Rheumatoid arthritis (RA) is an autoimmune disorder characterized by inflammation
and pain in the joints. Unlike osteoarthritis— the most common type
of arthritis—RA isn’t due to normal wear and tear but is caused
by immune cells attacking the body. RA’s onset can be much earlier
than osteoarthritis, although it can occur at any age.
Dealing with arthritis pain requires addressing the root cause, so each
type of disease has different management techniques. We spoke with
Dilrukshie Cooray, MD, FACR, a rheumatologist with the
Torrance Memorial Physician Network and an assistant clinical professor of medicine at the UCLA School of
Medicine, about how to approach RA pain.
What are the most common ways to deal with rheumatoid arthritis pain?
The most important factor in treating RA is diagnosing the disease early
and starting patients on therapy as soon as possible. Individuals with
RA are at risk for severe joint deformities, so it is imperative to start
therapy early not only to treat the symptoms, like inflammation and pain,
but also to prevent the severe joint deformities associated with progression.
We often start with medicines known as disease-modifying antirheumatic
drugs or DMARDs. DMARDs can be classified as traditional or biologic.
Examples of traditional DMARDs include methotrexate, sulfasalazine, Plaquenil
and Arava. Depending on the severity of their disease, patients may also
be treated with biologic DMARDs. The goal of RA therapy is early remission,
and several studies show that starting therapy early may induce remission.
Beyond prescription drugs, are there other lifestyle changes people can
make to help with inflammation and pain?
Trying to maintain a healthy weight and lifestyle is very important. In
individuals with arthritis of any type, weight-bearing exercises may cause
discomfort. We typically recommend non-weight bearing exercises such as
aquatic therapy and tai chi, which do not put stress on the joints.
Physical therapy (PT) can also be helpful in those individuals who have
long-standing RA and chronic deformities as a result. The idea is to try
to increase their range of motion and strengthen their muscles. We use
PT as an adjunct to other therapies to manage many different types of
arthritides, not just RA.
Also important are healthful living practices. Eating a healthy and balanced
diet is essential. Additionally, it is imperative to manage high cholesterol
and hypertension in patients with RA, as there is an increased risk for
developing cardiovascular disease in these individuals.
What about drugs for pain management?
Typically, once patients with RA start on the appropriate medications,
inflammation should subside and pain should improve. If pain symptoms
continue even after inflammation has subsided, then other causes for the
pain should be evaluated and addressed.
We usually want to avoid long-term narcotics to treat this disease and
to utilize RA drugs as much as possible to bring the disease under control.
Narcotics do not alter the course of the disease in any way and ultimately
may be more harmful than helpful in patients with RA.
What happens if a patient doesn’t respond to medications?
Some patients may not respond to just one medicine initially. Most patients
require treatment with more than one agent or require a combination of
medicines. At this time, we have so many FDA-approved medicines to treat
RA—if one doesn’t work, then it is reasonable to either add
another agent or switch to another medicine.
It is important for patients to have a good collaboration with their rheumatologist
to find the right class and agent that works. I tell my patients that
if there is a day and time when it’s “convenient” to
have RA, now is it. We have so many therapies available to treat patients
with RA. The ultimate goal is to impact quality of life and to try to
help individuals with RA live a normal life.