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Unlike osteoarthritis, which results from wear and tear on your joints, rheumatoid arthritis is an inflammatory condition. The exact cause of rheumatoid arthritis is unknown, but it’s believed to be the body’s immune system attacking the tissue that lines your joints (synovium).

Rheumatoid arthritis is two to three times more common in women than in men and generally strikes between the ages of 20 and 50. But rheumatoid arthritis can also affect young children and adults older than age 50.

There’s no cure for rheumatoid arthritis. But with proper treatment, a strategy for joint protection and changes in lifestyle, you can live a long, productive life with this condition.
Signs and symptoms

The signs and symptoms of rheumatoid arthritis may come and go over time. They include:

* Pain and swelling in your joints, especially in the smaller joints of your hands and feet
* Generalized aching or stiffness of the joints and muscles, especially after sleep or after periods of rest
* Loss of motion of the affected joints
* Loss of strength in muscles attached to the affected joints
* Fatigue, which can be severe during a flare-up
* Low-grade fever
* Deformity of your joints over time
* General sense of not feeling well (malaise)

Rheumatoid arthritis usually causes problems in several joints at the same time. Early in rheumatoid arthritis, the joints in your wrists, hands, feet and knees are the ones most often affected. As the disease progresses, your shoulders, elbows, hips, jaw and neck can become involved. It generally affects both sides of your body at the same time. The knuckles of both hands are one example.

Small lumps, called rheumatoid nodules, may form under your skin at pressure points and can occur at your elbows, hands, feet and Achilles tendons. Rheumatoid nodules may also occur elsewhere, including the back of your scalp, over your knee or even in your lungs. These nodules can range in size — from as small as a pea to as large as a walnut. Usually these lumps aren’t painful.

In contrast to osteoarthritis, which affects only your bones and joints, rheumatoid arthritis can cause inflammation of tear glands, salivary glands, the linings of your heart and lungs, your lungs themselves and, in rare cases, your blood vessels.

Although rheumatoid arthritis is often a chronic disease, it tends to vary in severity and may even come and go. Periods of increased disease activity — called flare-ups or flares — alternate with periods of relative remission, during which the swelling, pain, difficulty sleeping, and weakness fade or disappear.

Swelling or deformity may limit the flexibility of your joints. But even if you have a severe form of rheumatoid arthritis, you’ll probably retain flexibility in many joints.
Illustration comparing rheumatoid arthritis and osteoarthritis

Osteoarthritis, the most common form of arthritis, involves the wearing away of the cartilage that caps the bones in your joints. With rheumatoid arthritis, the synovial membrane that protects and lubricates joints becomes inflamed, causing pain and swelling. Joint erosion may follow.
More On This Topic

* Osteoarthritis

Causes

As with other forms of arthritis, rheumatoid arthritis involves inflammation of the joints. A membrane called the synovium lines each of your movable joints. When you have rheumatoid arthritis, white blood cells — whose usual job is to attack unwanted invaders, such as bacteria and viruses — move from your bloodstream into your synovium. Here, these blood cells appear to play an important role in causing the synovial membrane to become inflamed (synovitis).

This inflammation results in the release of proteins that, over months or years, cause thickening of the synovium. These proteins can also damage cartilage, bone, tendons and ligaments. Gradually, the joint loses its shape and alignment. Eventually, it may be destroyed.

Some researchers suspect that rheumatoid arthritis is triggered by an infection — possibly a virus or bacterium — in people with an inherited susceptibility. Although the disease itself is not inherited, certain genes that create an increased susceptibility are. People who have inherited these genes won’t necessarily develop rheumatoid arthritis. But they may have more of a tendency to do so than others. The severity of their disease may also depend on the genes inherited. Some researchers also believe that hormones may be involved in the development of rheumatoid arthritis.
Illustration showing inflammation of rheumatoid arthritis

Rheumatoid arthritis typically strikes joints, causing pain, swelling and deformity. As your synovial membranes become inflamed and thickened, fluid builds up and joints erode and degrade.
Risk factors

The exact causes of rheumatoid arthritis are unclear, but these factors may increase your risk:

* Getting older, because incidence of rheumatoid arthritis increases with age. However, incidence begins to decline in women over the age of 80.
* Being female.
* Being exposed to an infection, possibly a virus or bacterium, that may trigger rheumatoid arthritis in those with an inherited susceptibility.
* Inheriting specific genes that may make you more susceptible to rheumatoid arthritis.
* Smoking cigarettes over a long period of time.

When to seek medical advice

See your doctor if you have persistent discomfort and swelling in multiple joints on both sides of your body. Your doctor can work with you to develop a pain management and treatment plan. Also seek medical advice if you experience side effects from your arthritis medications. Side effects may include nausea, abdominal discomfort, black or tarry stools, changes in bowel habits, constipation and drowsiness.
Screening and diagnosis

If you have signs and symptoms of rheumatoid arthritis, your doctor will likely conduct a physical examination and request laboratory tests to determine if you have this form of arthritis. These tests may include:

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Blood tests. A blood test that measures your erythrocyte sedimentation rate (ESR or sed rate) can indicate the presence of an inflammatory process in your body. People with rheumatoid arthritis tend to have elevated ESRs. The ESRs in those with osteoarthritis tend to be normal.

