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Rheumatoid Arthritis

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What is Rheumatoid Arthritis (RA)?

Rheumatoid arthritis is a form of arthritis that lead to inflammation in the lining of the joints (ortho means joint and it is means inflammation).  Rheumatoid arthritis can last for many years and can effect many different joints in the body.  Over time, RA can damage various parts of a joint, such as cartilage, bone, tendons and ligaments.

Who Gets RA?

Anyone can be diagnosed with RA, including children and the elderly.  However, most people get RA during their young-to-middle adult years.  Women are diagnosed with RA approximately three times more often than men are.  Over two million people in the United States have RA.

How can I manage my RA?

Your doctor can suggest different ways to help you manage RA, including over-the-counter and prescription medications.  Other treatments may include rest, to reduce pain and discomfort, exercise and physical therapy treatment. 

 Specific exercises will assist you in maintaining muscle strength and joint mobility.  Exercise under the guidance of a physician is particularly important.  Exercise improves your strength, endurance and flexibility, so that you can perform daily activities better.  The key is to maintain a proper balance between rest and physical activity.  Many people with RA can safely participate in appropriate regular exercise programs.  Low-impact movement – such as swimming or bicycling – is especially beneficial, because it provides great cardiovascular exercise, without tiring or harming your body’s joints.  Always check with your physician before beginning or changing an exercise routine.

In addition to recommending exercise, rheumatologists may refer you to physical or occupational therapies. Physical therapy can help you maintain range of motion in your joints, whereas occupational therapy can teach you ways to cope with the day-to-day problems associated with the disease.

Medication Choices:

There are several different types of medications to help relieve you RA signs and symptoms.  Your rheumatologist will determine which medications to prescribe based on the severity of your disease.  A number of factors can determine whether a particular drug will work for you, including how much pain and stiffness you feel, how advanced your disease is and how you respond to various medications.  It is sometimes necessary to be on several medications at once, or to switch treatments from time to time.  The following is a list of the most commonly prescribed medications for RA:


Non-steroidal Anti-inflammatory Drugs (NSAIDs):

  NSAIDs are prescribed to quickly reduce the pain associated with RA.  They also reduce joint inflammation, although this benefit can be delayed for four to six weeks.  NSAIDs can make you feel better temporarily, but they do not alter the course of RA or prevent joint destruction.  They have side-effects such as stomach upset, stomach ulceration and bleeding.

  Some of the most commonly prescribed NSAIDs including Relafen (nabumetone), Naprosyn (naproxen), Arthrotec (diclofenac sodium and misoprostol), Daypro (oxaprozin) and Motrin (ibuprofen).

  A new category of NSAIDs is called COX-2 inhibitors.  Drugs in this class have fewer gastrointestinal side-effects because they do not interfere with an enzyme that is beneficial to the stomach lining.  They have the same effect as NSAIDs.  Like other NSAIDs, COX-2 inhibitors do not alter the progression of the disease.  Medications in this category include Celebrex (celecoxib) and Vioxx (rofecoxib).


Corticosteroids are steroids that have Anti‑inflammatory effects.  They are prescribed to quickly relieve RA signs and symptoms such as pain and inflammation.  However, physicians may have to monitor you more closely when you are on corticosteroids because of the possible development of serious side-effects, including weight gain, osteoporosis, glaucoma, hypertension and cataracts.  The side-effects of these drugs can increase both with longer usage and higher doses.

Commonly prescribed corticosteroids include prednisone and Medrol (methylprednisolone).  

Disease-Modifying Antirheumatic Drugs (DMARDs):

Medications in this class are prescribed to patients who continue to experience joint pain, significant morning stiffness, fatigue or other symptoms, even though they have taken high doses of NSAIDs.  These drugs can slow the loss of cartilage and bone adjacent to the joint.  However, benefits are often delayed for weeks or months.

Some DMARDs may have side-effects that will increase with the duration of treatment, so these drugs may require patients to be monitored with laboratory tests for side-effects.

  Commonly used medications in this group include gold compounds, sulfasalazine, Rheumatrex (methotrexate), Plaquenil (hydroxychloroquine sulfate), Solganal (aurothioglucose) and Arava (leflunomide).


Methotrexate is one of the most commonly prescribed DMARDs.  It appears to act more rapidly than other DMARDs, and provides longer effective relief from symptoms.  Rheumatologists may have to increase the dosage of the drug during the course of your treatment to maintain its effectiveness.  Despite increasing doses, the effectiveness of methotrexate can still taper off in some patients.  Methotrexate is well-tolerated by most patients.  It should not be used if you are pregnant, breast-feeding or planning to become pregnant.


Biological Response Modifiers:

This new class of biologic agents has been shown to have substantial benefits in patients for whom other therapies are inadequate.  They target the body's immune system to control the process of inflammation, significantly reducing disease activity.  

