheumatoid Arthritis: No. 7: With your hands in the neutral position and all of your knuckles straight, slowly and gently spread your fingers as far apart as you can, like a fan opening up. From this position, make a fist. Hold each position for five seconds. Repeat on both hands twice a day.

“These hand exercises are really effective for stretching and maintaining mobility in your hands if you have RA,” he says. “We don’t do these exercises for strength because the strength that comes with good hand mobility in the activities of daily living is quite satisfactory.”

Hand Exercises for RA to Avoid

Certain exercises may also do more harm than good, adds Francoise Cherry, a certified hand therapist at the Hospital for Joint Diseases in New York. “Most patients say, ‘I have been squeezing a ball,’” she says. “But don’t do this because it puts more stress in the joints.”

Hand Exercises for Rheumatoid Arthritis: Pain Is Not OK

Matteson says there is one rule about hand exercises and RA you should always follow: Hand exercises for rheumatoid arthritis should not hurt.

“If you experience pain, stop the hand exercises,” he says. “Once the pain has subsided, you can repeat the exercises with reduced intensity and speed.”

If the pain comes back or you can’t perform the hand exercises at reduced intensity, there may be something else going on, like a joint dislocation. If this occurs, “talk to your doctor,” he says.

Hand Exercises for RA: Protect Your Joints

Alexandra MacKenzie, an occupational therapist at the Hospital for Special Surgery in New York, stresses that joint protection is key. “We focus on protecting the joints, making sure inflammation is down and teaching people how to modify their activities,” she says.

Lifestyle changes can also help protect hand and wrist joints and preserve their function.

For example, “using heat first thing in the morning, which is when joints are the stiffest because they were not moving all night, can be helpful,” she says. This can take the form of a heating pad or just soaking your hands in warm water in the shower.

Jar openers and other adaptive equipment may also help, she says.

Cherry says hand and wrist splints are also important for people with RA. Splints help support and align joints. “The pattern of hand deformity is uniform in rheumatoid arthritis, and we have splints that target this deformity,” she says.

Your Medical Team for Rheumatoid Arthritis

Living with rheumatoid arthritis (RA) can sometimes feel like a full-time job. It’s important to remember that you can’t gain control of it all by yourself. It’s a complicated condition that can affect your whole life; it needs a coordinated approach.

Luckily, you don’t have to do it alone. You can build a “dream team” of professional health care providers who are trained to help you. Creating a coordinated medical team gives you the best chance against rheumatoid arthritis. Who should you look for to be on your team? There are several key players you should turn to.

Your Rheumatologist

A rheumatologist is a medical doctor with specialized training in rheumatology (joint disease). Your rheumatologist is at the center of your RA treatment team.

Visiting your rheumatologist regularly is the best thing you can do to get control of your rheumatoid arthritis. This is the person who will monitor your disease and its progression and make changes to your treatment plan.

Your Primary Care Doctor

You may also see a primary care or “regular” doctor, who will manage any other medical problems you may have. Primary care also includes general check-ups and preventive health maintenance (like mammograms or cholesterol checks).

Your Physical Therapist

Physical therapists are skilled at identifying muscle groups and joints that need improvement. They can assess your level of fitness and ability and design an exercise plan to help you build strength and flexibility where you need it most. Since exercise is key to keeping joints healthy, make sure you don’t keep your physical therapist on the sidelines.

Your Occupational Therapist

Occupational therapists help you keep your independence. If rheumatoid arthritis starts to slow you down, or if daily tasks become difficult, a visit with an occupational therapist will probably help. Occupational therapists have a playbook of “work-arounds” to let you continue to live your own way. They can also provide or recommend an arsenal of assistive devices that will smooth out the rough spots in your daily routine.

