Q: I was recently diagnosed with rheumatoid arthritis. In
addition to the medications my doctor prescribes, what else can I
do to help manage this disease?
Q: I was recently diagnosed with rheumatoid arthritis. In addition to the medications my doctor prescribes, what else can I do to help manage this disease?
A: Rheumatoid arthritis (RA) is a chronic, disabling disease that affects the body’s joints (the places where bones meet). It often strikes the wrists and hands, but can also affect joints in the neck, shoulders, knees, ankles and feet. The affected joints often are swollen, and feel warm and tender. They may be especially stiff and painful when you wake up or after you rest. It’s a frustrating disease because no one knows what causes RA, and there is no cure for it.
Doctors typically recommend a combination of drugs for RA that relieve pain, control inflammation (swelling), and slow the progression of the disease. They include painkillers such as acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin and others). Prescription-only painkillers known as COX-2 inhibitors are another option. However, these drugs may increase the risk of stroke and heart attack, so their use should be carefully considered.
Corticosteroids, such as prednisone, ease pain and swelling and can also slow joint damage. Recent research shows that early treatment with powerful drugs known as disease-modifying antirheumatic drugs (DMARDs) actually lessen the chance of long-term disability from RA for some people. As a result, most people with RA take a DMARD, usually the anti-cancer drug methotrexate. Another option is a group of drugs known as biological response modifiers (BRMs). One example is entanercept (Enbrel), which works by curbing the production of substances that cause inflammation in the hot joints.
In addition to these well-studied medications, some complementary approaches have shown promise. But their safety and effectiveness are not proven. Before trying any of them, consult your clinician.
n Fish and plant oils: Certain essential fatty acids may help ease RA symptoms, according to several studies. They include eicosapentaenoic acid, found in fish oil, and gamma linolenic acid, found in some plant oils. Fish oil capsules, available over the counter in drug stores, contain these fatty acids.
n Supplements: Certain vitamins, minerals and supplements may help improve symptoms. These include B vitamins, copper and zinc, and the amino acid L-histidine. But it’s best to get an adequate intake of vitamins and minerals through food and a standard multivitamin. Some supplements can interact with rheumatoid arthritis medications, so check with your doctor.
n S-Adenosymethionin (SAMe): SAMe is marketed as a supplement for improving joint mobility and pain symptoms in osteoarthritis. Early studies suggest it may help relieve rheumatoid arthritis pain. People who take methotrexate should not take SAMe.
n What about bee venom?
There’s no scientific evidence that bee venom injected – by bee or needle – into an affected joint helps in treating rheumatoid arthritis. Likewise, copper bracelets have no proven benefit.
Another important part of managing the symptoms of RA is knowing when and how to exercise and rest. Resting an inflamed joint reduces the inflammation. But too much rest can weaken muscles and make joints less able to move normally. Knowing how to adjust your activities can help keep your joints strong and flexible without overusing them. A physical therapist can teach you exercises and recommend splints and other devices to support and immobilize joints when at rest. Exercise also helps to prevent osteoporosis – a condition that’s more likely to occur in women who have rheumatoid arthritis.
Other non-drug approaches can help as well. An occupational therapist can show you how to protect your joints during daily activities and recommend devices that make it easier to eat, write, lift objects and do other chores. A podiatrist can make foot orthoses – shoe inserts that help redistribute the weight of the body and improve foot function. Finally, techniques such as cognitive behavioral therapy, biofeedback and stress management can lessen disability and pain caused by rheumatoid arthritis.
Submit questions to the Harvard Medical School Adviser at www.health.harvard.edu/adviser.