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Your Guide to Rheumatoid Arthritis Treatments Page 1
Your Guide to
Rheumatoid
Arthritis
Treatments
Find the best ways to
reduce and relieve RA
symptoms
by Lana Barhum
rheumatoid connect
Your Guide to Rheumatoid Arthritis Treatments Page 2
Rheumatoid Arthritis:
What are my treatment
options and how do they
work?
Treatment for rheumatoid arthritis is optimal when patients
and their doctors implement a comprehensive program that
includes medication, complementary therapies, lifestyle
changes, social and emotional support, joint protection, and
as a last resort, surgical intervention. While RA has no cure, the
aim of treatment is to help patients achieve the lowest levels of
disease activity and joint damage in order to live good quality
lives. Here you’ll find information on the leading RA treatments,
plus advice on getting the most from your relationship with your
RA doctor.
Your Guide to Rheumatoid Arthritis Treatments Page 3
Contents
Disease-Modifying Anti-Rheumatic Drugs (DMARDs) / Immunosuppressive Drugs......................................4
Biologic Response Modifiers or Biologics.................................................................................................................7
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)...............................................................................................10
Corticosteroids..............................................................................................................................................................12
Analgesics.......................................................................................................................................................................13
Natural Supplements..................................................................................................................................................14
Complementary and Alternative Treatments........................................................................................................15
Chiropractic Treatment...............................................................................................................................................17
Stress-Reduction Techniques....................................................................................................................................18
Exercise Strategies........................................................................................................................................................18
Diet Plans........................................................................................................................................................................20
Assistive Devices...........................................................................................................................................................21
Surgical Options...........................................................................................................................................................24
Talking about RA Treatments with Your Doctor....................................................................................................26
Preparing for Your Doctor Appointment: Have Three Main Questions...........................................................27
Working with Your Doctor to Find the Right RA Treatments..............................................................................30
What to Do when Your Doctor Won’t Tell You What to Do..................................................................................32
Your Guide to Rheumatoid Arthritis Treatments Page 4
Disease-Modifying
Anti-Rheumatic
Drugs (DMARDs) /
Immunosuppressive Drugs
Disease-modifying anti-rheumatic drugs (DMARDs) can slow
down the progression of rheumatoid arthritis and stop joint
damage. This section provides the leading information on
DMARDS. Learn how they differ and their possible side effects, to
help you and your doctor determine whether they may be right
for you. (As with all medicines, most patients will probably not
experience most of the possible side effects listed.)
Methotrexate
Methotrexate (Rheumatrex), a disease-modifying anti-rheumatic drug, is the drug commonly used for
rheumatoid arthritis treatment. It works to reduce inflammation and slow down the progression of RA. It can be
very effective in preventing disability and joint damage. People with RA can continue to take methotrexate with
other DMARDs because of the promising results and minimal side effects. Doctors often prescribe methotrexate
with another DMARD, such as leflunomide. Combination therapy will allow patients to take lower doses of one
drug, which helps to reduce the chance of adverse reactions. Taking folic acid can help minimize methotrexate
side effects.
Side effects: nausea; vomiting; stomach pain; drowsiness; dizziness; temporary hair loss.Serious side effects:
mouth sores; diarrhea; anemia; liver problems; easy bruising or bleeding; black stools; enlarged glands or lymph
nodes; dry cough; discoloration of skin; infection; muscle weakness.
Sulfasalazine (Azulfidine)
Sulfasalazine (Azulfidine) is created from salicylic acid, the main ingredient in aspirin, and sulfapyridine, an
antibiotic. It is taken orally and available in time-release tablets. Sulfasalazine reduces rheumatoid arthritis joint
inflammation and slows or halts the progression of the disease. It is more often used as an early treatment for
RA or in milder cases. It can be used in combination with non-steroidal anti-inflammatory drugs (NSAIDs) or with
disease-modifying anti-rheumatic drugs (DMARDs) for more severe forms of RA. It may take up to three months
for patients to notice improvement with sulfasalazine.
Side effects: stomach upset; nausea; vomiting; loss of appetite; headache; dizziness; unusual tiredness; skin
discoloration.
Leflunomide (Arava)
Leflunomide (Arava) is a disease-modifying anti-rheumatic drug (DMARD) that blocks the production of white
blood cells that cause rheumatoid arthritis inflammation. Leflunomide is often prescribed for patients who have
not responded to sulfasalazine or methotrexate. Patients taking leflunomide will need to have their liver function
checked regularly for signs of liver damage. Additionally, people who have a history of alcohol abuse or liver or
kidney disease should talk to their doctors before taking leflunomide.
Side effects: diarrhea; nausea; dizziness.
Serious but rare side effects: cough; numbness; tingling of hands or feet; hair loss; chest pain; fast heartbeat;
Your Guide to Rheumatoid Arthritis Treatments Page 5
increased thirst and/or urination; muscle pain or cramps; mood changes; vision changes; easy bruising or
bleeding; unusual growths/lumps; swollen glands; weight loss; unusual tiredness; increased blood pressure;
infection.
Hydroxychloroquine (Plaquenil)
Hydroxychloroquine (Plaquenil) is considered a disease-modifying anti-rheumatic drug (DMARD) because it
helps to decrease the pain and swelling associated with RA. It may also prevent joint damage and reduce the
risk of disability. Hydroxychloroquine is often prescribed for patients with mild RA or in combination with other
drugs for patients with a more severe form of the disease. Patients should have their vision monitored by an
ophthalmologist while taking hydroxychloroquine, as it has been known to cause vision changes and/or vision
loss in some patients. Patients can start to see improvement within one to two months of treatment, but it may
take up to six months to acquire full benefits from this medication.
Side effects: nausea; stomach cramps; loss of appetite; diarrhea; dizziness; headache.Rare but serious side
effects: arm/leg/back pain; fast/irregular heartbeat; hair loss; mood changes; ringing in ears or hearing loss;
worsening of skin conditions; low blood sugar; allergic reaction.
Azathioprine (Imuran)
Azathioprine (Imuran) treats pain and swelling and helps patients manage anti-inflammatory conditions such
as rheumatoid arthritis. Azathioprine works to reduce the body’s immune response by interfering with DNA
synthesis that allows cells to grow and divide. Some benefits of azathioprine can be seen as early as six weeks,
but it may take up to twelve weeks to see the full benefits.
Side effects: blood cell toxicity; abdominal pain; diarrhea; nausea and vomiting; hepatitis; pancreatitis; allergic
reactions; increased risk for cancer.
Cyclosporine (Neoral)
Cyclosporine (Neoral), a powerful immunosuppressant, is considered a disease-modifying drug (DMARD)
because it can decrease pain and swelling, while also preventing joint damage and reducing the risk of disability
in rheumatoid arthritis patients. It has been effective in treating RA patients who have not responded well to
other treatments. People taking cyclosporine may notice results within a week, but it may take up to three
months to get the full benefits of treatment.
Side effects: high blood pressure; kidney problems; gout; headaches; nausea; vomiting; abdominal pain;
swelling of the hands and feet; swelling of gums; muscle cramps; increased hair growth; numbness or tingling of
hands and feet; infection.
Cyclophosphamide (Cytoxan)
Cyclophosphamide (Cytoxan) is an immunosuppressant that is prescribed for patients who have severe
rheumatoid arthritis. Cyclophosphamide works by blocking the production of cells that play a key role
in autoimmune conditions including rheumatoid arthritis. Patients taking cyclophosphamide should be
carefully monitored by their physicians since the medication is often accompanied by serious side effects.
Cyclophosphamide is often used for no more than six months and helps patients go into remission. After patients
go in to remission, they are put on medications that are less potent and with fewer side effects to keep them in
remission.
Side effects: nausea or vomiting; skin rashes; unusual infections; shingles; abnormal blood cell counts; fertility
problems; bladder problems; increased risk for cancer.
Your Guide to Rheumatoid Arthritis Treatments Page 6
Biologic Response
Modifiers or Biologics
In the last ten years, there has been significant advancement in
the treatment of rheumatoid arthritis.
Newer disease modifying drugs called biologic response modifiers and/or biologics are now used to treat RA in
conjunction with Methotrexate or other DMARDs. They work by slowing down the immune system's signals that
lead to joint damage. Generally given by injection or IV infusion, they are used to treat moderate to severe RA
that has not responded to other treatments. This type of aggressive treatment can prevent long-term disability in
RA patients. A major side effect of these medications is the potential for serious infections. Moreover, long term
effects won't be known until patients have used these medications for many years.
Actemra
Tocilizumab, sold under the brand name Actemra, is administered as a monthly intravenous infusion. It was
approved by the FDA for use in RA patients whose RA has not been managed with TNF inhibitors, methotrexate
or other DMARDs. It has also been approved for use in children age 2 and up who have the systemic form of
juvenile idiopathic arthritis (also known as juvenile RA). Tocilizumab works by blocking the cytokine known as
interleukin 6, or IL-6, one of the factors behind RA inflammation. The goal of treatment with tocilizumab is to
reduce RA symptoms, especially pain and swelling. Studies have also shown tocilizumab to slow or prevent joint
damage associated with rheumatoid arthritis. The risk of infection with tocilizumab appears to be the same as
other biologic response modifiers.
Side effects: fever, chills, increased risk of infection, reduced blood platelet count, increased cholesterol levels
and liver enzymes.
Rare but serious complications: bowel perforation, or a hole in the bowel wall. Report any abdominal pain or
bloody bowel movements to your doctor immediately.
Cimzia
Certolizumab, under the brand name Cimzia, works by blocking a substance called tumor necrosis factor
(TNF). TNF promotes inflammation and other signs of inflammation, such as fever and swelling. Unchecked
inflammation eventually leads to joint destruction. Certolizumab binds to the body's TNF to block the effects of
TNF. As a result, inflammation and its consequences are reduced. The FDA approved certolizumab in April 2008
as an injection that most patients, once shown how, can give to themselves. Certolizumab is often prescribed to
be taken every 2 to 4 weeks, depending on the dose the doctor feels is right for the patient.
Side effects: injection site pain, upper respiratory infections, urinary tract infections, headache, high blood
pressure, back pain, abdominal pain, diarrhea, intestinal obstruction and inflammation of the nose and throat.
Enbrel
Like Cimzia, etanercet, sold under the brand name Enbrel, reduces RA inflammation and damage by blocking
TNF. This medication can stop the progression of the disease and joint damage, resulting in improved
functioning and better quality of life for patients. It is an injection that patients can give to themselves once or
twice weekly. Symptoms usual return within a month of stopping Enbrel.
Serious side effects: rash on nose and cheeks, dizziness, extreme fatigue, skin paleness, hair loss, swelling of
extremities, unusual bruising or bleeding, mood changes, severe headache, unexplained muscle weakness,
seizures, numbness and tingling of hands and/or feet, vision changes, severe stomach pain, persistent nausea or
vomiting, dark urine, yellowing of skin or eyes, and severe allergic reaction (although rare, allergy symptoms may
include rash, itching/swelling, dizziness and trouble breathing).
Humira
Humira is the brand name for the drug adalimumab that works by blocking the protein TNF. Humira is a fully
human monoclonal antibody, meaning it is made using human proteins and no animal proteins. It was approved
Your Guide to Rheumatoid Arthritis Treatments Page 7
by the FDA in 2002 as the third biologic for the treatment of RA. Humira is available as a self-injection given under
the skin once every two weeks. A single-use, disposable Humira pen has been developed to make injections
easier for patients. Humira should not be used by patients with a known allergy to the drug ingredients, women
who are pregnant or nursing, or those who are predisposed to infection, including uncontrolled diabetes or a
history of repeat infections.
Side effects: mild reaction at injection site, rash, headache, stomach upset, nausea, upper respiratory infection
(including sinus infection), and back pain.
Serious side effects: serious infections, including sepsis, tuberculosis, and fungal infections, allergic reactions,
nervous system problems, liver problems, and unusual bleeding and bruising.
Kineret
Kineret is the brand name for anakinra and is prescribed to treat RA and less common forms of arthritis when
standard treatments don’t work. Kineret is often associated with an increased risk for infections, so patients
should notify their doctor immediately if they develop fever or other infection symptoms. Kineret works by
blocking the inflammation-producing protein IL-1b through a different protein called IL-1Ra. Since there are other
proteins that cause inflammation, Kineret may not relieve all symptoms. The drug is administered as a daily self-
injection.
Side effects: injection site reactions, such as redness, itching, rash, and pain, bruising or bleeding, infections,
headaches, and low white blood cell counts.
Orencia
Abatacept, sold under the brand name Orencia, treats moderate to severe RA in adults and moderate to severe
juvenile idiopathic arthritis (JIA) in children age 6 and up. It is prescribed when DMARDs are found not to be
helpful. Orencia contains a protein that blocks signals that trigger T-cells in the immune system. These T-cells
are significant contributors to the development of RA. Orencia is administered by weekly injection or through
intravenous infusion. There is a higher risk for infections with Orcenia and some forms of cancer have been
reported in patients taking the drug, but studies are pending as to whether the two are related.
Side effects: headache, sore throat, nausea, diarrhea, cough, fever, dizziness, back pain and abdominal pain.
Serious side effects/adverse reactions: severe allergic reaction and severe infections, including pneumonia
and tuberculosis.
Simponi
Golimumab, marketed under the brand name Simponi, contains an injectable man-made protein that binds TNF
in the body and blocks its effects in RA patients. As a result, inflammation and its complications, such as joint
damage, are reduced or prevented. Simponi was approved in 2009 by the FDA and is prescribed to be taken once
a month by self-injection or every other month through intravenous infusion.
Sideeffects: injection site reactions, including redness and swelling, upper respiratory infections, runny nose,
elevated liver levels and high blood pressure.
Serious side effects/adverse reactions: serious infections, such as tuberculosis, sepsis and fungal infections,
nervous system reactions, congestive heart failure and increased risk for certain types of cancer.
Xeljanz
Tofacitinib, available under the brand name Xeljanz, is the newest biologic for RA treatment. It was approved by
the FDA in 2012 and is an ideal medication for patients who cannot take Methotrexate. Xeljanz belongs to a class
of drugs called Janus kinase (JAK) inhibitors. JAKs are proteins that interfere with chemical signals that control
the biologic immune process that causes inflammation. Inhibition of JAKs prevents inflammation and tissue
damage associated with RA. Xeljanz is available as a 5mg immediate release tablet.
Side effects: increased cholesterol levels, headache, diarrhea, sore throat, runny nose, urinary tract infections,
and upper respiratory infections.
Adverse reactions: serious infections that may lead to hospitalization or death.
Your Guide to Rheumatoid Arthritis Treatments Page 8
Non-Steroidal Anti-
Inflammatory Drugs
(NSAIDs)
The major effect of NSAIDs is the reduction of severe
inflammation, which decreases pain and increases function.
These drugs have mild to moderate pain-killing effects that are separate from their inflammation-fighting
qualities. NSAIDs do not have disease-modifying qualities, so they do not alter the course of rheumatoid arthritis
or prevent joint damage.
Aspirin
Aspirin is the oldest NSAID prescribed for its inflammation-fighting qualities. But because of its high toxicity
and the requirement to take multiple daily doses, it is often replaced with other NSAIDs, such as ibuprofen and
naproxen. Aspirin should never be taken for long periods, as there is potential for aspirin poisoning. Inappropriate
dosing is often the cause of such poisoning, including pain medications being taken in combination. This is
especially common in people with chronic illnesses, such as RA. Aspirin is an over-the-counter NSAID.
Side effects: shortness of breath; nausea; vomiting; diarrhea; constipation; decreased appetite; rash; dizziness;
headache; drowsiness; prolonged bleeding after injury or surgery.
More serious side effects/complications: fatal liver disease; fatal stomach and intestinal adverse reactions;
edema; ulcers; stomach bleeding; kidney failure; heart attack; stroke.
Ibuprofen
Ibuprofen, sold generically and under brand names such as Advil, is an NSAID that can relieve mild to moderate
RA pain. It can be taken every six to eight hours for pain relief. Ibuprofen reduces inflammation by blocking
the production of inflammation-building chemicals. It also provides anti-fever and blood-thinning actions.