Your Psychologist, Psychiatrist, or Social Worker

Coping with rheumatoid arthritis is something that can be learned. Many people need extra support with the psychological and emotional challenges it brings. These professionals specialize in the more human and emotional aspects of managing your condition:

• Social workers can help you navigate the health care system; provide counseling during tough times; and help you find community or government resources to help you get the care and support you deserve.
• Psychologists and psychiatrists provide counseling, psychotherapy, or stress management therapy. Psychiatrists can also prescribe medicines, such as antidepressants, if needed.

Your Orthopedic Surgeon

Surgical therapy for rheumatoid arthritis has improved greatly over the past decades. There is a variety of surgical procedures that can help you keep good use of your joints for as long as possible. If you feel like your current treatment isn’t working, ask your rheumatologist if surgery is a reasonable option.

Organizing Your Medical Team

To organize your medical team, start with your rheumatologist, who probably has a network of contacts with whom you can get in touch.

• Keep records. Don’t assume all your team members are communicating or sharing copies of your chart. Recent changes to health care law make it your legal right to receive a copy of your medical record. Ask for it, and carry all your records to your appointments.
• Communicate. Make sure each team member knows about important changes, like recent surgeries, hospitalizations, or major changes in your medicines.
• Keep in touch. Maintain your relationships with the members of your team, by keeping your appointments and taking an interest in your care plan.
• Ask questions. People who take an interest in their care for rheumatoid arthritis stay involved and tend to do better.

Working With Your Doctor to Manage Your Rheumatoid Arthritis

Studies have shown that people with rheumatoid arthritis who see a rheumatologist regularly (several times a year) do better than people who visit erratically or not at all. The first step is finding one!

• Your primary care doctor can refer you to a rheumatologist. If you like your doctor and have a good relationship, chances are good you’ll get along with the rheumatologist your doctor recommends.
• You may be able to see a rheumatologist directly without a referral; check your insurance plan and its list of providers.
• Ask around: someone you know may have had a good experience and be able to recommend a rheumatologist.
• The American College of Rheumatology (www.rheumatology.org) maintains a national database of members. Go to their web site and click on “Find a Rheumatologist.”

In many parts of the country, rheumatologists are in short supply. Even if you feel like the situation with your own rheumatologist could be better, don’t stop going. Either try to find a way to work through the problems, or continue your regular visits while you search for a new rheumatologist.

Regular visits to a rheumatologist are your “early warning system” for rheumatoid arthritis. Because this is a long-term disease, it’s important to catch any changes early.

What can you expect from regular rheumatologist visits?

• Frequent exams of your joints to look for swelling, changes in strength, or changes in range of motion.
• Periodic X-rays and blood tests to follow active inflammation or joint changes.
• Fill out a questionnaire at least twice a year to document your ability level and any changes. Download the Health Assessment Questionnaire (HAQ) at aramis.stanford.edu or ask your doctor for a copy of the questionnaire.

At least once a year, discuss the “big picture” of your treatment plan with your doctor. This can include:

• A diagnosis of the stage and severity of your rheumatoid arthritis
• An estimation of the yearly progression of your disease so far. While not perfect, this can be used to predict future progression.
• New joint damage that has occurred, if any
• Any changes in your level of functioning
• Referrals or the addition of new treatment team members, if needed. This could include physical or occupational therapists, psychologists, orthopedic surgeons, or other health professionals.

Many times, you may feel like not much at all was done, or nothing has changed. Was the visit a waste of your time, or your rheumatologist’s time? Nothing could be further from the truth.

• If no changes to therapy need to be made, chances are good your rheumatoid arthritis is stable and progressing slowly, if at all.
• Regular visits, however brief, build the relationship between you and your rheumatologist. Your case of rheumatoid arthritis is unique, because everyone is affected differently. The more often you go, the better your doctor can understand you as a person, as well as your rheumatoid arthritis and how it affects your life overall.

Coping with Rheumatoid Arthritis Pain

Being in pain can be the hardest part of living with rheumatoid arthritis. While medicines help, they don’t always make the pain go away completely.