The most common side-effects of biological response modifiers are injection-site reactions and infections.  The medications should be used with caution if you are at risk for infections.  Drugs in this class include Remicade, Enbrel and Humira and Abatacept:


Remicade (infliximab) - an intravenous (IV) infusion therapy used with methotrexate.  Healthcare professionals administer Remicade to patients once every eight weeks after a starting dose regimen (please see full prescribing information at www.remicade.com)  

Remicade is part of a class of advanced biologic agents that has been shown to have substantial benefits in patients with a number of inflammatory disorders involving the immune system. These biologic agents target specific proteins in the body's immune system to control the development of inflammation, significantly reducing painful symptoms in diseases such as ulcerative colitis, Crohn's disease, ankylosing spondylitis, psoriatic arthritis, and rheumatoid arthritis.  

Remicade is given by IV infusion, a simple process that usually takes about two hours. A healthcare professional administers the treatment in a supervised environment, which is either a physician's office or a treatment center. You will receive your first dose followed by additional doses at two and six weeks after the first dose. You will then receive a dose every eight weeks. If you have AS, you will receive treatment every six weeks.  

With Remicade , all you have to do is come for your appointment. Your healthcare professional will carefully calculate the dosage customized to your weight so that you get the best response to the treatment. Individual results may vary.  

Enbrel (etanercept) - a subcutaneous (under the skin) injection that patients give to themselves twice a week.

Enbrel is a type of protein called a tumor necrosis factor (TNF) blocker that blocks the action of a substance your body's immune system makes called TNF. People with an immune disease, such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and psoriasis, have too much TNF in their bodies. ENBREL can reduce the amount of TNF in the body to normal levels, helping to treat your disease. But, in doing so, ENBREL can also lower the ability of your immune system to fight infections.  

Enbrel is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in patients with moderately to severely active rheumatoid arthritis.
ENBREL can be initiated in combination with methotrexate (MTX) or used alone.  


What is Adalimumab?    

Adalimumab reduces the effects of a substance in the body called tumor necrosis factor alpha (TNF-alpha). TNF-alpha is involved in inflammatory processes in the body.    

Adalimumab is used in the treatment of rheumatoid arthritis.    

Adalimumab may also be used for purposes other than those listed here.    

Adalimumab is administered as a subcutaneous (under the skin) injection. Do not inject this medication intramuscularly (into a muscle) or intravenously (into a vein).  

Abatacept is an investigational biologic drug for the treatment of rheumatoid arthritis and its development program was granted Fast Track status by the FDA.  

Abatacept is Bristol-Myers Squibb's first internally discovered biologic and, if approved, would be the first in a new class of agents called selective T-cell co-stimulation modulators.  

Talk To Your Rheumatologist

Rheumatologists have experience in a wide range of therapies for RA.  If you are diagnosed with RA, your rheumatologist can work with you to determine the best drug or combination of drugs for you.  Rheumatologists are highly-trained specialists who want to support you and your management of RA, so be sure to talk to them whenever you have a question or a concern about your medication.

New investigation of therapies will change practice patterns in the near future.  

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Do I have Arthritis?



What Is Arthritis? Top

    Many people start to feel pain and stiffness in their bodies over time. Sometimes their hands or knees or hips get sore and are hard to move. These people may have arthritis (ar-THRY-tis).


    Image of male body.

    Any part of your body can become inflamed or painful from arthritis.

    Arthritis is an illness that can cause pain and swelling in your joints. Over time, the joint can become severely damaged. Joints are places where two bones meet, such as your elbow or knee. Some kinds of arthritis can cause problems in other organs, such as your eyes, or in your chest. It can affect your skin, too.

    These problems may be caused by inflammation (in-flah-MAY-shun), a swelling that can include pain or redness. They are telling you that something is wrong.

    Some people may worry that arthritis means they won't be able to work or take care of their children and their family. Others think that you just have to accept things like arthritis.

    It's true that arthritis can be painful. But there are things you can do to feel better. This booklet tells you some facts about arthritis and gives you some ideas about what to do, so you can keep doing the things you want to do.

    There are several kinds of arthritis. The two most common ones are rheumatoid (ROO-mah-toyd) arthritis and osteoarthritis (AH-stee-oh-ar-THRY-tis).

    Osteoarthritis is the most common form of arthritis. This is the form that usually comes with age and most often affects the fingers, knees, and hips. Sometimes osteoarthritis follows an injury to a joint. For example, a young person might hurt his knee badly playing soccer. Then, years after the knee has apparently healed, he might get arthritis in his knee joint.

    Father and son play football

    A sports injury to a knee when a person is young can lead to arthritis years later.

    Rheumatoid arthritis happens when the body's own defense system doesn't work properly. It affects joints, bones, and organs--often the hands and feet. You may feel sick or tired, and you may have a fever.

    Other conditions can also cause arthritis. Some include:

    • Gout, in which crystals build up in the joints. It usually affects the big toe.

    • Lupus (LOOP-us), in which the body's defense system can harm the joints, the heart, the skin, the kidneys, and other organs.

    • Viral hepatitis (VY-rul HEP-ah-TY-tis), in which an infection of the liver can cause arthritis.

    Lady writing a letter.

    Rheumatoid arthritis can make it hard to hold a pencil or a brush.

Do I Have Arthritis? Top

    Pain is the way your body tells you that something is wrong. Most kinds of arthritis cause pain in your joints. You might have trouble moving around. Some kinds of arthritis can affect different parts of your body. So, along with the arthritis, you may:

    • Have a fever.