Ibuprofen, while effective, can bring with it some serious side effects, including a higher risk of heart attack or
stroke. Ibuprofen is an over-the-counter NSAID.
Side effects: shortness of breath; nausea; vomiting; diarrhea; constipation; decreased appetite; rash; dizziness;
headache; drowsiness; prolonged bleeding after injury or surgery.
More serious side effects/complications: fatal liver disease; fatal stomach and intestinal adverse reactions;
edema; ulcers; stomach bleeding; kidney failure; heart attack; stroke.
Naproxen
Naproxen, sold generically and under brand names such as Aleve, is an NSAID used to treat rheumatoid
arthritis. It has been available as an over-the-counter medication for over 20 years. It is primarily used to reduce
inflammation, pain and stiffness. Patients taking methotrexate should avoid naproxen, as the combination of the
two medications has been found to cause serious adverse reactions. Patients who are aspirin sensitive and who
have had ulcers, kidney or liver problems or stomach bleeding should not take naproxen.
Side effects: shortness of breath; nausea; vomiting; diarrhea; constipation; decreased appetite; rash; dizziness;
headache; drowsiness; prolonged bleeding after injury or surgery.
More serious side effects/complications: fatal liver disease; fatal stomach and intestinal adverse reactions;
edema; ulcers; stomach bleeding; kidney failure; heart attack; stroke.
Celebrex
NSAIDs also include a class of drugs called COX-2 inhibitors that are effective in controlling inflammation.
Celebrex, like other COX-2 inhibitors, is designed to decrease gastrointestinal risks posed by other NSAIDs. There
are no NSAIDs that surpass the effectiveness of COX-2 inhibitors in the treatment of RA because COX-2 inhibits
Your Guide to Rheumatoid Arthritis Treatments Page 9
the COX-2 inflammation-promoting enzyme. The downside to Celebrex and other COX-2 inhibitors is the high
risk for heart attacks and strokes. Two other COX-2 inhibitors, Vioxx and Bextra, were taken out of the U.S. market
after multiple reports of heart attacks in people who took them. While the Food and Drug Administration has
not pulled Celebrex from the market, it is labeled with strong warnings and doctors are required to prescribe it in
small doses.
Side effects: shortness of breath; nausea; vomiting; diarrhea; constipation; decreased appetite; rash; dizziness;
headache; drowsiness; prolonged bleeding after injury or surgery.
More serious side effects/complications: fatal liver disease; fatal stomach and intestinal adverse reactions;
edema; ulcers; stomach bleeding; kidney failure; heart attack; stroke.
Your Guide to Rheumatoid Arthritis Treatments Page 10
Corticosteroids
Corticosteroids have anti-inflammatory and immunoregulatory
qualities. They can be given orally, intravenously or injected
directly into the joints. They can quickly bring down
inflammation and are often used during rheumatoid arthritis
flares.
Oral Corticosteroids
Generic drugs: cortisone acetate, dexamethasone, hydrocortisone, methylprednisolone, prednisolone,
prednisone
All corticosteroid drugs are a manmade form of cortisol, a hormone that our bodies produce naturally. These
drugs decrease inflammation and produce an effect that calms down the body’s immune-system response. They
are more often prescribed for patients whose RA is not well controlled with NSAIDS and DMARDs.
Side effects: blurred vision; cataracts or glaucoma; easy bruising; sleep issues; high blood pressure; weight gain;
increase in body hair; lowered resistance to infections; nervousness and restlessness; stomach issues including
bleeding; mood swings; puffy face; swollen ankles; water retention; worsening of diabetes symptoms.
Injected Corticosteroids
Generic drugs: methylprednisolone, triamcinolone, betamethasone. Name brand: Depo-Medrol
Corticosteroid injections help to reduce inflammation and reduce pain in a specific area of the body. They are
usually injected into the joints, including the knees, spine, shoulder, hands and feet. These injections are typically
performed in your doctor’s office. The amount of injected corticosteroids you can take yearly is limited because
of a high potential for side effects.
Side effects: infection; hives; allergic reaction; pain and swelling at injection site; skin discoloration.
Serious side effects: bleeding in the joints; tendon rupture; weakening of bones, ligaments and tendons; trouble
breathing; swelling of face, lips, tongue, or throat.
Your Guide to Rheumatoid Arthritis Treatments Page 11
Analgesics
Analgesics are designed to relieve pain. Analgesics block pain
signals and interfere with the brain’s interpretation of pain.
Acetaminophen (Tylenol, Aspirin-Free Anacin)
Acetaminophen is often prescribed for rheumatoid arthritis pain relief in patients who are sensitive to aspirin
or NSAIDs. Acetaminophen does not have anti-inflammatory properties. It is available as an over-the-counter
medicine.
Opioid Analgesics
Research has shown that weak opioid analgesics, such as codeine and tramadol, may be effective in short-term
pain management of rheumatoid arthritis.
Codeine
Codeine is a narcotic painkiller used to treat severe rheumatoid arthritis pain. Codeine is often combined with
acetaminophen or aspirin. It helps to block the nerves that transmit pain impulses and reduces the brain’s
awareness of these impulses. Codeine should not be used for more than three days at a time due to the potential
for overdose.
Side effects: drowsiness; lightheadedness; dizziness; sedation; shortness of breath; nausea or vomiting;
sweating; itching; rash; constipation.
More serious and less common side effects: low heart rate; weak pulse; fainting; shallow breathing; feeling like
you might pass out; confusion; agitation; hallucinations; unusual thoughts or behavior; extreme happiness or
sadness; seizure; problems with urination.
Tramadol (Ultram, Ultram ER)
Tramadol, sold under the brand name Ultram or Ultram ER, is a prescription narcotic painkiller used to treat
moderate to severe rheumatoid arthritis pain. It is usually taken every four to six hours as needed. It is also
available in an extended-release tablet for patients in need of continuous relief and for overnight pain. In some
studies, researchers observed that tramadol was just as effective as NSAIDs for pain management in RA patients.
Side effects: dizziness; weakness; sleepiness; nervousness; headache; muscle tightness; nausea or vomiting;
diarrhea.
Your Guide to Rheumatoid Arthritis Treatments Page 12
Natural Supplements
Natural supplements may help people with rheumatoid arthritis
to have greater control over pain, symptoms and daily activities.
Make sure you keep your doctor apprised of all the medications
and supplements you are taking for RA treatment. Supplements
for RA that have shown promising results include fish oil, folic
acid, SAMe, calcium and vitamin D.
Fish Oil
Fish oil supplements are a good source of omega-3s, potent fatty acids that help fight inflammation and
therefore help to manage rheumatoid arthritis. They can also increase the production of good chemicals that
hinder inflammation. Fish oil supplements may also help RA patients by reducing joint pain and swelling. Various
studies have shown that people taking fish oil supplements have seen marked improvements in pain reduction
and minimized joint stiffness and tenderness in less than three months.
Side effects: belching; bad breath; nausea; heartburn; loose stools; skin rashes; nose bleeds.
Folic Acid/Folate
Folic Acid is a B vitamin that promotes health and supports metabolism. In natural form, folic acid is called folate.
Some RA drugs, including methotrexate and sulfasalazine, can interfere with our body’s natural use of folic acid.
Eating more foods with folic acid such as spinach, broccoli, peas and oranges can help, but some people may
need to take folic acid supplements. Ask your doctor how much folic acid you need to minimize and prevent side
effects of your RA medications.
Rare side effects: fever; general weakness/discomfort; red skin; shortness of breath; skin rash or itching; chest
tightness; trouble breathing; wheezing; nausea; abdominal discomfort; gas; bitter taste; sleep disturbances;
concentration issues; irritability; anxiety; depression; confusion; impaired judgment.
SAMe
S-adenosyl-L-methionine (SAMe) is a naturally occurring chemical in the body that helps with mobility, rebuilding
cartilage and reducing the symptoms of arthritis. It has proven anti-inflammatory and analgesic properties.
People taking SAMe often see results within a week’s time. In research studies, SAMe was found to be comparable
to NSAIDs in relieving pain, without the gastric side effects associated with those drugs. While there has been
significant research about the benefits of SAMe for osteoarthritis, there have been few studies evaluating its
effectiveness in RA patients. RA patients who find it helpful to take SAMe should take it with B vitamins, including
folic acid.
Side effects: anxiety; skin rashes; dizziness; heart palpitations; concentration and memory issues; sleep issues;
nausea; skin flushing.
Calcium
Our bodies need calcium to function, and when our calcium levels are low, the body takes it from our bones.
Calcium helps our hearts to pump and our muscles to contract. Most people can get enough calcium from dairy
products and other foods, but if that isn’t enough, calcium supplements can help. Some medications used to
treatment RA, including corticosteroids, make it hard for the body to use calcium. This can lead to bone loss and
osteoporosis. The calcium recommendation is 1,000 milligrams for people under 50 and 1,200 for those 51 and
older. Your doctor may recommend taking calcium supplements if your levels are low or at risk of being low.
Vitamin D
Vitamin D promotes healthy bones by absorbing calcium. It is found in many foods, including milk, and sunlight
exposure (without sunscreen) stimulates our bodies to manufacture it. Rheumatoid arthritis symptoms tend to
be more active when vitamin D levels are low, and low levels are fairly common in RA patients as a result of the
medications they take to treat the disease. Moreover, low vitamin D may also play a role in the development
Your Guide to Rheumatoid Arthritis Treatments Page 13
of RA. The recommendations for daily vitamin D intake are 600 IUs (international units) for adults under 70
and 1,000 IU for people older than 70. Higher doses may be recommended by your doctor to correct vitamin D
deficiency.
Side effects: weakness; fatigue; sleep issues; headaches; appetite loss; dry mouth; nausea and vomiting; metallic
taste; vitamin D toxicity if too much is taken.
Your Guide to Rheumatoid Arthritis Treatments Page 14
Complementary and
Alternative Treatments
Complementary and alternative treatments can be a great way
to supplement RA medication to further alleviate RA symptoms.
Before trying them, be sure to discuss them with your doctor.
Heat and Cold Therapy
Many doctors recommend heat and/or cold therapy to help reduce rheumatoid arthritis symptoms. This therapy
will require some trial and error to find out what works best for your pain. Generally, cold compresses help to
reduce joint swelling and inflammation. You can apply ice packs to affected joints during RA flare-ups to ease
pain and inflammation. It is best to apply cold treatments for 15-minute intervals and to take at least a 30-minute
break between treatments. Hot compresses can help to relax muscles and increase blood flow. You can also use
heat therapy while showering by letting warm water hit the painful areas of your body. Hot tubs are also a good
way to relax stiff and painful joints.
Acupuncture
There is growing evidence that acupuncture may help people with rheumatoid arthritis. A study published
inArthritis & Rheumatism found that patients who tried acupuncture reported reductions in erythrocyte
sedimentation rate (ESR) and/or C-reactive protein (CRP), the blood tests that measure or indicate inflammation.
Patients also reported decreased pain and a reduction in morning stiffness. Acupuncture focuses on what its
advocates describe as essential life energy called qi, which flows through the body through invisible channels
called meridians. When energy is out of balance or blocked, they say, pain and illness occur. There are thousands
of acupuncture points that connect to the meridians and stimulating these points is believed to correct flow and
alleviate pain. These acupuncture points may also help release tight muscles and regulate the body’s nervous
system by releasing pain-fighting endorphins. It is also believed that acupuncture helps the body find trauma
and illness in order to heal them. Last, acupuncture may alter the perception of pain as the inserted needles
deactivate the part of the brain that manages pain perception.
Hydrotherapy
Hydrotherapy is a water treatment ideal for arthritis patients. It is as simple as sitting in a whirlpool bath to relieve
pain and relax muscles without putting unnecessary stress on tired joints. Hydrotherapy can also be part of
an exercise program in a pool setting. It is easy on the joints since water takes weight off of painful joints while
providing resistance, reducing swelling and strengthening muscles. This type of therapy can be beneficial to RA
patients who have lost range of motion, flexibility and strength and who have limited function on dry surfaces.
Massage
A report presented at the American Massage Therapy Association National Convention suggested that
therapeutic massage helped RA patients achieve muscle release in affected joints, which can stall joint
deterioration. A 2013 study also showed that RA patients who had increased pain in the arms, hands, and wrists
benefited from moderate-pressure massage. Massage helps many RA patients manage pain and stress. While
massage is not a confirmed treatment for rheumatoid arthritis, it is safe when done properly and by a licensed
practitioner and is free of side effects. The areas that are affected with inflammation and swelling should not be
directly massaged.
Your Guide to Rheumatoid Arthritis Treatments Page 15
Chiropractic Treatment
For people with RA, chiropractic-related treatments may help
minimize damage, slow the progress of the disease and ease
pain. Here are some of the RA therapies frequently offered by
chiropractors.
Ultrasound Therapy
Ultrasound therapy uses sound waves to create gentle heat that increases blood circulation in deep issues. It
also helps to reduce inflammation, pain and stiffness. Ultrasound can help increase range of motion, which is a
typical symptom of rheumatoid arthritis.
TENS (Transcutaneous Electrical Nerve Stimulation)
TENS therapy is believed to help trigger the release of endorphins, which are the body’s natural painkillers. It
involves taping electrodes to the skin that send tiny electrical currents to key points in the nerve pathways. It
might sound painful and tense but it is a gentle, passive treatment.
Low-Level Laser Therapy
There has been some limited evidence that shows that low-level laser therapy (LLLT) may be effective in
reducing rheumatoid arthritis pain and stiffness in a minimum of four weeks. LLLT uses a light source to generate
photochemical responses that penetrate deep into the tissue to help reduce inflammation. It has been used as a
non-invasive therapy for RA for the last ten years. No adverse effects or evidence of harm has been reported with
its use.
Therapeutic Exercises and Stretches
Therapeutic exercises and stretches can be designed specifically for people with RA to promote strength and
endurance. These exercises address specific joints or body parts affected by rheumatoid arthritis. They are good
for RA patients who have been inactive, have restricted joint motion or muscle strength, and/or are experiencing
joint pain. Once patients learn these exercises and stretches, they can perform them at home, at work or
anywhere else.
Your Guide to Rheumatoid Arthritis Treatments Page 16
Stress-Reduction
Techniques
Meditation and relaxation techniques may help rheumatoid
arthritis patients relieve stress and ease symptoms. These
techniques can be done alone or in a group led by a specialized
healthcare professional.
Meditation
Meditation uses awareness to relax the body and quiet the mind. According to a study published by the National
Institutes of Health, meditation may help to increase a person’s pain tolerance and self-esteem. It could also
help with decreasing stress, anxiety, depression and pain levels. Transcendental meditation and mindfulness
meditation are the two most common types. In transcendental meditation, the patient repeats chants to allow
negative feelings and thoughts to pass through the body and mind. Mindfulness mediation typically involves
sitting with your eyes closed focusing only on your breathing. It has been known to reduce pain and improve
mood for some people living with rheumatoid arthritis. In one study, women with RA who entered into an
eight-week mindfulness maintenance program showed significant improvement in psychological distress and
wellbeing.
Yoga
Gentle yoga exercises that involve stretching and body movements combined with meditation can help to ease
pain and stiffness while building strength, improving flexibility and increasing range of motion. A yoga program
of breathing, relaxation and poses can make a big difference to joint tenderness and swelling, according to the
Arthritis Foundation. Yoga can also be a fun alternative to walking, biking or swimming.
Tai Chi
Tai chi is a Chinese mind and body exercise that combines gentle, slow motions with focused breathing and
meditation. Some studies have found that when tai chi is included in an RA treatment plan, patients can see
improvement in daily function and balance.
Spiritual Belief
Spiritual or religious belief in combination with a positive attitude may be effective in helping to manage RA pain
and improve the ability to cope. Several studies show spirituality can improve health benefits for people living
with chronic illnesses such as rheumatoid arthritis. One study out of the University of Missouri revealed that
religious and spiritual support helps both men and women cope with chronic illness.
Your Guide to Rheumatoid Arthritis Treatments Page 17
Exercise Strategies
Studies suggest that even as little as three hours of exercise over
six weeks may help people with rheumatoid arthritis reduce
inflammation and relieve stiffness and weakness.