Coping with your pain means acknowledging that the problem is not just the pain itself. Constant pain has an effect on your whole life.

Most people with rheumatoid arthritis are faced with frequent or ongoing pain. While you may not be able to avoid pain, you can take control of the situation. Is the pain of rheumatoid arthritis starting to affect your life? There are specific positive steps you can take to live with it — but keep it in its place:

Get Educated About Arthritis Pain

Understanding your pain will better help you deal with it. There are a number of types of pain caused by rheumatoid arthritis.

• Acute pain from inflammation. Anyone with rheumatoid arthritis knows the pain that comes with a flare.
• Pain from joint damage. Joints may become damaged over time by rheumatoid arthritis and cause pain even though your arthritis itself is inactive.
• Exacerbation of pain. After living a long time with pain and the other struggles of rheumatoid arthritis, you can get stressed and worn out. The real pain you feel is made worse by your emotional state.

Most people with rheumatoid arthritis will experience all of these types of pain. This can become a complicated and overwhelming situation and requires an overall approach.

There are educational programs available to help people who have to live with pain. The benefits they provide can make a big difference.

• Learn how pain works, why it happens, and what it means.
• Gain coping and life-management skills for when you are in pain.
• Get trained in cognitive-behavioral therapy or biofeedback. These are methods of reducing the pain you feel by using your mind.

Contact the Arthritis Foundation (www.arthritis.org) to find your local chapter and sign up.

Come Up With a Pain Management Plan

When pain strikes, consider it a signal to take positive action, not to give in and suffer. Even if you are not able to eliminate pain completely, you are doing what you can to help yourself. There are a number of tools at your disposal to manage pain. Experiment until you find what works for you.

• Pain-relieving medicines. Consider taking your pain medicines on a schedule, rather than waiting until you are in more pain and have to play “catch-up.” Severe rheumatoid arthritis pain usually requires maximum doses of NSAIDs, although side effects must be considered at higher doses.
• Meditation and relaxation. Escape from stressful situations and relax your mind. Meditation can help relieve pain, and it is a skill that can be learned.
• Distraction. Focusing on pain makes it worse, not better. Do something you enjoy instead – or any activity that keeps you busy and has you thinking about something else.
• Heat, cold, and massage. These tried-and-true treatments are easy and can provide some quick relief for mild symptoms.

Nurture a Healthy Attitude

No one should have to live with pain. It doesn’t seem fair, and it’s not. It is natural to sometimes feel like a victim, or experience any number of other emotions.

• Frustration
• Despair
• Anger
• Anxiety
• Depression

While these emotions are normal human responses to chronic pain, they don’t help you feel any better. In fact, just the opposite — they can bog you down in negative thoughts, making the situation worse.

There is nothing positive about pain, but you can take a positive approach to living with it. Know the strategies and commit to giving them a chance.

• Cognitive-behavioral training. This is a kind of psychotherapy you can do yourself. A psychologist or other mental health professional can teach you the methods. Cognitive-behavioral training can help you avoid negative thoughts that make pain worse.
• Join a support group. Being with people who understand what you’re dealing with makes you feel less alone.
• Exercise. Believe it or not, exercise will make your joints feel better, not worse. Even if you’re in pain, there are some exercises you can do. Talk to your doctor or a physical therapist. Build an exercise schedule into your treatment plan and stick to it. Over time, the results can be dramatic.
• Eat a healthy balanced diet. Drink alcohol only in moderation. Don’t smoke! Cigarettes, alcohol or unhealthy foods can seem comforting when you are in pain, but in the long-term they won’t help. You deserve better — you deserve the benefits of a healthy lifestyle.
• Get additional support from a mental health professional. The vast majority of people with rheumatoid arthritis are not mentally ill, but being in chronic pain can cause feelings of depression. Asking for help can be a sign of strength, not weakness.

Visit the Arthritis Foundation Pain Center for more information. Link to
http://www.arthritis.org/conditions/pain_center/default.asp.