    • Lose weight.

    • Have trouble breathing.

    • Get a rash or itch.

    These symptoms may also be signs of other illnesses.

    Woman gardening.

    Having stiffness or pain when you move could be a sign of arthritis.

What Can I Do? Top

    Go see a doctor. Many people use herbs or medicines that you can buy without a prescription for pain. You should tell your doctor if you do. Only a doctor can tell if you have arthritis or a related condition and what to do about it. It's important not to wait.

    You'll need to tell the doctor how you feel and where you hurt. The doctor will examine you and may take x rays (pictures) of your bones or joints. The x rays don't hurt and aren't dangerous. You may also have to give a little blood for tests that will help the doctor decide if you have arthritis and what kind you have.
    Doctor examines x-ray with patient.

    The x rays will tell the doctor what is happening to the bones and joints inside your body.

How Will the Doctor Help? Top

    After the doctor knows what kind of arthritis you have, he or she will talk with you about the best way to treat it. The doctor may give you a prescription for medicine that will help with the pain, stiffness, and inflammation. Health insurance or public assistance may help you pay for the medicine, doctor visits, tests, and x rays.

    Patient receiving medicine from a pharmacist.

    To get your medicine, take your prescription to your local drugstore or send it to your mail-order provider.

How Should I Use Arthritis Medicine? Top

    Before you leave the doctor's office, make sure you ask about the best way to take the medicine the doctor prescribes. For example, you may need to take some medicines with milk, or you may need to eat something just before or after taking them, to make sure they don't upset your stomach.

    You should also ask how often to take the medicine or to put cream on the spots that bother you. Creams might make your skin and joints feel better. Sometimes, though, they can make your skin burn or break out in a rash. If this happens, call the doctor.

    Woman at breakfast table taking arthritis medicine.

    You may need to drink milk or eat when you take your medicine.

What If I Still Hurt? Top

    Sometimes you might still have pain after using your medicine. Here are some things to try:

    • Take a warm shower.

    • Do some gentle stretching exercises.

    • Use an ice pack on the sore area.

    • Rest the sore joint.

    If you still hurt after using your medicine correctly and doing one or more of these things, call your doctor. Another kind of medicine might work better for you. Some people can also benefit from surgery, such as joint replacement.

    Man resting on couch with ice pack on his neck.

    Using an ice pack on a sore joint can help relieve pain.

You Can Feel Better! Top

    Arthritis can damage your joints, organs, and skin. There are things you can do to keep the damage from getting worse. They might also make you feel better.

    • Try to keep your weight down. Too much weight can make your knees and hips hurt.

    • Exercise. Moving all of your joints will help you. The doctor or nurse can show you how to move more easily. Going for a walk every day will help, too.

    • Take your medicines when and how you are supposed to. They can help reduce pain and stiffness.

    • Try taking a warm shower in the morning.

    • See your doctor regularly.

    • Seek information that can help you.

    Woman in a swimming pool.

    Keeping active may help reduce the stiffness in your joints.

For More Help Top

    For more information on arthritis and musculoskeletal and skin diseases, contact any of the following organizations:

    National Institute of Arthritis and Musculoskeletal and
    Skin Diseases (NIAMS) Information Clearinghouse

    National Institutes of Health
    1 AMS Circle
    Bethesda, MD 20892-3675
    (301) 495-4484
    Toll free: (877) 22-NIAMS
    TTY: (301) 565-2966
    Fax: (301) 718-6366
    World Wide Web address: http://www.niams.nih.gov/hi/

    The NIAMS, a part of the National Institutes of Health (NIH), leads the Federal Government research effort in arthritis and musculoskeletal and skin diseases in the United States. The National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse is a public service sponsored by the NIAMS.

    Arthritis Foundation
    1330 West Peachtree Street
    Atlanta, GA 30309
    (800) 283-7800
    (404) 872-7100 or your local chapter listed in the telephone book.
    World Wide Web address: http://www.arthritis.org/

    The Arthritis Foundation is the major voluntary organization devoted to supporting arthritis research and providing education and other services to people with arthritis. This foundation publishes free pamphlets on arthritis, as well as arthritis self-help books in English and Spanish.

    American Academy of Orthopaedic Surgeons
    P.O. Box 2058
    Des Plaines, IL 60017
    (800) 824-BONES (2663)
    Fax: (847) 823-8125
    Fax-on-Demand: (800) 999-2939
    World Wide Web address: http://www.aaos.org/

    The academy provides education and self-help services for orthopaedic surgeons (doctors) and other health providers. It supports improved patient care and informs the public about the science of orthopaedics (bone and joint health).

    American College of Rheumatology
    1800 Century Place, Suite 250
    Atlanta, GA 30345
    (404) 633-3777
    Fax: (404) 633-1870
    World Wide Web address: http://www.rheumatology.org/

    This association provides referrals to doctors and health professionals who work on arthritis, rheumatic diseases, and related conditions. The association also provides educational materials and guidelines.

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Copyright © 2005 Dr. Solomon Forouzesh
Last modified: December 06, 2005