The goal of exercise for rheumatoid arthritis patients is to maintain a wide range of motion and increase strength,
endurance and mobility.
Range-of-Motion Exercises
Range-of-motion exercises can help rheumatoid arthritis patients maintain joint function by increasing and
sustaining joint mobility and flexibility. The joints are straightened and bent in a controlled manner as far as they
will go comfortably. The joints are stretched farther until normal or near normal range of motion is achieved and
maintained. These exercises are also a vital way to warm up for engaging in strength training and aerobic activity.
A physical therapist can teach you how to perform these types of exercises safely and correctly.
Strength Training
A rheumatoid arthritis program of strengthening exercises targets specific muscle groups. Having strong
muscles helps to keep weak joints stable and protect them against additional damage. There are two types
of strengthening exercises that help with this: isometric and isotonic. Isometrics strengthen muscles through
isolated muscle flexes and periods of rest. Isotonic exercises involve intensive strength development through
increased repetition and weight resistance. A licensed physical therapist can instruct you on how to properly
perform isometric and isotonic strengthening exercises.
Aerobic Exercises
The main basis for endurance training is aerobic exercise, which includes activity that increases heart rate for a
prolonged time period. When combined with a healthy diet, aerobic activity can help RA patients to lose excess
weight, which reduces excess pressure on joints and improves overall health. RA patients should start with about
15 minutes of aerobic activity three times a week and gradually move up to 30 minutes a day. Activity should
include warm-up time and cool-down activity. Examples of aerobic activity include low-impact activities like
walking and swimming and more rigorous activities like aerobic dance or using an elliptical machine.
Your Guide to Rheumatoid Arthritis Treatments Page 18
Diet Plans
The connection between rheumatoid arthritis and diet is
complex, but diet can influence and affect RA symptoms. A
diet filled with anti-inflammatory foods can help control RA
inflammation. Several diets, including gluten-free, elimination,
anti-inflammatory and Mediterranean, have been helpful to RA
patients and have become popular in recent years.
Gluten-Free Diet
A gluten-free diet excludes gluten, which is found in grains like wheat, rye and barley. Some rheumatoid arthritis
patients experience joint pain, stiffness, and swelling when they eat foods with gluten. Having an autoimmune
disease such as RA puts patients at risk for gluten sensitivity. Some who become gluten sensitive see an increase
in RA symptoms. RA patients should talk to their doctors about the risks and benefits of implementing a gluten-
free diet. There are many gluten-free options at markets and restaurants.
Elimination Diet
An elimination diet removes reactive foods that may cause inflammation and rheumatoid arthritis symptoms.
Keep in mind that not everyone is sensitive to the same foods. For example, some people may tolerate dairy
while others may report increased RA flare-ups if they consume milk or cheese. You can start an elimination diet
by removing all foods that contain gluten, dairy, soy, and nightshade vegetables, such as potatoes, eggplant,
tomatoes, and peppers, from your diet for at least three weeks. Then start adding these foods one at a time into
your diet, three days apart. If you notice joint stiffness by adding a specific food, chances are you are sensitive to
it. Continue to stay away from such foods to keep your RA symptoms at bay.
Anti-inflammatory Diet
An anti-inflammatory diet is key to managing rheumatoid arthritis flare-ups. This diet centers on plant-based
foods. In this diet, two-thirds of your food comes from vegetables, fruits and whole grains. The other third
includes fat-free or low-fat dairy and lean meats. People with RA should avoid processed foods and excess
carbohydrates because these foods could spark inflammation. RA patients should also eat foods high in
omega-3 fatty acids, which are found in fatty fish and certain types of oils. Omega-3 fatty acids can help to reduce
C-reactive protein (CRP) and interleukin-6, two inflammatory proteins in the body. Beans are also a great anti-
inflammatory food because they offer both antioxidant and anti-inflammatory properties.
Mediterranean Diet
The Mediterranean diet may help to reduce pain and swelling of joints affected by rheumatoid arthritis, even
though relief may not be seen right away. The Mediterranean diet includes olive and canola oils as the primary
sources of fat, along with plenty of fish, poultry, nuts, produce and beans. The diet also moderates dairy and
red meat and includes red wine. Because it contains healthy amounts of omega-3s and minimal amounts of
unhealthy foods and carbohydrates, RA sufferers may experience quick and sustained pain relief.
Your Guide to Rheumatoid Arthritis Treatments Page 19
Assistive Devices
Assistive devices can make life with rheumatoid arthritis easier.
They might be new gadgets to add to your home, office, or car,
or improvements to items you already have.
In this section you’ll find information on simple devices that can ease and simplify daily activities like cooking,
cleaning, getting dressed, bathing, moving around, getting in and out of your car easily and even working at your
job.
Cane or Walker
A cane or walker can make movement easier and help you to keep your joints healthy. Use a cane on the
opposite side of a painful hip or knee.
Splints/Braces
Splints and braces can provide support for joints and take strain off of those joints. An occupational therapist can
make a splint for you and a physical therapist can help you to pick out a brace and advise you on how to properly
use it.
Reachers
A reacher is a long rod with a grip handle on one end and a claw on the other end. This device can help you to
reach for objects without bending or stretching so you can avoid stress to your joints.
Orthotics
Orthotics are inserts for your shoes. You can purchase them over the counter or have them custom designed.
These inserts help provide relief for painful feet and make it easier to stand and walk.
Stepstools
Stepstools can help you reach items that are higher up without too much strain. Make sure the stepstool is well
balanced and lightweight for easy movement.
Jar-Opening Device
A manual jar-opening device attaches to a jar lid to give you a better grip. These opening devices are reasonably
priced and can save your hands, wrists and fingers from pain and strain. Electric jar openers are also available.
Wide Grips/Large Handles
Replace cabinet and closet door handles with easy-to-grip knobs and levers that don’t require a lot of turning.
Large handles on your pots and pans can make them easier for you to carry and grip during food preparation.
Small Kitchen Appliances
A food processer can make chopping, grating and other food preparation tasks easier. An electric can opener is a
great power tool to help you open cans without putting strain on your fingers, hands and wrists.
Tub Bench/Shower Seat
A tub bench or shower seat can help you to bathe more comfortably and reduces the chance of a fall in the
shower or bathroom. Shower mats can also help you to make your bathtub or shower safer. You can also place a
seat near the sink in case you get tired washing your face or shaving.
Safety Bars
Grab bars will make it easier and safer for you to get in and out of the bath or shower. You can also place these
bars near the toilet to help you get on and off. Wherever there are stairs in your home, make sure there are easily
accessible railings.
Your Guide to Rheumatoid Arthritis Treatments Page 20
Raised Toilet Seat
A raised toilet seat will make it easier for you to get on or off the toilet. This device will help prevent falls and keep
strain off your joints.
Long-Handled Grooming Tools
Sponges with long handles can help you to wash your body without reaching and bending too much. A long-
handled comb or brush can make combing and hair brushing easier.
Electric Grooming Tools
An electric toothbrush can help you to keep your teeth and gums healthy without putting pressure on your hands
and wrists. An electric razor can also help to make grooming easier.
Buttoning Aid/Big Buttons/Front Closures
A buttoning aid is designed to help you button and unbutton shirts, skirts, dresses and pants. You should also
consider switching to big buttons, buttonhooks or even hook-and-loop closures such as Velcro. Front closures on
dresses and bras are easier to take on and off and require less reaching and less strain on arms, hands, wrists and
fingers.
Zipper Pull
A zipper pull makes it easier to grab and pull zippers. This device helps to you to put less stress on hands, wrists
and fingers.
Clothes Fastener
A clothes fastener offers a combination tool that includes a button aid and a zipper pull. This device has a
buttonhook on one end for small buttons and a hook on the other end for pulling zippers up and down.
Sock Aid/Shoehorn
A sock aid can help you pull socks up without bending your legs. A long-handled shoehorn makes it easier to put
shoes on without having to bend over.
Touch Lamps
Lamps with tiny knobs can be challenging for people with rheumatoid arthritis in their hands. Touch lamps are
activated simply by touch so you can avoid putting pressure on hands and fingers.
Large Knobs or Levers
You can switch out small knobs and levers on doors for larger versions. Other things being equal, levers are easier
for RA patients to manipulate than doorknobs. Floor switches are an option as well, to operate doors with your
feet.
Telephone Headset
A telephone headset for hands-free use can prevent neck, shoulder, arm, wrist and hand pain. The Arthritis
Foundation has recommended an ergonomic handset design with large, easy-to-operate buttons made by a
company called Clarify. You can visit the Arthritis Foundation website for more information.
Ergonomic Keyboard
An ergonomic keyboard will keep you from having to bend your wrists as you type. Most of the design options for
these types of keyboards are constructed in a V shape and allow the right and left hands to type at an angle that
is more natural.
Adjustable Chair
An adjustable ergonomic chair will support your lower back and minimize stress on your joints by promoting a
comfortable sitting position and a neutral posture as you work. When shopping for the best ergonomic chair, you
should look for one that best fits your body. Keep in mind that not every chair with the label “ergonomic” has
all the adjustment features to truly be ergonomic. The things you should look at are seat height, seat width and
depth, lumbar support, the backrest and the material of the chair.
Your Guide to Rheumatoid Arthritis Treatments Page 21
Wide Key Holder
Turning a small key can be difficult for people with arthritis in their hands and fingers. You can purchase an
inexpensive wide key holder that can make it easier to start your car or open car doors. If you are looking to
purchase a new vehicle, consider one with keyless entry and a keyless starter.
Seatbelt Extender
A seatbelt extender attaches to your existing automobile seatbelt. This device will make grasping, pulling and
buckling your seatbelt easier and puts less strain on your arms, wrists, hands and fingers.
Wide-Angle Mirrors
Wide-angle mirrors are available for people who have arthritis neck pain and stiffness. Installing a panoramic
mirror or a wide-angle mirror in your vehicle will keep you from straining your neck.
Your Guide to Rheumatoid Arthritis Treatments Page 22
Surgical Options
Surgical options for rheumatoid arthritis can help patients with
severe pain find relief and can improve function of severely
damaged joints that are not responding to medicine and
physical therapy.
Spinal Instrumentation for Cervical RA
Spinal instrumentation is used to treat spine deformities and instabilities, prevent disability and provide
permanent stability to the spine. The surgery makes use of rods, bars, wires and screws specially designed for this
type of medical procedure. These tools hold the spine straight during a fusion procedure. Fusion is an adhesive
process that joins together the bony spinal components. RA patients who benefit the most form a cervical
procedure are those living with uncontrollable pain and neurologic dysfunction, myelopathy (any neurological
deficit of the spine) with spine instability, and severe weakness that results in functional disability.
Spinal Fusion for Cervical RA
In a spinal fusion, the spine is stabilized over time. The surgeon uses a bone graft, which usually comes from
the patient’s own body but may instead be a donated bone graft. A biological substance which stimulates bone
growth, is another option. Fusion will stop the movement between vertebrae to provide long-term stability. RA
patients who benefit the most from a cervical procedure are those living with uncontrollable pain and neurologic
dysfunction, myelopathy (any neurological deficit of the spine) with spine instability, and severe weakness that
results in functional disability.
Arthroplasty
In patients with rheumatoid arthritis, arthroplasty is done to restore function to a joint or correct a deformity.
Bones in your joints can either be reshaped or replaced with metal, plastic or ceramic parts. Recovery from
arthroplasty may require a 2- to 14-day hospital stay and, depending on which joint is affected, rehabilitation
may take weeks or months. Arthroplasty is considered if RA symptoms and pain are no longer controlled with
medicine, therapy or exercise; if patients are no longer able to perform daily activities; or if the narrowing of the
joint space or wearing of the bone and cartilage is causing severe pain and/or reduced range of motion. The
risks of this procedure include general surgical risks, such as anesthetic use, infections in the artificial joints,
development of blood clots and loosening of the joint.
Arthroscopy
Arthroscopy is a joint surgical procedure where a thin tube with a light source, called an arthoscope, is inserted
into the joint though a small incision in the skin, allowing the surgeon to see the joints inside without making
a larger opening. Other instruments are then inserted to work on the joint. This procedure does not cure RA or
halt the disease but it will help to improve function and alleviate pain. Arthroscopy does not require an overnight
hospital stay, and the joint can be used within a few days. This procedure treats large joints and includes cleaning
and removing debris from the joint, removing free-floating particles, smoothing out rough surfaces of the joints,
and removal of inflamed tissue. General surgical risks are possible, including infection and bleeding within the
joint.
Carpal Tunnel Release
Carpal tunnel syndrome is a common nerve disorder. The carpal tunnel is located at the wrist on the palm side
of the hand just below the skin surface. There are eight small wrist bones that form the three sides of the tunnel.
The part of the tunnel just below the skin surface consists of soft tissues and the transverse carpal ligament.
When the median nerve in the wrist is compressed because of swollen tissues, nerve impulses become blocked.
As a result, people may experience mild and occasional numbness, hand weakness, loss of feeling and loss of
hand function. People with rheumatoid arthritis can develop nerve compression including inflammation of
the structures in the tunnel, including the tendons. Carpal tunnel release involves cutting the transverse carpal
ligament and releasing the median nerve. The size and shape of the incision may be different for each patient.
After surgery, the hand is wrapped and stiches are removed 10 to 14 days later. The pain and numbness may go
Your Guide to Rheumatoid Arthritis Treatments Page 23
away right after surgery or it may take several months to resolve. It is recommend that patients avoid heavy use
of the hand for up to three months.
Synovectomy
Synovectomy surgery removes inflamed joint tissue that is causing severe pain or limiting a patient’s ability to
function. Right after surgery, a physical therapist will teach the patient how and when to move the joint. Recovery
will depend on the nature of the procedure and the location of the incisions.
Your Guide to Rheumatoid Arthritis Treatments Page 24
Talking about RA
Treatments with Your
Doctor
Better teamwork leads to better treatment results! Here are
three articles thatcan help you improve communication and
collaboration with your RA doctor.
Your Guide to Rheumatoid Arthritis Treatments Page 25
Preparing for Your Doctor
Appointment: Have Three
Main Questions
Get the most out of your limited time with the doctor
Gary McClain
Two just people left their doctor’s appointment feeling pretty frustrated. Why? Because they didn’t get answers to
their questions.
Dave had thought a lot about what he wanted to ask his doctor and had come prepared with a list of questions.
About a dozen. He was planning to go through them with his doctor, one by one.
Lisa had also done a lot of thinking about her appointment. While she didn’t actually make a list, she knew she
would remember them.
Dave and Lisa didn’t get their question answered for two different reasons. But for the same reason.
Dave had said to his doctor: “I have a list of questions to go over with you. Can you go through it now?”
Dave’s doctor, who has always been willing to share information, had smiled as he looked through the list, and
then said: “There are a lot of questions on this list, Dave. Some of them are too early in your treatment for me to
have answers to. Others you can find out on the Internet. But I see a couple I can answer today.”
And while Dave’s doctor had provided the answers to these questions, Dave felt like he hadn’t been given the
information he thought he needed and deserved.
Lisa’s doctor started the appointment by asking her some questions. She was considering making changes to
Lisa’s medication regimen, and wanted to review Lisa’s current progress before she made her decision. This
caught Lisa off guard. As a result, not only did she forget her questions, but she forgot she had questions in the
first place.
Get the Answers You Need
What’s next for Dave and Lisa? Chances are, another appointment to get the answers that they didn’t get this
time.
So how could this situation have been avoided? After all, while Lisa didn’t have her questions written down, Dave
had taken the time to make a list. Yet they both walked out with unanswered questions.
The solution here lies somewhere in the middle. Not remembering to ask your questions basically guarantees
that you won’t get answers. On the other hand, bringing a long, overwhelming list of questions pretty much
guarantees the same thing. But how about coming to the appointment with a reasonable list of questions, based
on what you most need to know? And that your doctor can answer within the time that you have together?
Maybe three questions?
Sound like a plan? Here’s how to get started:
Prep Your Attitude
Keep realistic expectations. Physicians are limited by their organizations and/or managed care in terms of how
much time they can spend with each patient. As a result, they usually don’t have time to pore through long lists
of questions. So both patients and physicians each have a responsibility to make the best use of that time. Time
is money. That’s the system.