Life With Rheumatoid Arthritis

Carla Guillory was in her 30s — enjoying life, raising her kids — when the first symptoms began. “We’d been hiking on vacation, and I thought I had bruised my foot, but it didn’t seem to get better. Then my hands started aching,” she remembers.

Right away, doctors suspected she had rheumatoid arthritis. Guillory was tenacious about finding the right doctor — one who would treat her aggressively. She knew she had to tackle this thing head-on, she says. And that she did — with disease-modifying drugs that helped curb the damaging inflammation at her joints.

That aggressive treatment, and getting it early, has made all the difference, says Guillory. “I have some deformity in my hands, but not a whole lot. It’s nothing like other people I’ve met.”

The Changing Picture of Rheumatoid Arthritis

Twenty years ago, the picture for most patients was very different. “A person in the fairly young part of life would get this disease, and within five years they would be deformed and disabled. About half the people with RA had to quit working within 10 years,” says Stephen Lindsey, MD, chairman of rheumatology at the Ochsner Clinical Foundation in Baton Rouge, La.

More than two million Americans suffer from rheumatoid arthritis, also known as RA. About 75% of them are women, according to the American College of Rheumatology. While RA can develop at any age, it often begins between ages 30 and 50. Pain, stiffness, swelling, and limited motion and function of joints — especially hand and foot joints — are the primary symptoms.

Today, doctors are better able better to diagnose the disease, determine how advanced it is – and how best to treat it, says Lindsey. New research has revealed more about the disease itself.

Rheumatoid arthritis is an autoimmune disease, which means that the body mistakenly identifies certain cells as foreign and attacks them — triggering the inflammation that damages healthy joints. Exactly what sparks this malfunction remains unclear, but research has led to important new treatments.

Some remarkable drugs have emerged to specifically short-circuit the immune system malfunction, says Lindsey, who has treated Guillory for the past eight years. “The last decade’s been amazing. It used to be that we could treat the pain but not the disability. That’s dramatically different now. The key is early diagnosis, then aggressive treatment with the right medicine.”

Newer, Better Drugs for Rheumatoid Arthritis

To protect joints from damage, doctors turn to disease-modifying antirheumatic drugs (DMARDs). These include several drugs used in the 1960s and 1970s to treat other diseases — and were discovered to also work with rheumatoid arthritis.

For example, methotrexate, a drug that Guillory took early on, was first used as a form of cancer chemotherapy. It’s still considered an important medication for slowing RA, although it is prescribed at lower doses than used for cancer treatment, Lindsey explains. “The side effects are more acceptable for methotrexate than with other cancer drugs,” he tells WebMD.

Today, DMARDs are prescribed earlier in treatment than ever before, Lindsey says. “The most joint damage and deformity occurs in the first two years and will progress over time, leading to disability. We can prevent that joint damage.”

A newer class of drugs — biological response modifiers, or biologics — is generating the most excitement. Evidence shows that biologics can actually halt the disease when used early on, he tells WebMD. “Instead of seeing the progressive deterioration and disability, we can now stop disease progression.” Biologics approved by the FDA include Enbrel, Humira, Kineret, Orencia, Remicade, Cimzia and Rituxan.

Very often, patients are switched to different drugs — and often take multiple drugs — during the course of treatment, he points out. “Each patient is different, so we have to follow them really carefully, every month. If they don’t improve, we quickly move to a different drug.”

Guillory now takes a biologic drug to better control her disease. And it has, she reports. It’s also made a huge difference in her quality of life, she tells WebMD. “Before I started taking it, I would be exhausted by midday, ready for a nap. Now I don’t have as many days that I’m tired. It’s made a tremendous difference.”

As noted above, the articles within this post have been written by writers from WebMD and reviewed by medical doctors. Even though you can trust what has been written here, please review any changes you wish to make to your treatment plan with your medical provider.