Don’t view your doctor as your only source of information. In the not-too-distant past, physicians rolled their
eyes in annoyance when patients started to talk about what they had learned in their own research. Now, most
doctors expect their patients to take responsibility for keeping themselves informed.
Your Guide to Rheumatoid Arthritis Treatments Page 26
Give yourself permission to participate actively in your healthcare. Sometimes patients feel hesitant
about asking their doctor questions. They may be concerned that their doctor might think they doubt his/her
competence. Or that they will be viewed as “high maintenance.” But doctors appreciate when patients take an
active role in their healthcare, and that includes asking questions.
Prep Your List
Do some brainstorming with yourself. To start the process of coming up with the best questions to ask
your doctor, keep an ongoing list between appointments. Anything that comes to mind, jot it down. As your
appointment gets closer, take some time to sit down and add any other question that pops into your mind. Don’t
hold back. The idea here is to have a big list that you can then narrow down to a few key questions.
Do some of your own research. When you brainstorm on questions to ask your doctor, you may come up with a
few that you haven’t thought about before. This might be a time to jump on the web and go to some trustworthy
sites to update your research. You may find some of your own answers, or you may come up with some better
questions based on what you learn. It’s never a bad idea to keep your knowledge up to date.
Narrow your list down to what you need to know now. After you have done your research, go back through
your list and decide what questions you most need answers to. (Our friend Dave could have benefitted from this
exercise.) Not sure how to make this decision? Here are some areas of questioning to consider:
•	 RA symptoms you aren’t sure about or need to be on the watch for
•	 Anything else you should be doing to take care of yourself
•	 How your doctor feels the RA treatment is working and any anticipated changes for the future
•	 Any testing that might be needed in the future
•	 Anything you learned in your RA research that you want your doctor’s opinion on
Ideally, limit your list to three questions. These should be the questions you are most concerned about, or you
feel are the most urgent. Keep in mind that three questions will not be sufficient in every situation. For example,
if you are newly diagnosed with RA, or are making a major medication change, or are experiencing unusual
symptoms, you will most likely need to ask your doctor more than three questions. Also, some physicians are
better communicators than others. If your doctor tends to be more reserved, then you may routinely have to do
more digging to get the information you need. If your doctor is a talker, he/she may anticipate your questions
before you even ask.
Record your questions. Write/type them on something you can easily access and won’t leave behind. Your
smartphone or some other electronic media. A notecard. A piece of paper. And then make sure you take this with
you when you are at your doctor’s office. You may have to tie a string around your finger to remind yourself to
pull out your questions. Whatever it takes. You’ve only got one chance here, unless you want to make another
appointment or get your doctor’s attention by phone or email.
Get Down to Business with your Doctor
Start by listening. It’s human nature to be so concerned about what you want to say next that you don’t hear
what the other person is saying. Remind yourself to begin the appointment in listening mode. Your doctor is
most likely seeing one patient after the other, so you may benefit by not breaking his/her train of thought. And,
after having reviewed your record, your doctor probably has an initial agenda for the appointment, e.g. to ask
you some questions, to tell you something, or to examine you. It might help to have your questions in front of you
so you don’t have to worry about forgetting them. Your doctor may answer some of your questions before you
even need to ask them.
Choose the right time to bring up your questions. You may want to ask a question or two at appropriate times
during the appointment. Or you may want to save your questions until the end. Use your judgment. You know
your doctor, and you know what’s comfortable for you.
Assert yourself. For example, your doctor may be talking about one of your medications and one of your
questions may pertain to that medication. If so, wait until he/she pauses, and jump in, or hold a finger up to
signal that you need to speak, and introduce your question with something like: “I actually have a question about
__________.” And ask your question. Or it may be more appropriate to wait until the end of the appointment,
and then say, “I brought in a couple of quick questions that I need to ask you before we finish.” And ask your
questions.
Your Guide to Rheumatoid Arthritis Treatments Page 27
Don’t take no for an answer … or at least try not to. Physicians don’t always seem very receptive to being
asked questions. They may be in a rush. They may not understand the importance of the question to you. They
may feel they have already answered that question (and maybe they did, but you didn’t get it the first time, or
they have you confused with someone else). Gently but firmly let your doctor know that you expect an answer.
Ways to get your point across include: “This has been on my mind and I really need to know your thoughts.” “You
may have told me this before but I didn’t understand your answer.” “I need just a couple more minutes of your
time before we finish.”
And if no is the usual answer, then maybe it’s time to consider talking to another doctor. We live in age of
empowered medical consumers. Doctors have learned to appreciate, and even welcome, questions from their
patients. That’s how doctors and patients communicate. If your doctor doesn’t seem willing to answer your
questions, or if you don’t feel like you are getting complete answers, then it may be time to obtain a second
opinion. Or to find a physician who considers you to be a member of the team.
Dave and Lisa were better prepared for their next doctor’s appointment. Lisa took the time to write a couple of
questions on her smartphone. Dave pared his list down to three questions, which he wrote on a notecard. As a
result they left the appointment with answers instead of questions. And probably avoided having to schedule
another appointment to fill in the gaps.
Your time is important. Your doctor’s time is important. Get prepared for your appointments by knowing what
you already know, and being ready to ask what you need to know.
Your Guide to Rheumatoid Arthritis Treatments Page 28
Working with Your Doctor
to Find the Right RA
Treatments
Tips for communicating with your doctor
Gary McClainMike has recently been diagnosed with a chronic medical condition. His physician explained to
him that, in addition to medication, Mike will need to make extensive lifestyle changes, including modifying his
activity level and adopting a new diet. Looking back on that conversation, Mike remembers that an alarm when
off in his mind when his doctor said the words: “This should be easy.”
Later that day, while reviewing the pamphlet about his condition he had been given, Mike agreed that, yes, the
plan should indeed be easy. And probably was easy. For someone. But not for him.
"Easy? Not for Me."
Have you had the same experience as Mike?
Physicians have the best of intentions when they recommend lifestyle changes to individuals facing a medical
diagnosis. But their suggestions might not be attainable for you.
Maybe it's an exercise routine that doesn’t fit with the way you want to exercise, or that doesn’t fit with your
budget. A diet that doesn’t include any of the foods you are used to eating, or introduces foods you already know
you don’t like or that will be difficult or expensive for you to prepare. Changes in your daily routine that, unless
you are living alone, just aren’t going to be realistic for the others in your household. Or maybe, now that you’ve
reviewed the list, the recommendations just aren’t all that clear ("I’m supposed to be eating what?").
As a result, like Mike, you may be reviewing your rheumatoid arthritis doctor’s recommendations and, instead
of nodding in agreement like you did in his or her office, now you’re shaking your head in disbelief and asking
yourself, “What did I agree to?” On one hand, you know that change is necessary to manage your RA and take
the best possible care of yourself. On the other hand, you may not see how you can accomplish this with the
recommendations your doctor gave you.
Treatment Plans: A Collaborative Effort
Your RA treatment plan should be a collaborative effort between you and your physician. Here’s how to get the
collaboration started:
Don’t assume that there is only one way to live with RA. If you view the plan you have been given as the only
approach to maintaining your self-care, then you may feel like giving up before you get started. Instead, think of
these recommendations as getting the conversation started — an ideal approach, but not the only approach.
Your self-care plan is a work in progress, and will most likely evolve over time.
And, don’t assume that your doctor’s attitude is “my way or the highway.” Physicians are busy, and they
don’t always have time to tailor a lifestyle management plan for each individual patient. Partnering with your
doctor means asking questions and having discussions about your RA treatment and self-care, so that as your
doctor better understands your wants and needs, the plan can become more tailored to what will best work for
you.
Ask yourself what is making you uncomfortable. Reading through a list of RA treatment guidelines can be
scary, especially the first time you go through them. To help get past the initial shock, go through them one by
one. And for each recommendation, ask yourself: What would be involved in following this recommendation?
What’s hard about it? How would it benefit me? Is it possible that I could make it work?
This exercise may not give you all the answers, but at least you will come out of it with a better sense of which
ones are immediately doable, and which ones present challenges.
Take an honest look at your own willingness to make changes. If there is one thing human beings often
avoid, it is change. We like our familiar routines and habits — even if some of them aren’t so good for us. So as
Your Guide to Rheumatoid Arthritis Treatments Page 29
you evaluate your doctor’s recommendations, ask yourself: “What’s bothering me here? The plan itself, or the
changes that I would have to make in my familiar routine?”
Do some of your own research. The Internet is rich with medical information, including recommendations for
rheumatoid arthritis self-care. Do some research on alternatives to your physician’s recommended plan. See
what you can come up with that might meet the same goals. Print them to take to your next appointment.
Ask to meet again and discuss the plan. After you’ve thought about the recommendations your doctor has
made, done your research on the alternatives and even tried to follow the ones that you could follow, schedule
another appointment.
And come prepared. Keep in mind your doctor most likely doesn’t have a lot of time. So be prepared to briefly
present your concerns, your key questions, and your proposed solutions.
Start the conversation on a positive note. Physicians are often confronted by patients who are argumentative,
refuse to be compliant or are hoping if they whine long enough and loudly enough, they can talk their doctors
out of having to make any changes in their comfortable — but damaging — routines. Who knows, the patient
before you may have fit into one of those categories. Be clear about your goals, beginning with the overall goal of
wanting to team up with your doctor to support him or her in treating your RA.
Be ready to negotiate. Your RA self-care plan is a work in progress. Ask your doctor what aspects of the plan can
be swapped out. For example, alternative ways to get exercise, or a diet that you can more easily follow. It may
be possible to gradually phase in some of the changes that are most disruptive to your current routine. Let your
doctor know you’re willing to be flexible, but you also need him or her to be flexible as well.
Get the Treatment Plan That Works for You
Here’s what Mike did: He went through his doctor’s list of recommendations and picked out the ones that he
either knew weren’t realistic or that he didn’t understand. He went to a trusted website and found alternatives
that would be a better fit. He made a list of questions. He provided his doctor with a plan that he could commit
to. They ironed out a new plan.
Remember it’s about teamwork, not about being right. Optimal lifestyle management doesn’t have to be a
power struggle between you and your doctor. In fact, most physicians welcome the opportunity to collaborate
with their patients on the best way for them to stay compliant on the treatment journey, and recognize that
patients have preferences and limitations that will require some fine-tuning along the way.
The success of your RA treatment plan is your hands. Team up with your doctor and create a self-care plan that
you can — and will — follow.
Your Guide to Rheumatoid Arthritis Treatments Page 30
What to Do when Your
Doctor Won’t Tell You What
to Do
Having several RA treatment options may seem scary, but it can
also be an opportunity.
Gary McClain
After Jenn’s doctor talked to her about her diagnosis, he briefly went through the treatment options with her, one
by one. After he was finished, he said, “Go home and think about what direction you want to go in, and let me
know when we meet next week.”
Jenn left his office with a handful of pamphlets and an uneasy feeling. She paused in the waiting room to glance
through the materials she has been provided. One of them discussed patients and doctors working together as a
team and “shared decision making.”
That evening, Jenn told her husband, Tom, about the conversation she had with her physician. “I’m not sure
how empowered I want to be,” she said. “Sure, I want to be involved in the decision. But I also want to know what
direction my doctor recommends. Isn’t he the expert?”
Have you ever felt like Jenn?
As a rheumatoid arthritis patient, you have the right to make decisions about your treatment, including where
you are treated, how you are treated, and even if you are going to receive any treatment at all. That’s what
patient empowerment is all about. However, hearing about new treatment options, especially when they are first
presented, can be scary. Being told that the decision is yours can be scarier.
If you have been in this position, you may have had a reaction similar to Jenn’s. On one hand, you may indeed
want to be involved in the decision. After all, it’s your body and the treatment route you choose will impact
many different aspects of your life. On the other hand, you may be hoping that your doctor will give you a strong
recommendation, based on his/her knowledge and experience. And let’s be honest — you may be feeling
like dealing with your RA is already so overwhelming, you would rather not have to think about the treatment
options.
Doctors are learning how their role is changing in the new world of patient empowerment, just as patients are.
They are seeking to follow the best practice guidelines for communicating with patients, including sharing
decisions. Consequently, patients sometimes feel that their doctors are erring on the side of sharing the decision
to the point that they do not provide the recommendation the patients want and need.
So what can you do when your doctor won’t tell you what to do? It starts with communication! Here are some
ideas to get the process moving:
First, don’t turn uncertainty into a catastrophe. When you’re feeling overwhelmed, it’s only human to get
caught up in the emotions of the moment. While being presented with treatment options can be scary, especially
when you are newly diagnosed, being provided with options doesn’t have to mean the decision is being dropped
in your lap. So take a moment to get some perspective. Take a deep breath. Tell yourself that options are a good
thing because options mean there is more than one way to treat your rheumatoid arthritis.
Get clarification on your physician’s intention. Sometimes when we are feeling strong and uncomfortable
emotions, like fear, it’s easy to misunderstand what the other person is saying. It’s just human nature. But
misunderstanding can also lead to assumptions. So take a moment and ask for clarification: “Doctor, it sounded
like this is my decision alone. Is that what you meant?”
Be honest with your doctor about your discomfort. Let him or her know that you are feeling unprepared
to evaluate the options that you have been provided, or even wondering why you should have to. And that
while you appreciate being part of the decision-making process, you also need more guidance in terms of a
Your Guide to Rheumatoid Arthritis Treatments Page 31
recommendation. “I need for you to know that I am uncomfortable with being asked to make this decision. I feel
left out on a limb.”
Get an understanding of his or her position. Your doctor may have specific reasons for leaving the decision
up to you. He or she may want you to feel like you are not being told what to do, but that you also have a voice.
Patients who buy in to their RA treatment path are likely to be more compliant. Clinic or hospital guidelines may
also be a factor. So just ask: “Can you explain what your role is and what my role is in this decision?’
Ask your doctor to take you through the options. Focus on what’s involved in each treatment, what you can
expect, what you need to be concerned about. Ask questions. If your doctor doesn’t have time, ask if someone
in his or her office, another doctor, a nurse or a physician’s assistant, can help, and if he or she can recommend
other resources. “What is the best way for me to get a clear picture of my options?”
Get a sense of how urgent the decision is. If you aren’t ready to make a decision based on the options you have
been provided, ask your doctor how urgent it is that you decide right away, or if you have time to think about the
options. Your doctor should be able to provide some perspective regarding urgency, as well as any short-term
treatment you can be administered as you are making your decision. “When do I need to get going on treatment?
How long can I safely delay it while evaluate my options?”
Go home and do some of your own research. The Web is filled with information about research rheumatoid
arthritis and its treatment. So do some searching on reputable sites. A couple of good places to get objective
treatment information are WebMD.com and MayoClinic.com. You might also want to review discussions
regarding rheumatoid arthritis and its treatment on our RheumatoidConnect.com website, or post a discussion
of your own.
Consider getting a second opinion. If you are feeling especially conflicted about the options that your physician
has presented to you, you might also want to get a second opinion from a specialist in rheumatoid arthritis. This
will provide you with additional input into the decision process. If you are concerned that your doctor’s hesitance
may be related to his/her discomfort or lack of experience in treating your condition, then a second — or even a
third — opinion is recommended. You may also want to consider seeking further treatment from a physician who
has more demonstrated expertise.
Have another discussion. Summarize what you have learned and present it to your doctor at a subsequent
appointment. Focus on anything you learned about the treatment options that the two of you haven’t already
discussed. Bring a list of questions.
Try the “What would you do?” question. At this point, it might help to ask your doctor to talk about what
would be chosen if he or she, or a loved one, were in your situation. This is not intended to be a trick question. It
might help your doctor to talk more directly about a recommended course of action, or at least give you further
insight into how to make your decision. “If you were in my position, what factors would you consider most
important as you evaluated the treatment options?”
And ask yourself: Can this be an opportunity? Wanting your doctor to recommend a treatment when you are
first diagnosed with RA, as well as further along in the treatment journey, can be a double-edged sword. Sure, it
can be a relief to be told what to do, and not have to do a lot of thinking about treatment options. However, not
evaluating your options before you commit to a treatment path can lead to feelings of uncertainty in the future, if
not regret.
Jenn and her husband did some research on the options her doctor had presented to her, including the pros,
the cons, and the benefits. On her next visit with her doctor, she and her doctor had a talk about what she had
learned. Because she was informed, Jenn felt more confident. She asked questions, and her doctor gave her
honest answers, including the risks. Jenn left his office feeling like they had worked together to create a treatment
plan that she felt comfortable with.
Think teamwork. And that means a meeting of the minds: you and your doctor. Begin your RA treatment
journey with confidence that you have thoroughly evaluated the options and that you understand your doctor’s
perspective. Talk. Ask questions. Keep talking. Get prepared for the road ahead.
Your Guide to Rheumatoid Arthritis Treatments Page 32
Find more information
and caring support to help
you live with rheumatoid
arthritis in our FREE online
community
rheumatoid connect
This guide is for informational purposes only. It is not intended to diagnose, treat, cure or prevent any
health condition, or to replace the advice and care of your doctor or other healthcare professional. ©
Alliance Health Networks, LLC

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ra-guide-r3

  • 1. Your Guide to Rheumatoid Arthritis Treatments Page 1 Your Guide to Rheumatoid Arthritis Treatments Find the best ways to reduce and relieve RA symptoms by Lana Barhum rheumatoid connect
  • 2. Your Guide to Rheumatoid Arthritis Treatments Page 2 Rheumatoid Arthritis: What are my treatment options and how do they work? Treatment for rheumatoid arthritis is optimal when patients and their doctors implement a comprehensive program that includes medication, complementary therapies, lifestyle changes, social and emotional support, joint protection, and as a last resort, surgical intervention. While RA has no cure, the aim of treatment is to help patients achieve the lowest levels of disease activity and joint damage in order to live good quality lives. Here you’ll find information on the leading RA treatments, plus advice on getting the most from your relationship with your RA doctor.
  • 3. Your Guide to Rheumatoid Arthritis Treatments Page 3 Contents Disease-Modifying Anti-Rheumatic Drugs (DMARDs) / Immunosuppressive Drugs......................................4 Biologic Response Modifiers or Biologics.................................................................................................................7 Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)...............................................................................................10 Corticosteroids..............................................................................................................................................................12 Analgesics.......................................................................................................................................................................13 Natural Supplements..................................................................................................................................................14 Complementary and Alternative Treatments........................................................................................................15 Chiropractic Treatment...............................................................................................................................................17 Stress-Reduction Techniques....................................................................................................................................18 Exercise Strategies........................................................................................................................................................18 Diet Plans........................................................................................................................................................................20 Assistive Devices...........................................................................................................................................................21 Surgical Options...........................................................................................................................................................24 Talking about RA Treatments with Your Doctor....................................................................................................26 Preparing for Your Doctor Appointment: Have Three Main Questions...........................................................27 Working with Your Doctor to Find the Right RA Treatments..............................................................................30 What to Do when Your Doctor Won’t Tell You What to Do..................................................................................32
  • 4. Your Guide to Rheumatoid Arthritis Treatments Page 4 Disease-Modifying Anti-Rheumatic Drugs (DMARDs) / Immunosuppressive Drugs Disease-modifying anti-rheumatic drugs (DMARDs) can slow down the progression of rheumatoid arthritis and stop joint damage. This section provides the leading information on DMARDS. Learn how they differ and their possible side effects, to help you and your doctor determine whether they may be right for you. (As with all medicines, most patients will probably not experience most of the possible side effects listed.) Methotrexate Methotrexate (Rheumatrex), a disease-modifying anti-rheumatic drug, is the drug commonly used for rheumatoid arthritis treatment. It works to reduce inflammation and slow down the progression of RA. It can be very effective in preventing disability and joint damage. People with RA can continue to take methotrexate with other DMARDs because of the promising results and minimal side effects. Doctors often prescribe methotrexate with another DMARD, such as leflunomide. Combination therapy will allow patients to take lower doses of one drug, which helps to reduce the chance of adverse reactions. Taking folic acid can help minimize methotrexate side effects. Side effects: nausea; vomiting; stomach pain; drowsiness; dizziness; temporary hair loss.Serious side effects: mouth sores; diarrhea; anemia; liver problems; easy bruising or bleeding; black stools; enlarged glands or lymph nodes; dry cough; discoloration of skin; infection; muscle weakness. Sulfasalazine (Azulfidine) Sulfasalazine (Azulfidine) is created from salicylic acid, the main ingredient in aspirin, and sulfapyridine, an antibiotic. It is taken orally and available in time-release tablets. Sulfasalazine reduces rheumatoid arthritis joint inflammation and slows or halts the progression of the disease. It is more often used as an early treatment for RA or in milder cases. It can be used in combination with non-steroidal anti-inflammatory drugs (NSAIDs) or with disease-modifying anti-rheumatic drugs (DMARDs) for more severe forms of RA. It may take up to three months for patients to notice improvement with sulfasalazine. Side effects: stomach upset; nausea; vomiting; loss of appetite; headache; dizziness; unusual tiredness; skin discoloration. Leflunomide (Arava) Leflunomide (Arava) is a disease-modifying anti-rheumatic drug (DMARD) that blocks the production of white blood cells that cause rheumatoid arthritis inflammation. Leflunomide is often prescribed for patients who have not responded to sulfasalazine or methotrexate. Patients taking leflunomide will need to have their liver function checked regularly for signs of liver damage. Additionally, people who have a history of alcohol abuse or liver or kidney disease should talk to their doctors before taking leflunomide. Side effects: diarrhea; nausea; dizziness. Serious but rare side effects: cough; numbness; tingling of hands or feet; hair loss; chest pain; fast heartbeat;
  • 5. Your Guide to Rheumatoid Arthritis Treatments Page 5 increased thirst and/or urination; muscle pain or cramps; mood changes; vision changes; easy bruising or bleeding; unusual growths/lumps; swollen glands; weight loss; unusual tiredness; increased blood pressure; infection. Hydroxychloroquine (Plaquenil) Hydroxychloroquine (Plaquenil) is considered a disease-modifying anti-rheumatic drug (DMARD) because it helps to decrease the pain and swelling associated with RA. It may also prevent joint damage and reduce the risk of disability. Hydroxychloroquine is often prescribed for patients with mild RA or in combination with other drugs for patients with a more severe form of the disease. Patients should have their vision monitored by an ophthalmologist while taking hydroxychloroquine, as it has been known to cause vision changes and/or vision loss in some patients. Patients can start to see improvement within one to two months of treatment, but it may take up to six months to acquire full benefits from this medication. Side effects: nausea; stomach cramps; loss of appetite; diarrhea; dizziness; headache.Rare but serious side effects: arm/leg/back pain; fast/irregular heartbeat; hair loss; mood changes; ringing in ears or hearing loss; worsening of skin conditions; low blood sugar; allergic reaction. Azathioprine (Imuran) Azathioprine (Imuran) treats pain and swelling and helps patients manage anti-inflammatory conditions such as rheumatoid arthritis. Azathioprine works to reduce the body’s immune response by interfering with DNA synthesis that allows cells to grow and divide. Some benefits of azathioprine can be seen as early as six weeks, but it may take up to twelve weeks to see the full benefits. Side effects: blood cell toxicity; abdominal pain; diarrhea; nausea and vomiting; hepatitis; pancreatitis; allergic reactions; increased risk for cancer. Cyclosporine (Neoral) Cyclosporine (Neoral), a powerful immunosuppressant, is considered a disease-modifying drug (DMARD) because it can decrease pain and swelling, while also preventing joint damage and reducing the risk of disability in rheumatoid arthritis patients. It has been effective in treating RA patients who have not responded well to other treatments. People taking cyclosporine may notice results within a week, but it may take up to three months to get the full benefits of treatment. Side effects: high blood pressure; kidney problems; gout; headaches; nausea; vomiting; abdominal pain; swelling of the hands and feet; swelling of gums; muscle cramps; increased hair growth; numbness or tingling of hands and feet; infection. Cyclophosphamide (Cytoxan) Cyclophosphamide (Cytoxan) is an immunosuppressant that is prescribed for patients who have severe rheumatoid arthritis. Cyclophosphamide works by blocking the production of cells that play a key role in autoimmune conditions including rheumatoid arthritis. Patients taking cyclophosphamide should be carefully monitored by their physicians since the medication is often accompanied by serious side effects. Cyclophosphamide is often used for no more than six months and helps patients go into remission. After patients go in to remission, they are put on medications that are less potent and with fewer side effects to keep them in remission. Side effects: nausea or vomiting; skin rashes; unusual infections; shingles; abnormal blood cell counts; fertility problems; bladder problems; increased risk for cancer.
  • 6. Your Guide to Rheumatoid Arthritis Treatments Page 6 Biologic Response Modifiers or Biologics In the last ten years, there has been significant advancement in the treatment of rheumatoid arthritis. Newer disease modifying drugs called biologic response modifiers and/or biologics are now used to treat RA in conjunction with Methotrexate or other DMARDs. They work by slowing down the immune system's signals that lead to joint damage. Generally given by injection or IV infusion, they are used to treat moderate to severe RA that has not responded to other treatments. This type of aggressive treatment can prevent long-term disability in RA patients. A major side effect of these medications is the potential for serious infections. Moreover, long term effects won't be known until patients have used these medications for many years. Actemra Tocilizumab, sold under the brand name Actemra, is administered as a monthly intravenous infusion. It was approved by the FDA for use in RA patients whose RA has not been managed with TNF inhibitors, methotrexate or other DMARDs. It has also been approved for use in children age 2 and up who have the systemic form of juvenile idiopathic arthritis (also known as juvenile RA). Tocilizumab works by blocking the cytokine known as interleukin 6, or IL-6, one of the factors behind RA inflammation. The goal of treatment with tocilizumab is to reduce RA symptoms, especially pain and swelling. Studies have also shown tocilizumab to slow or prevent joint damage associated with rheumatoid arthritis. The risk of infection with tocilizumab appears to be the same as other biologic response modifiers. Side effects: fever, chills, increased risk of infection, reduced blood platelet count, increased cholesterol levels and liver enzymes. Rare but serious complications: bowel perforation, or a hole in the bowel wall. Report any abdominal pain or bloody bowel movements to your doctor immediately. Cimzia Certolizumab, under the brand name Cimzia, works by blocking a substance called tumor necrosis factor (TNF). TNF promotes inflammation and other signs of inflammation, such as fever and swelling. Unchecked inflammation eventually leads to joint destruction. Certolizumab binds to the body's TNF to block the effects of TNF. As a result, inflammation and its consequences are reduced. The FDA approved certolizumab in April 2008 as an injection that most patients, once shown how, can give to themselves. Certolizumab is often prescribed to be taken every 2 to 4 weeks, depending on the dose the doctor feels is right for the patient. Side effects: injection site pain, upper respiratory infections, urinary tract infections, headache, high blood pressure, back pain, abdominal pain, diarrhea, intestinal obstruction and inflammation of the nose and throat. Enbrel Like Cimzia, etanercet, sold under the brand name Enbrel, reduces RA inflammation and damage by blocking TNF. This medication can stop the progression of the disease and joint damage, resulting in improved functioning and better quality of life for patients. It is an injection that patients can give to themselves once or twice weekly. Symptoms usual return within a month of stopping Enbrel. Serious side effects: rash on nose and cheeks, dizziness, extreme fatigue, skin paleness, hair loss, swelling of extremities, unusual bruising or bleeding, mood changes, severe headache, unexplained muscle weakness, seizures, numbness and tingling of hands and/or feet, vision changes, severe stomach pain, persistent nausea or vomiting, dark urine, yellowing of skin or eyes, and severe allergic reaction (although rare, allergy symptoms may include rash, itching/swelling, dizziness and trouble breathing). Humira Humira is the brand name for the drug adalimumab that works by blocking the protein TNF. Humira is a fully human monoclonal antibody, meaning it is made using human proteins and no animal proteins. It was approved
  • 7. Your Guide to Rheumatoid Arthritis Treatments Page 7 by the FDA in 2002 as the third biologic for the treatment of RA. Humira is available as a self-injection given under the skin once every two weeks. A single-use, disposable Humira pen has been developed to make injections easier for patients. Humira should not be used by patients with a known allergy to the drug ingredients, women who are pregnant or nursing, or those who are predisposed to infection, including uncontrolled diabetes or a history of repeat infections. Side effects: mild reaction at injection site, rash, headache, stomach upset, nausea, upper respiratory infection (including sinus infection), and back pain. Serious side effects: serious infections, including sepsis, tuberculosis, and fungal infections, allergic reactions, nervous system problems, liver problems, and unusual bleeding and bruising. Kineret Kineret is the brand name for anakinra and is prescribed to treat RA and less common forms of arthritis when standard treatments don’t work. Kineret is often associated with an increased risk for infections, so patients should notify their doctor immediately if they develop fever or other infection symptoms. Kineret works by blocking the inflammation-producing protein IL-1b through a different protein called IL-1Ra. Since there are other proteins that cause inflammation, Kineret may not relieve all symptoms. The drug is administered as a daily self- injection. Side effects: injection site reactions, such as redness, itching, rash, and pain, bruising or bleeding, infections, headaches, and low white blood cell counts. Orencia Abatacept, sold under the brand name Orencia, treats moderate to severe RA in adults and moderate to severe juvenile idiopathic arthritis (JIA) in children age 6 and up. It is prescribed when DMARDs are found not to be helpful. Orencia contains a protein that blocks signals that trigger T-cells in the immune system. These T-cells are significant contributors to the development of RA. Orencia is administered by weekly injection or through intravenous infusion. There is a higher risk for infections with Orcenia and some forms of cancer have been reported in patients taking the drug, but studies are pending as to whether the two are related. Side effects: headache, sore throat, nausea, diarrhea, cough, fever, dizziness, back pain and abdominal pain. Serious side effects/adverse reactions: severe allergic reaction and severe infections, including pneumonia and tuberculosis. Simponi Golimumab, marketed under the brand name Simponi, contains an injectable man-made protein that binds TNF in the body and blocks its effects in RA patients. As a result, inflammation and its complications, such as joint damage, are reduced or prevented. Simponi was approved in 2009 by the FDA and is prescribed to be taken once a month by self-injection or every other month through intravenous infusion. Sideeffects: injection site reactions, including redness and swelling, upper respiratory infections, runny nose, elevated liver levels and high blood pressure. Serious side effects/adverse reactions: serious infections, such as tuberculosis, sepsis and fungal infections, nervous system reactions, congestive heart failure and increased risk for certain types of cancer. Xeljanz Tofacitinib, available under the brand name Xeljanz, is the newest biologic for RA treatment. It was approved by the FDA in 2012 and is an ideal medication for patients who cannot take Methotrexate. Xeljanz belongs to a class of drugs called Janus kinase (JAK) inhibitors. JAKs are proteins that interfere with chemical signals that control the biologic immune process that causes inflammation. Inhibition of JAKs prevents inflammation and tissue damage associated with RA. Xeljanz is available as a 5mg immediate release tablet. Side effects: increased cholesterol levels, headache, diarrhea, sore throat, runny nose, urinary tract infections, and upper respiratory infections. Adverse reactions: serious infections that may lead to hospitalization or death.
  • 8. Your Guide to Rheumatoid Arthritis Treatments Page 8 Non-Steroidal Anti- Inflammatory Drugs (NSAIDs) The major effect of NSAIDs is the reduction of severe inflammation, which decreases pain and increases function. These drugs have mild to moderate pain-killing effects that are separate from their inflammation-fighting qualities. NSAIDs do not have disease-modifying qualities, so they do not alter the course of rheumatoid arthritis or prevent joint damage. Aspirin Aspirin is the oldest NSAID prescribed for its inflammation-fighting qualities. But because of its high toxicity and the requirement to take multiple daily doses, it is often replaced with other NSAIDs, such as ibuprofen and naproxen. Aspirin should never be taken for long periods, as there is potential for aspirin poisoning. Inappropriate dosing is often the cause of such poisoning, including pain medications being taken in combination. This is especially common in people with chronic illnesses, such as RA. Aspirin is an over-the-counter NSAID. Side effects: shortness of breath; nausea; vomiting; diarrhea; constipation; decreased appetite; rash; dizziness; headache; drowsiness; prolonged bleeding after injury or surgery. More serious side effects/complications: fatal liver disease; fatal stomach and intestinal adverse reactions; edema; ulcers; stomach bleeding; kidney failure; heart attack; stroke. Ibuprofen Ibuprofen, sold generically and under brand names such as Advil, is an NSAID that can relieve mild to moderate RA pain. It can be taken every six to eight hours for pain relief. Ibuprofen reduces inflammation by blocking the production of inflammation-building chemicals. It also provides anti-fever and blood-thinning actions. Ibuprofen, while effective, can bring with it some serious side effects, including a higher risk of heart attack or stroke. Ibuprofen is an over-the-counter NSAID. Side effects: shortness of breath; nausea; vomiting; diarrhea; constipation; decreased appetite; rash; dizziness; headache; drowsiness; prolonged bleeding after injury or surgery. More serious side effects/complications: fatal liver disease; fatal stomach and intestinal adverse reactions; edema; ulcers; stomach bleeding; kidney failure; heart attack; stroke. Naproxen Naproxen, sold generically and under brand names such as Aleve, is an NSAID used to treat rheumatoid arthritis. It has been available as an over-the-counter medication for over 20 years. It is primarily used to reduce inflammation, pain and stiffness. Patients taking methotrexate should avoid naproxen, as the combination of the two medications has been found to cause serious adverse reactions. Patients who are aspirin sensitive and who have had ulcers, kidney or liver problems or stomach bleeding should not take naproxen. Side effects: shortness of breath; nausea; vomiting; diarrhea; constipation; decreased appetite; rash; dizziness; headache; drowsiness; prolonged bleeding after injury or surgery. More serious side effects/complications: fatal liver disease; fatal stomach and intestinal adverse reactions; edema; ulcers; stomach bleeding; kidney failure; heart attack; stroke. Celebrex NSAIDs also include a class of drugs called COX-2 inhibitors that are effective in controlling inflammation. Celebrex, like other COX-2 inhibitors, is designed to decrease gastrointestinal risks posed by other NSAIDs. There are no NSAIDs that surpass the effectiveness of COX-2 inhibitors in the treatment of RA because COX-2 inhibits
  • 9. Your Guide to Rheumatoid Arthritis Treatments Page 9 the COX-2 inflammation-promoting enzyme. The downside to Celebrex and other COX-2 inhibitors is the high risk for heart attacks and strokes. Two other COX-2 inhibitors, Vioxx and Bextra, were taken out of the U.S. market after multiple reports of heart attacks in people who took them. While the Food and Drug Administration has not pulled Celebrex from the market, it is labeled with strong warnings and doctors are required to prescribe it in small doses. Side effects: shortness of breath; nausea; vomiting; diarrhea; constipation; decreased appetite; rash; dizziness; headache; drowsiness; prolonged bleeding after injury or surgery. More serious side effects/complications: fatal liver disease; fatal stomach and intestinal adverse reactions; edema; ulcers; stomach bleeding; kidney failure; heart attack; stroke.
  • 10. Your Guide to Rheumatoid Arthritis Treatments Page 10 Corticosteroids Corticosteroids have anti-inflammatory and immunoregulatory qualities. They can be given orally, intravenously or injected directly into the joints. They can quickly bring down inflammation and are often used during rheumatoid arthritis flares. Oral Corticosteroids Generic drugs: cortisone acetate, dexamethasone, hydrocortisone, methylprednisolone, prednisolone, prednisone All corticosteroid drugs are a manmade form of cortisol, a hormone that our bodies produce naturally. These drugs decrease inflammation and produce an effect that calms down the body’s immune-system response. They are more often prescribed for patients whose RA is not well controlled with NSAIDS and DMARDs. Side effects: blurred vision; cataracts or glaucoma; easy bruising; sleep issues; high blood pressure; weight gain; increase in body hair; lowered resistance to infections; nervousness and restlessness; stomach issues including bleeding; mood swings; puffy face; swollen ankles; water retention; worsening of diabetes symptoms. Injected Corticosteroids Generic drugs: methylprednisolone, triamcinolone, betamethasone. Name brand: Depo-Medrol Corticosteroid injections help to reduce inflammation and reduce pain in a specific area of the body. They are usually injected into the joints, including the knees, spine, shoulder, hands and feet. These injections are typically performed in your doctor’s office. The amount of injected corticosteroids you can take yearly is limited because of a high potential for side effects. Side effects: infection; hives; allergic reaction; pain and swelling at injection site; skin discoloration. Serious side effects: bleeding in the joints; tendon rupture; weakening of bones, ligaments and tendons; trouble breathing; swelling of face, lips, tongue, or throat.
  • 11. Your Guide to Rheumatoid Arthritis Treatments Page 11 Analgesics Analgesics are designed to relieve pain. Analgesics block pain signals and interfere with the brain’s interpretation of pain. Acetaminophen (Tylenol, Aspirin-Free Anacin) Acetaminophen is often prescribed for rheumatoid arthritis pain relief in patients who are sensitive to aspirin or NSAIDs. Acetaminophen does not have anti-inflammatory properties. It is available as an over-the-counter medicine. Opioid Analgesics Research has shown that weak opioid analgesics, such as codeine and tramadol, may be effective in short-term pain management of rheumatoid arthritis. Codeine Codeine is a narcotic painkiller used to treat severe rheumatoid arthritis pain. Codeine is often combined with acetaminophen or aspirin. It helps to block the nerves that transmit pain impulses and reduces the brain’s awareness of these impulses. Codeine should not be used for more than three days at a time due to the potential for overdose. Side effects: drowsiness; lightheadedness; dizziness; sedation; shortness of breath; nausea or vomiting; sweating; itching; rash; constipation. More serious and less common side effects: low heart rate; weak pulse; fainting; shallow breathing; feeling like you might pass out; confusion; agitation; hallucinations; unusual thoughts or behavior; extreme happiness or sadness; seizure; problems with urination. Tramadol (Ultram, Ultram ER) Tramadol, sold under the brand name Ultram or Ultram ER, is a prescription narcotic painkiller used to treat moderate to severe rheumatoid arthritis pain. It is usually taken every four to six hours as needed. It is also available in an extended-release tablet for patients in need of continuous relief and for overnight pain. In some studies, researchers observed that tramadol was just as effective as NSAIDs for pain management in RA patients. Side effects: dizziness; weakness; sleepiness; nervousness; headache; muscle tightness; nausea or vomiting; diarrhea.
  • 12. Your Guide to Rheumatoid Arthritis Treatments Page 12 Natural Supplements Natural supplements may help people with rheumatoid arthritis to have greater control over pain, symptoms and daily activities. Make sure you keep your doctor apprised of all the medications and supplements you are taking for RA treatment. Supplements for RA that have shown promising results include fish oil, folic acid, SAMe, calcium and vitamin D. Fish Oil Fish oil supplements are a good source of omega-3s, potent fatty acids that help fight inflammation and therefore help to manage rheumatoid arthritis. They can also increase the production of good chemicals that hinder inflammation. Fish oil supplements may also help RA patients by reducing joint pain and swelling. Various studies have shown that people taking fish oil supplements have seen marked improvements in pain reduction and minimized joint stiffness and tenderness in less than three months. Side effects: belching; bad breath; nausea; heartburn; loose stools; skin rashes; nose bleeds. Folic Acid/Folate Folic Acid is a B vitamin that promotes health and supports metabolism. In natural form, folic acid is called folate. Some RA drugs, including methotrexate and sulfasalazine, can interfere with our body’s natural use of folic acid. Eating more foods with folic acid such as spinach, broccoli, peas and oranges can help, but some people may need to take folic acid supplements. Ask your doctor how much folic acid you need to minimize and prevent side effects of your RA medications. Rare side effects: fever; general weakness/discomfort; red skin; shortness of breath; skin rash or itching; chest tightness; trouble breathing; wheezing; nausea; abdominal discomfort; gas; bitter taste; sleep disturbances; concentration issues; irritability; anxiety; depression; confusion; impaired judgment. SAMe S-adenosyl-L-methionine (SAMe) is a naturally occurring chemical in the body that helps with mobility, rebuilding cartilage and reducing the symptoms of arthritis. It has proven anti-inflammatory and analgesic properties. People taking SAMe often see results within a week’s time. In research studies, SAMe was found to be comparable to NSAIDs in relieving pain, without the gastric side effects associated with those drugs. While there has been significant research about the benefits of SAMe for osteoarthritis, there have been few studies evaluating its effectiveness in RA patients. RA patients who find it helpful to take SAMe should take it with B vitamins, including folic acid. Side effects: anxiety; skin rashes; dizziness; heart palpitations; concentration and memory issues; sleep issues; nausea; skin flushing. Calcium Our bodies need calcium to function, and when our calcium levels are low, the body takes it from our bones. Calcium helps our hearts to pump and our muscles to contract. Most people can get enough calcium from dairy products and other foods, but if that isn’t enough, calcium supplements can help. Some medications used to treatment RA, including corticosteroids, make it hard for the body to use calcium. This can lead to bone loss and osteoporosis. The calcium recommendation is 1,000 milligrams for people under 50 and 1,200 for those 51 and older. Your doctor may recommend taking calcium supplements if your levels are low or at risk of being low. Vitamin D Vitamin D promotes healthy bones by absorbing calcium. It is found in many foods, including milk, and sunlight exposure (without sunscreen) stimulates our bodies to manufacture it. Rheumatoid arthritis symptoms tend to be more active when vitamin D levels are low, and low levels are fairly common in RA patients as a result of the medications they take to treat the disease. Moreover, low vitamin D may also play a role in the development
  • 13. Your Guide to Rheumatoid Arthritis Treatments Page 13 of RA. The recommendations for daily vitamin D intake are 600 IUs (international units) for adults under 70 and 1,000 IU for people older than 70. Higher doses may be recommended by your doctor to correct vitamin D deficiency. Side effects: weakness; fatigue; sleep issues; headaches; appetite loss; dry mouth; nausea and vomiting; metallic taste; vitamin D toxicity if too much is taken.
  • 14. Your Guide to Rheumatoid Arthritis Treatments Page 14 Complementary and Alternative Treatments Complementary and alternative treatments can be a great way to supplement RA medication to further alleviate RA symptoms. Before trying them, be sure to discuss them with your doctor. Heat and Cold Therapy Many doctors recommend heat and/or cold therapy to help reduce rheumatoid arthritis symptoms. This therapy will require some trial and error to find out what works best for your pain. Generally, cold compresses help to reduce joint swelling and inflammation. You can apply ice packs to affected joints during RA flare-ups to ease pain and inflammation. It is best to apply cold treatments for 15-minute intervals and to take at least a 30-minute break between treatments. Hot compresses can help to relax muscles and increase blood flow. You can also use heat therapy while showering by letting warm water hit the painful areas of your body. Hot tubs are also a good way to relax stiff and painful joints. Acupuncture There is growing evidence that acupuncture may help people with rheumatoid arthritis. A study published inArthritis & Rheumatism found that patients who tried acupuncture reported reductions in erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP), the blood tests that measure or indicate inflammation. Patients also reported decreased pain and a reduction in morning stiffness. Acupuncture focuses on what its advocates describe as essential life energy called qi, which flows through the body through invisible channels called meridians. When energy is out of balance or blocked, they say, pain and illness occur. There are thousands of acupuncture points that connect to the meridians and stimulating these points is believed to correct flow and alleviate pain. These acupuncture points may also help release tight muscles and regulate the body’s nervous system by releasing pain-fighting endorphins. It is also believed that acupuncture helps the body find trauma and illness in order to heal them. Last, acupuncture may alter the perception of pain as the inserted needles deactivate the part of the brain that manages pain perception. Hydrotherapy Hydrotherapy is a water treatment ideal for arthritis patients. It is as simple as sitting in a whirlpool bath to relieve pain and relax muscles without putting unnecessary stress on tired joints. Hydrotherapy can also be part of an exercise program in a pool setting. It is easy on the joints since water takes weight off of painful joints while providing resistance, reducing swelling and strengthening muscles. This type of therapy can be beneficial to RA patients who have lost range of motion, flexibility and strength and who have limited function on dry surfaces. Massage A report presented at the American Massage Therapy Association National Convention suggested that therapeutic massage helped RA patients achieve muscle release in affected joints, which can stall joint deterioration. A 2013 study also showed that RA patients who had increased pain in the arms, hands, and wrists benefited from moderate-pressure massage. Massage helps many RA patients manage pain and stress. While massage is not a confirmed treatment for rheumatoid arthritis, it is safe when done properly and by a licensed practitioner and is free of side effects. The areas that are affected with inflammation and swelling should not be directly massaged.
  • 15. Your Guide to Rheumatoid Arthritis Treatments Page 15 Chiropractic Treatment For people with RA, chiropractic-related treatments may help minimize damage, slow the progress of the disease and ease pain. Here are some of the RA therapies frequently offered by chiropractors. Ultrasound Therapy Ultrasound therapy uses sound waves to create gentle heat that increases blood circulation in deep issues. It also helps to reduce inflammation, pain and stiffness. Ultrasound can help increase range of motion, which is a typical symptom of rheumatoid arthritis. TENS (Transcutaneous Electrical Nerve Stimulation) TENS therapy is believed to help trigger the release of endorphins, which are the body’s natural painkillers. It involves taping electrodes to the skin that send tiny electrical currents to key points in the nerve pathways. It might sound painful and tense but it is a gentle, passive treatment. Low-Level Laser Therapy There has been some limited evidence that shows that low-level laser therapy (LLLT) may be effective in reducing rheumatoid arthritis pain and stiffness in a minimum of four weeks. LLLT uses a light source to generate photochemical responses that penetrate deep into the tissue to help reduce inflammation. It has been used as a non-invasive therapy for RA for the last ten years. No adverse effects or evidence of harm has been reported with its use. Therapeutic Exercises and Stretches Therapeutic exercises and stretches can be designed specifically for people with RA to promote strength and endurance. These exercises address specific joints or body parts affected by rheumatoid arthritis. They are good for RA patients who have been inactive, have restricted joint motion or muscle strength, and/or are experiencing joint pain. Once patients learn these exercises and stretches, they can perform them at home, at work or anywhere else.
  • 16. Your Guide to Rheumatoid Arthritis Treatments Page 16 Stress-Reduction Techniques Meditation and relaxation techniques may help rheumatoid arthritis patients relieve stress and ease symptoms. These techniques can be done alone or in a group led by a specialized healthcare professional. Meditation Meditation uses awareness to relax the body and quiet the mind. According to a study published by the National Institutes of Health, meditation may help to increase a person’s pain tolerance and self-esteem. It could also help with decreasing stress, anxiety, depression and pain levels. Transcendental meditation and mindfulness meditation are the two most common types. In transcendental meditation, the patient repeats chants to allow negative feelings and thoughts to pass through the body and mind. Mindfulness mediation typically involves sitting with your eyes closed focusing only on your breathing. It has been known to reduce pain and improve mood for some people living with rheumatoid arthritis. In one study, women with RA who entered into an eight-week mindfulness maintenance program showed significant improvement in psychological distress and wellbeing. Yoga Gentle yoga exercises that involve stretching and body movements combined with meditation can help to ease pain and stiffness while building strength, improving flexibility and increasing range of motion. A yoga program of breathing, relaxation and poses can make a big difference to joint tenderness and swelling, according to the Arthritis Foundation. Yoga can also be a fun alternative to walking, biking or swimming. Tai Chi Tai chi is a Chinese mind and body exercise that combines gentle, slow motions with focused breathing and meditation. Some studies have found that when tai chi is included in an RA treatment plan, patients can see improvement in daily function and balance. Spiritual Belief Spiritual or religious belief in combination with a positive attitude may be effective in helping to manage RA pain and improve the ability to cope. Several studies show spirituality can improve health benefits for people living with chronic illnesses such as rheumatoid arthritis. One study out of the University of Missouri revealed that religious and spiritual support helps both men and women cope with chronic illness.
  • 17. Your Guide to Rheumatoid Arthritis Treatments Page 17 Exercise Strategies Studies suggest that even as little as three hours of exercise over six weeks may help people with rheumatoid arthritis reduce inflammation and relieve stiffness and weakness. The goal of exercise for rheumatoid arthritis patients is to maintain a wide range of motion and increase strength, endurance and mobility. Range-of-Motion Exercises Range-of-motion exercises can help rheumatoid arthritis patients maintain joint function by increasing and sustaining joint mobility and flexibility. The joints are straightened and bent in a controlled manner as far as they will go comfortably. The joints are stretched farther until normal or near normal range of motion is achieved and maintained. These exercises are also a vital way to warm up for engaging in strength training and aerobic activity. A physical therapist can teach you how to perform these types of exercises safely and correctly. Strength Training A rheumatoid arthritis program of strengthening exercises targets specific muscle groups. Having strong muscles helps to keep weak joints stable and protect them against additional damage. There are two types of strengthening exercises that help with this: isometric and isotonic. Isometrics strengthen muscles through isolated muscle flexes and periods of rest. Isotonic exercises involve intensive strength development through increased repetition and weight resistance. A licensed physical therapist can instruct you on how to properly perform isometric and isotonic strengthening exercises. Aerobic Exercises The main basis for endurance training is aerobic exercise, which includes activity that increases heart rate for a prolonged time period. When combined with a healthy diet, aerobic activity can help RA patients to lose excess weight, which reduces excess pressure on joints and improves overall health. RA patients should start with about 15 minutes of aerobic activity three times a week and gradually move up to 30 minutes a day. Activity should include warm-up time and cool-down activity. Examples of aerobic activity include low-impact activities like walking and swimming and more rigorous activities like aerobic dance or using an elliptical machine.
  • 18. Your Guide to Rheumatoid Arthritis Treatments Page 18 Diet Plans The connection between rheumatoid arthritis and diet is complex, but diet can influence and affect RA symptoms. A diet filled with anti-inflammatory foods can help control RA inflammation. Several diets, including gluten-free, elimination, anti-inflammatory and Mediterranean, have been helpful to RA patients and have become popular in recent years. Gluten-Free Diet A gluten-free diet excludes gluten, which is found in grains like wheat, rye and barley. Some rheumatoid arthritis patients experience joint pain, stiffness, and swelling when they eat foods with gluten. Having an autoimmune disease such as RA puts patients at risk for gluten sensitivity. Some who become gluten sensitive see an increase in RA symptoms. RA patients should talk to their doctors about the risks and benefits of implementing a gluten- free diet. There are many gluten-free options at markets and restaurants. Elimination Diet An elimination diet removes reactive foods that may cause inflammation and rheumatoid arthritis symptoms. Keep in mind that not everyone is sensitive to the same foods. For example, some people may tolerate dairy while others may report increased RA flare-ups if they consume milk or cheese. You can start an elimination diet by removing all foods that contain gluten, dairy, soy, and nightshade vegetables, such as potatoes, eggplant, tomatoes, and peppers, from your diet for at least three weeks. Then start adding these foods one at a time into your diet, three days apart. If you notice joint stiffness by adding a specific food, chances are you are sensitive to it. Continue to stay away from such foods to keep your RA symptoms at bay. Anti-inflammatory Diet An anti-inflammatory diet is key to managing rheumatoid arthritis flare-ups. This diet centers on plant-based foods. In this diet, two-thirds of your food comes from vegetables, fruits and whole grains. The other third includes fat-free or low-fat dairy and lean meats. People with RA should avoid processed foods and excess carbohydrates because these foods could spark inflammation. RA patients should also eat foods high in omega-3 fatty acids, which are found in fatty fish and certain types of oils. Omega-3 fatty acids can help to reduce C-reactive protein (CRP) and interleukin-6, two inflammatory proteins in the body. Beans are also a great anti- inflammatory food because they offer both antioxidant and anti-inflammatory properties. Mediterranean Diet The Mediterranean diet may help to reduce pain and swelling of joints affected by rheumatoid arthritis, even though relief may not be seen right away. The Mediterranean diet includes olive and canola oils as the primary sources of fat, along with plenty of fish, poultry, nuts, produce and beans. The diet also moderates dairy and red meat and includes red wine. Because it contains healthy amounts of omega-3s and minimal amounts of unhealthy foods and carbohydrates, RA sufferers may experience quick and sustained pain relief.
  • 19. Your Guide to Rheumatoid Arthritis Treatments Page 19 Assistive Devices Assistive devices can make life with rheumatoid arthritis easier. They might be new gadgets to add to your home, office, or car, or improvements to items you already have. In this section you’ll find information on simple devices that can ease and simplify daily activities like cooking, cleaning, getting dressed, bathing, moving around, getting in and out of your car easily and even working at your job. Cane or Walker A cane or walker can make movement easier and help you to keep your joints healthy. Use a cane on the opposite side of a painful hip or knee. Splints/Braces Splints and braces can provide support for joints and take strain off of those joints. An occupational therapist can make a splint for you and a physical therapist can help you to pick out a brace and advise you on how to properly use it. Reachers A reacher is a long rod with a grip handle on one end and a claw on the other end. This device can help you to reach for objects without bending or stretching so you can avoid stress to your joints. Orthotics Orthotics are inserts for your shoes. You can purchase them over the counter or have them custom designed. These inserts help provide relief for painful feet and make it easier to stand and walk. Stepstools Stepstools can help you reach items that are higher up without too much strain. Make sure the stepstool is well balanced and lightweight for easy movement. Jar-Opening Device A manual jar-opening device attaches to a jar lid to give you a better grip. These opening devices are reasonably priced and can save your hands, wrists and fingers from pain and strain. Electric jar openers are also available. Wide Grips/Large Handles Replace cabinet and closet door handles with easy-to-grip knobs and levers that don’t require a lot of turning. Large handles on your pots and pans can make them easier for you to carry and grip during food preparation. Small Kitchen Appliances A food processer can make chopping, grating and other food preparation tasks easier. An electric can opener is a great power tool to help you open cans without putting strain on your fingers, hands and wrists. Tub Bench/Shower Seat A tub bench or shower seat can help you to bathe more comfortably and reduces the chance of a fall in the shower or bathroom. Shower mats can also help you to make your bathtub or shower safer. You can also place a seat near the sink in case you get tired washing your face or shaving. Safety Bars Grab bars will make it easier and safer for you to get in and out of the bath or shower. You can also place these bars near the toilet to help you get on and off. Wherever there are stairs in your home, make sure there are easily accessible railings.
  • 20. Your Guide to Rheumatoid Arthritis Treatments Page 20 Raised Toilet Seat A raised toilet seat will make it easier for you to get on or off the toilet. This device will help prevent falls and keep strain off your joints. Long-Handled Grooming Tools Sponges with long handles can help you to wash your body without reaching and bending too much. A long- handled comb or brush can make combing and hair brushing easier. Electric Grooming Tools An electric toothbrush can help you to keep your teeth and gums healthy without putting pressure on your hands and wrists. An electric razor can also help to make grooming easier. Buttoning Aid/Big Buttons/Front Closures A buttoning aid is designed to help you button and unbutton shirts, skirts, dresses and pants. You should also consider switching to big buttons, buttonhooks or even hook-and-loop closures such as Velcro. Front closures on dresses and bras are easier to take on and off and require less reaching and less strain on arms, hands, wrists and fingers. Zipper Pull A zipper pull makes it easier to grab and pull zippers. This device helps to you to put less stress on hands, wrists and fingers. Clothes Fastener A clothes fastener offers a combination tool that includes a button aid and a zipper pull. This device has a buttonhook on one end for small buttons and a hook on the other end for pulling zippers up and down. Sock Aid/Shoehorn A sock aid can help you pull socks up without bending your legs. A long-handled shoehorn makes it easier to put shoes on without having to bend over. Touch Lamps Lamps with tiny knobs can be challenging for people with rheumatoid arthritis in their hands. Touch lamps are activated simply by touch so you can avoid putting pressure on hands and fingers. Large Knobs or Levers You can switch out small knobs and levers on doors for larger versions. Other things being equal, levers are easier for RA patients to manipulate than doorknobs. Floor switches are an option as well, to operate doors with your feet. Telephone Headset A telephone headset for hands-free use can prevent neck, shoulder, arm, wrist and hand pain. The Arthritis Foundation has recommended an ergonomic handset design with large, easy-to-operate buttons made by a company called Clarify. You can visit the Arthritis Foundation website for more information. Ergonomic Keyboard An ergonomic keyboard will keep you from having to bend your wrists as you type. Most of the design options for these types of keyboards are constructed in a V shape and allow the right and left hands to type at an angle that is more natural. Adjustable Chair An adjustable ergonomic chair will support your lower back and minimize stress on your joints by promoting a comfortable sitting position and a neutral posture as you work. When shopping for the best ergonomic chair, you should look for one that best fits your body. Keep in mind that not every chair with the label “ergonomic” has all the adjustment features to truly be ergonomic. The things you should look at are seat height, seat width and depth, lumbar support, the backrest and the material of the chair.
  • 21. Your Guide to Rheumatoid Arthritis Treatments Page 21 Wide Key Holder Turning a small key can be difficult for people with arthritis in their hands and fingers. You can purchase an inexpensive wide key holder that can make it easier to start your car or open car doors. If you are looking to purchase a new vehicle, consider one with keyless entry and a keyless starter. Seatbelt Extender A seatbelt extender attaches to your existing automobile seatbelt. This device will make grasping, pulling and buckling your seatbelt easier and puts less strain on your arms, wrists, hands and fingers. Wide-Angle Mirrors Wide-angle mirrors are available for people who have arthritis neck pain and stiffness. Installing a panoramic mirror or a wide-angle mirror in your vehicle will keep you from straining your neck.
  • 22. Your Guide to Rheumatoid Arthritis Treatments Page 22 Surgical Options Surgical options for rheumatoid arthritis can help patients with severe pain find relief and can improve function of severely damaged joints that are not responding to medicine and physical therapy. Spinal Instrumentation for Cervical RA Spinal instrumentation is used to treat spine deformities and instabilities, prevent disability and provide permanent stability to the spine. The surgery makes use of rods, bars, wires and screws specially designed for this type of medical procedure. These tools hold the spine straight during a fusion procedure. Fusion is an adhesive process that joins together the bony spinal components. RA patients who benefit the most form a cervical procedure are those living with uncontrollable pain and neurologic dysfunction, myelopathy (any neurological deficit of the spine) with spine instability, and severe weakness that results in functional disability. Spinal Fusion for Cervical RA In a spinal fusion, the spine is stabilized over time. The surgeon uses a bone graft, which usually comes from the patient’s own body but may instead be a donated bone graft. A biological substance which stimulates bone growth, is another option. Fusion will stop the movement between vertebrae to provide long-term stability. RA patients who benefit the most from a cervical procedure are those living with uncontrollable pain and neurologic dysfunction, myelopathy (any neurological deficit of the spine) with spine instability, and severe weakness that results in functional disability. Arthroplasty In patients with rheumatoid arthritis, arthroplasty is done to restore function to a joint or correct a deformity. Bones in your joints can either be reshaped or replaced with metal, plastic or ceramic parts. Recovery from arthroplasty may require a 2- to 14-day hospital stay and, depending on which joint is affected, rehabilitation may take weeks or months. Arthroplasty is considered if RA symptoms and pain are no longer controlled with medicine, therapy or exercise; if patients are no longer able to perform daily activities; or if the narrowing of the joint space or wearing of the bone and cartilage is causing severe pain and/or reduced range of motion. The risks of this procedure include general surgical risks, such as anesthetic use, infections in the artificial joints, development of blood clots and loosening of the joint. Arthroscopy Arthroscopy is a joint surgical procedure where a thin tube with a light source, called an arthoscope, is inserted into the joint though a small incision in the skin, allowing the surgeon to see the joints inside without making a larger opening. Other instruments are then inserted to work on the joint. This procedure does not cure RA or halt the disease but it will help to improve function and alleviate pain. Arthroscopy does not require an overnight hospital stay, and the joint can be used within a few days. This procedure treats large joints and includes cleaning and removing debris from the joint, removing free-floating particles, smoothing out rough surfaces of the joints, and removal of inflamed tissue. General surgical risks are possible, including infection and bleeding within the joint. Carpal Tunnel Release Carpal tunnel syndrome is a common nerve disorder. The carpal tunnel is located at the wrist on the palm side of the hand just below the skin surface. There are eight small wrist bones that form the three sides of the tunnel. The part of the tunnel just below the skin surface consists of soft tissues and the transverse carpal ligament. When the median nerve in the wrist is compressed because of swollen tissues, nerve impulses become blocked. As a result, people may experience mild and occasional numbness, hand weakness, loss of feeling and loss of hand function. People with rheumatoid arthritis can develop nerve compression including inflammation of the structures in the tunnel, including the tendons. Carpal tunnel release involves cutting the transverse carpal ligament and releasing the median nerve. The size and shape of the incision may be different for each patient. After surgery, the hand is wrapped and stiches are removed 10 to 14 days later. The pain and numbness may go
  • 23. Your Guide to Rheumatoid Arthritis Treatments Page 23 away right after surgery or it may take several months to resolve. It is recommend that patients avoid heavy use of the hand for up to three months. Synovectomy Synovectomy surgery removes inflamed joint tissue that is causing severe pain or limiting a patient’s ability to function. Right after surgery, a physical therapist will teach the patient how and when to move the joint. Recovery will depend on the nature of the procedure and the location of the incisions.
  • 24. Your Guide to Rheumatoid Arthritis Treatments Page 24 Talking about RA Treatments with Your Doctor Better teamwork leads to better treatment results! Here are three articles thatcan help you improve communication and collaboration with your RA doctor.
  • 25. Your Guide to Rheumatoid Arthritis Treatments Page 25 Preparing for Your Doctor Appointment: Have Three Main Questions Get the most out of your limited time with the doctor Gary McClain Two just people left their doctor’s appointment feeling pretty frustrated. Why? Because they didn’t get answers to their questions. Dave had thought a lot about what he wanted to ask his doctor and had come prepared with a list of questions. About a dozen. He was planning to go through them with his doctor, one by one. Lisa had also done a lot of thinking about her appointment. While she didn’t actually make a list, she knew she would remember them. Dave and Lisa didn’t get their question answered for two different reasons. But for the same reason. Dave had said to his doctor: “I have a list of questions to go over with you. Can you go through it now?” Dave’s doctor, who has always been willing to share information, had smiled as he looked through the list, and then said: “There are a lot of questions on this list, Dave. Some of them are too early in your treatment for me to have answers to. Others you can find out on the Internet. But I see a couple I can answer today.” And while Dave’s doctor had provided the answers to these questions, Dave felt like he hadn’t been given the information he thought he needed and deserved. Lisa’s doctor started the appointment by asking her some questions. She was considering making changes to Lisa’s medication regimen, and wanted to review Lisa’s current progress before she made her decision. This caught Lisa off guard. As a result, not only did she forget her questions, but she forgot she had questions in the first place. Get the Answers You Need What’s next for Dave and Lisa? Chances are, another appointment to get the answers that they didn’t get this time. So how could this situation have been avoided? After all, while Lisa didn’t have her questions written down, Dave had taken the time to make a list. Yet they both walked out with unanswered questions. The solution here lies somewhere in the middle. Not remembering to ask your questions basically guarantees that you won’t get answers. On the other hand, bringing a long, overwhelming list of questions pretty much guarantees the same thing. But how about coming to the appointment with a reasonable list of questions, based on what you most need to know? And that your doctor can answer within the time that you have together? Maybe three questions? Sound like a plan? Here’s how to get started: Prep Your Attitude Keep realistic expectations. Physicians are limited by their organizations and/or managed care in terms of how much time they can spend with each patient. As a result, they usually don’t have time to pore through long lists of questions. So both patients and physicians each have a responsibility to make the best use of that time. Time is money. That’s the system. Don’t view your doctor as your only source of information. In the not-too-distant past, physicians rolled their eyes in annoyance when patients started to talk about what they had learned in their own research. Now, most doctors expect their patients to take responsibility for keeping themselves informed.
  • 26. Your Guide to Rheumatoid Arthritis Treatments Page 26 Give yourself permission to participate actively in your healthcare. Sometimes patients feel hesitant about asking their doctor questions. They may be concerned that their doctor might think they doubt his/her competence. Or that they will be viewed as “high maintenance.” But doctors appreciate when patients take an active role in their healthcare, and that includes asking questions. Prep Your List Do some brainstorming with yourself. To start the process of coming up with the best questions to ask your doctor, keep an ongoing list between appointments. Anything that comes to mind, jot it down. As your appointment gets closer, take some time to sit down and add any other question that pops into your mind. Don’t hold back. The idea here is to have a big list that you can then narrow down to a few key questions. Do some of your own research. When you brainstorm on questions to ask your doctor, you may come up with a few that you haven’t thought about before. This might be a time to jump on the web and go to some trustworthy sites to update your research. You may find some of your own answers, or you may come up with some better questions based on what you learn. It’s never a bad idea to keep your knowledge up to date. Narrow your list down to what you need to know now. After you have done your research, go back through your list and decide what questions you most need answers to. (Our friend Dave could have benefitted from this exercise.) Not sure how to make this decision? Here are some areas of questioning to consider: • RA symptoms you aren’t sure about or need to be on the watch for • Anything else you should be doing to take care of yourself • How your doctor feels the RA treatment is working and any anticipated changes for the future • Any testing that might be needed in the future • Anything you learned in your RA research that you want your doctor’s opinion on Ideally, limit your list to three questions. These should be the questions you are most concerned about, or you feel are the most urgent. Keep in mind that three questions will not be sufficient in every situation. For example, if you are newly diagnosed with RA, or are making a major medication change, or are experiencing unusual symptoms, you will most likely need to ask your doctor more than three questions. Also, some physicians are better communicators than others. If your doctor tends to be more reserved, then you may routinely have to do more digging to get the information you need. If your doctor is a talker, he/she may anticipate your questions before you even ask. Record your questions. Write/type them on something you can easily access and won’t leave behind. Your smartphone or some other electronic media. A notecard. A piece of paper. And then make sure you take this with you when you are at your doctor’s office. You may have to tie a string around your finger to remind yourself to pull out your questions. Whatever it takes. You’ve only got one chance here, unless you want to make another appointment or get your doctor’s attention by phone or email. Get Down to Business with your Doctor Start by listening. It’s human nature to be so concerned about what you want to say next that you don’t hear what the other person is saying. Remind yourself to begin the appointment in listening mode. Your doctor is most likely seeing one patient after the other, so you may benefit by not breaking his/her train of thought. And, after having reviewed your record, your doctor probably has an initial agenda for the appointment, e.g. to ask you some questions, to tell you something, or to examine you. It might help to have your questions in front of you so you don’t have to worry about forgetting them. Your doctor may answer some of your questions before you even need to ask them. Choose the right time to bring up your questions. You may want to ask a question or two at appropriate times during the appointment. Or you may want to save your questions until the end. Use your judgment. You know your doctor, and you know what’s comfortable for you. Assert yourself. For example, your doctor may be talking about one of your medications and one of your questions may pertain to that medication. If so, wait until he/she pauses, and jump in, or hold a finger up to signal that you need to speak, and introduce your question with something like: “I actually have a question about __________.” And ask your question. Or it may be more appropriate to wait until the end of the appointment, and then say, “I brought in a couple of quick questions that I need to ask you before we finish.” And ask your questions.
  • 27. Your Guide to Rheumatoid Arthritis Treatments Page 27 Don’t take no for an answer … or at least try not to. Physicians don’t always seem very receptive to being asked questions. They may be in a rush. They may not understand the importance of the question to you. They may feel they have already answered that question (and maybe they did, but you didn’t get it the first time, or they have you confused with someone else). Gently but firmly let your doctor know that you expect an answer. Ways to get your point across include: “This has been on my mind and I really need to know your thoughts.” “You may have told me this before but I didn’t understand your answer.” “I need just a couple more minutes of your time before we finish.” And if no is the usual answer, then maybe it’s time to consider talking to another doctor. We live in age of empowered medical consumers. Doctors have learned to appreciate, and even welcome, questions from their patients. That’s how doctors and patients communicate. If your doctor doesn’t seem willing to answer your questions, or if you don’t feel like you are getting complete answers, then it may be time to obtain a second opinion. Or to find a physician who considers you to be a member of the team. Dave and Lisa were better prepared for their next doctor’s appointment. Lisa took the time to write a couple of questions on her smartphone. Dave pared his list down to three questions, which he wrote on a notecard. As a result they left the appointment with answers instead of questions. And probably avoided having to schedule another appointment to fill in the gaps. Your time is important. Your doctor’s time is important. Get prepared for your appointments by knowing what you already know, and being ready to ask what you need to know.
  • 28. Your Guide to Rheumatoid Arthritis Treatments Page 28 Working with Your Doctor to Find the Right RA Treatments Tips for communicating with your doctor Gary McClainMike has recently been diagnosed with a chronic medical condition. His physician explained to him that, in addition to medication, Mike will need to make extensive lifestyle changes, including modifying his activity level and adopting a new diet. Looking back on that conversation, Mike remembers that an alarm when off in his mind when his doctor said the words: “This should be easy.” Later that day, while reviewing the pamphlet about his condition he had been given, Mike agreed that, yes, the plan should indeed be easy. And probably was easy. For someone. But not for him. "Easy? Not for Me." Have you had the same experience as Mike? Physicians have the best of intentions when they recommend lifestyle changes to individuals facing a medical diagnosis. But their suggestions might not be attainable for you. Maybe it's an exercise routine that doesn’t fit with the way you want to exercise, or that doesn’t fit with your budget. A diet that doesn’t include any of the foods you are used to eating, or introduces foods you already know you don’t like or that will be difficult or expensive for you to prepare. Changes in your daily routine that, unless you are living alone, just aren’t going to be realistic for the others in your household. Or maybe, now that you’ve reviewed the list, the recommendations just aren’t all that clear ("I’m supposed to be eating what?"). As a result, like Mike, you may be reviewing your rheumatoid arthritis doctor’s recommendations and, instead of nodding in agreement like you did in his or her office, now you’re shaking your head in disbelief and asking yourself, “What did I agree to?” On one hand, you know that change is necessary to manage your RA and take the best possible care of yourself. On the other hand, you may not see how you can accomplish this with the recommendations your doctor gave you. Treatment Plans: A Collaborative Effort Your RA treatment plan should be a collaborative effort between you and your physician. Here’s how to get the collaboration started: Don’t assume that there is only one way to live with RA. If you view the plan you have been given as the only approach to maintaining your self-care, then you may feel like giving up before you get started. Instead, think of these recommendations as getting the conversation started — an ideal approach, but not the only approach. Your self-care plan is a work in progress, and will most likely evolve over time. And, don’t assume that your doctor’s attitude is “my way or the highway.” Physicians are busy, and they don’t always have time to tailor a lifestyle management plan for each individual patient. Partnering with your doctor means asking questions and having discussions about your RA treatment and self-care, so that as your doctor better understands your wants and needs, the plan can become more tailored to what will best work for you. Ask yourself what is making you uncomfortable. Reading through a list of RA treatment guidelines can be scary, especially the first time you go through them. To help get past the initial shock, go through them one by one. And for each recommendation, ask yourself: What would be involved in following this recommendation? What’s hard about it? How would it benefit me? Is it possible that I could make it work? This exercise may not give you all the answers, but at least you will come out of it with a better sense of which ones are immediately doable, and which ones present challenges. Take an honest look at your own willingness to make changes. If there is one thing human beings often avoid, it is change. We like our familiar routines and habits — even if some of them aren’t so good for us. So as
  • 29. Your Guide to Rheumatoid Arthritis Treatments Page 29 you evaluate your doctor’s recommendations, ask yourself: “What’s bothering me here? The plan itself, or the changes that I would have to make in my familiar routine?” Do some of your own research. The Internet is rich with medical information, including recommendations for rheumatoid arthritis self-care. Do some research on alternatives to your physician’s recommended plan. See what you can come up with that might meet the same goals. Print them to take to your next appointment. Ask to meet again and discuss the plan. After you’ve thought about the recommendations your doctor has made, done your research on the alternatives and even tried to follow the ones that you could follow, schedule another appointment. And come prepared. Keep in mind your doctor most likely doesn’t have a lot of time. So be prepared to briefly present your concerns, your key questions, and your proposed solutions. Start the conversation on a positive note. Physicians are often confronted by patients who are argumentative, refuse to be compliant or are hoping if they whine long enough and loudly enough, they can talk their doctors out of having to make any changes in their comfortable — but damaging — routines. Who knows, the patient before you may have fit into one of those categories. Be clear about your goals, beginning with the overall goal of wanting to team up with your doctor to support him or her in treating your RA. Be ready to negotiate. Your RA self-care plan is a work in progress. Ask your doctor what aspects of the plan can be swapped out. For example, alternative ways to get exercise, or a diet that you can more easily follow. It may be possible to gradually phase in some of the changes that are most disruptive to your current routine. Let your doctor know you’re willing to be flexible, but you also need him or her to be flexible as well. Get the Treatment Plan That Works for You Here’s what Mike did: He went through his doctor’s list of recommendations and picked out the ones that he either knew weren’t realistic or that he didn’t understand. He went to a trusted website and found alternatives that would be a better fit. He made a list of questions. He provided his doctor with a plan that he could commit to. They ironed out a new plan. Remember it’s about teamwork, not about being right. Optimal lifestyle management doesn’t have to be a power struggle between you and your doctor. In fact, most physicians welcome the opportunity to collaborate with their patients on the best way for them to stay compliant on the treatment journey, and recognize that patients have preferences and limitations that will require some fine-tuning along the way. The success of your RA treatment plan is your hands. Team up with your doctor and create a self-care plan that you can — and will — follow.
  • 30. Your Guide to Rheumatoid Arthritis Treatments Page 30 What to Do when Your Doctor Won’t Tell You What to Do Having several RA treatment options may seem scary, but it can also be an opportunity. Gary McClain After Jenn’s doctor talked to her about her diagnosis, he briefly went through the treatment options with her, one by one. After he was finished, he said, “Go home and think about what direction you want to go in, and let me know when we meet next week.” Jenn left his office with a handful of pamphlets and an uneasy feeling. She paused in the waiting room to glance through the materials she has been provided. One of them discussed patients and doctors working together as a team and “shared decision making.” That evening, Jenn told her husband, Tom, about the conversation she had with her physician. “I’m not sure how empowered I want to be,” she said. “Sure, I want to be involved in the decision. But I also want to know what direction my doctor recommends. Isn’t he the expert?” Have you ever felt like Jenn? As a rheumatoid arthritis patient, you have the right to make decisions about your treatment, including where you are treated, how you are treated, and even if you are going to receive any treatment at all. That’s what patient empowerment is all about. However, hearing about new treatment options, especially when they are first presented, can be scary. Being told that the decision is yours can be scarier. If you have been in this position, you may have had a reaction similar to Jenn’s. On one hand, you may indeed want to be involved in the decision. After all, it’s your body and the treatment route you choose will impact many different aspects of your life. On the other hand, you may be hoping that your doctor will give you a strong recommendation, based on his/her knowledge and experience. And let’s be honest — you may be feeling like dealing with your RA is already so overwhelming, you would rather not have to think about the treatment options. Doctors are learning how their role is changing in the new world of patient empowerment, just as patients are. They are seeking to follow the best practice guidelines for communicating with patients, including sharing decisions. Consequently, patients sometimes feel that their doctors are erring on the side of sharing the decision to the point that they do not provide the recommendation the patients want and need. So what can you do when your doctor won’t tell you what to do? It starts with communication! Here are some ideas to get the process moving: First, don’t turn uncertainty into a catastrophe. When you’re feeling overwhelmed, it’s only human to get caught up in the emotions of the moment. While being presented with treatment options can be scary, especially when you are newly diagnosed, being provided with options doesn’t have to mean the decision is being dropped in your lap. So take a moment to get some perspective. Take a deep breath. Tell yourself that options are a good thing because options mean there is more than one way to treat your rheumatoid arthritis. Get clarification on your physician’s intention. Sometimes when we are feeling strong and uncomfortable emotions, like fear, it’s easy to misunderstand what the other person is saying. It’s just human nature. But misunderstanding can also lead to assumptions. So take a moment and ask for clarification: “Doctor, it sounded like this is my decision alone. Is that what you meant?” Be honest with your doctor about your discomfort. Let him or her know that you are feeling unprepared to evaluate the options that you have been provided, or even wondering why you should have to. And that while you appreciate being part of the decision-making process, you also need more guidance in terms of a
  • 31. Your Guide to Rheumatoid Arthritis Treatments Page 31 recommendation. “I need for you to know that I am uncomfortable with being asked to make this decision. I feel left out on a limb.” Get an understanding of his or her position. Your doctor may have specific reasons for leaving the decision up to you. He or she may want you to feel like you are not being told what to do, but that you also have a voice. Patients who buy in to their RA treatment path are likely to be more compliant. Clinic or hospital guidelines may also be a factor. So just ask: “Can you explain what your role is and what my role is in this decision?’ Ask your doctor to take you through the options. Focus on what’s involved in each treatment, what you can expect, what you need to be concerned about. Ask questions. If your doctor doesn’t have time, ask if someone in his or her office, another doctor, a nurse or a physician’s assistant, can help, and if he or she can recommend other resources. “What is the best way for me to get a clear picture of my options?” Get a sense of how urgent the decision is. If you aren’t ready to make a decision based on the options you have been provided, ask your doctor how urgent it is that you decide right away, or if you have time to think about the options. Your doctor should be able to provide some perspective regarding urgency, as well as any short-term treatment you can be administered as you are making your decision. “When do I need to get going on treatment? How long can I safely delay it while evaluate my options?” Go home and do some of your own research. The Web is filled with information about research rheumatoid arthritis and its treatment. So do some searching on reputable sites. A couple of good places to get objective treatment information are WebMD.com and MayoClinic.com. You might also want to review discussions regarding rheumatoid arthritis and its treatment on our RheumatoidConnect.com website, or post a discussion of your own. Consider getting a second opinion. If you are feeling especially conflicted about the options that your physician has presented to you, you might also want to get a second opinion from a specialist in rheumatoid arthritis. This will provide you with additional input into the decision process. If you are concerned that your doctor’s hesitance may be related to his/her discomfort or lack of experience in treating your condition, then a second — or even a third — opinion is recommended. You may also want to consider seeking further treatment from a physician who has more demonstrated expertise. Have another discussion. Summarize what you have learned and present it to your doctor at a subsequent appointment. Focus on anything you learned about the treatment options that the two of you haven’t already discussed. Bring a list of questions. Try the “What would you do?” question. At this point, it might help to ask your doctor to talk about what would be chosen if he or she, or a loved one, were in your situation. This is not intended to be a trick question. It might help your doctor to talk more directly about a recommended course of action, or at least give you further insight into how to make your decision. “If you were in my position, what factors would you consider most important as you evaluated the treatment options?” And ask yourself: Can this be an opportunity? Wanting your doctor to recommend a treatment when you are first diagnosed with RA, as well as further along in the treatment journey, can be a double-edged sword. Sure, it can be a relief to be told what to do, and not have to do a lot of thinking about treatment options. However, not evaluating your options before you commit to a treatment path can lead to feelings of uncertainty in the future, if not regret. Jenn and her husband did some research on the options her doctor had presented to her, including the pros, the cons, and the benefits. On her next visit with her doctor, she and her doctor had a talk about what she had learned. Because she was informed, Jenn felt more confident. She asked questions, and her doctor gave her honest answers, including the risks. Jenn left his office feeling like they had worked together to create a treatment plan that she felt comfortable with. Think teamwork. And that means a meeting of the minds: you and your doctor. Begin your RA treatment journey with confidence that you have thoroughly evaluated the options and that you understand your doctor’s perspective. Talk. Ask questions. Keep talking. Get prepared for the road ahead.
  • 32. Your Guide to Rheumatoid Arthritis Treatments Page 32 Find more information and caring support to help you live with rheumatoid arthritis in our FREE online community rheumatoid connect This guide is for informational purposes only. It is not intended to diagnose, treat, cure or prevent any health condition, or to replace the advice and care of your doctor or other healthcare professional. © Alliance Health Networks, LLC