Another blood test looks for an antibody called rheumatoid factor. Most people with rheumatoid arthritis eventually have this abnormal antibody, although it may be absent early in the disease. It’s also possible to have the rheumatoid factor in your blood and not have rheumatoid arthritis.
* Imaging. Doctors may take X-rays of your joints to differentiate between osteoarthritis and rheumatoid arthritis. A sequence of X-rays obtained over time can show the progression of arthritis.

Complications

Rheumatoid arthritis causes stiffness and pain and may also cause fatigue. It can lead to difficulty with everyday tasks, such as turning a doorknob or holding a pen. Dealing with the pain and the unpredictability of rheumatoid arthritis can also cause symptoms of depression.

Rheumatoid arthritis may also increase your risk of developing osteoporosis, especially if you take corticosteroids. Some researchers believe that rheumatoid arthritis can increase your risk of heart disease. This may be because the inflammation that rheumatoid arthritis causes can also affect your arteries and heart muscle tissue.

In the past, people with rheumatoid arthritis may have ended up confined to a wheelchair because damage to joints made it difficult or impossible to walk. That’s not as likely today because of better treatments and self-care methods.
More On This Topic

* Osteoporosis

Treatment

Treatments for arthritis have improved in recent years. Most treatments involve medications. But in some cases, surgical procedures may be necessary.

Medications
Medications for rheumatoid arthritis can relieve its symptoms and slow or halt its progression. They include:

* Nonsteroidal anti-inflammatory drugs (NSAIDs). This group of medications, which includes aspirin, helps relieve both pain and inflammation if you take the drugs regularly. NSAIDs that are available over-the-counter include aspirin, ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve). These are available at higher dosages, and other NSAIDs are available by prescription — such as ketoprofen, naproxen (Anaprox, Naprosyn), tolmetin (Tolectin), diclofenac (Voltaren), nabumetone (Relafen) and indomethacin (Indocin). Taking NSAIDs can lead to side effects such as indigestion and stomach bleeding. Other potential side effects may include damage to the liver and kidneys, ringing in your ears (tinnitus), fluid retention and high blood pressure. NSAIDs, except aspirin, may also increase your risk of cardiovascular events such as heart attack or stroke.
* COX-2 inhibitors. This class of NSAIDs may be less damaging to your stomach. Like other NSAIDs, COX-2 inhibitors — such as celecoxib (Celebrex) — suppress an enzyme called cyclooxygenase (COX) that’s active in joint inflammation. Other types of NSAIDs work against two versions of the COX enzyme that are present in your body: COX-1 and COX-2. However, there’s evidence that by suppressing COX-1, NSAIDs may cause stomach and other problems because COX-1 is the enzyme that protects your stomach lining. Unlike other NSAIDs, COX-2 inhibitors suppress only COX-2, the enzyme involved in inflammation. Side effects may include fluid retention and causing or exacerbating high blood pressure. Furthermore, this class of drugs has been linked to an increased risk of heart attack and stroke.
* Corticosteroids. These medications, such as prednisone and methylprednisolone (Medrol), reduce inflammation and pain, and slow joint damage. In the short term, corticosteroids can make you feel dramatically better. But when used for many months or years, they may become less effective and cause serious side effects. Side effects may include easy bruising, thinning of bones, cataracts, weight gain, a round face and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.
* Disease-modifying antirheumatic drugs (DMARDs). Physicians prescribe DMARDs to limit the amount of joint damage that occurs in rheumatoid arthritis. Taking these drugs at early stages in the development of rheumatoid arthritis is especially important in the effort to slow the disease and save the joints and other tissues from permanent damage. Because many of these drugs act slowly — it may take weeks to months before you notice any benefit — DMARDs typically are used with an NSAID or a corticosteroid. While the NSAID or corticosteroid handles your immediate symptoms and limits inflammation, the DMARD goes to work on the disease itself. Some commonly used DMARDs include hydroxychloroquine (Plaquenil), the gold compound auranofin (Ridaura), sulfasalazine (Azulfidine), minocycline (Dynacin, Minocin) and methotrexate (Rheumatrex). Other forms of DMARDs include immunosuppressants and tumor necrosis factor (TNF) blockers.
* Immunosuppressants. These medications act to tame your immune system, which is out of control in rheumatoid arthritis. In addition, some of these drugs attack and eliminate cells that are associated with the disease. Some of the commonly used immunosuppressants include leflunomide (Arava), azathioprine (Imuran), cyclosporine (Neoral, Sandimmune) and cyclophosphamide (Cytoxan). These medications can have potentially serious side effects such as increased susceptibility to infection.
* TNF blockers. These are a class of DMARDs known as biologic response modifiers. TNF is a cytokine, or cell protein, that acts as an inflammatory agent in rheumatoid arthritis. TNF blockers, or anti-TNF medications, target or block this cytokine and can help reduce pain, morning stiffness and tender or swollen joints — usually within one or two weeks after treatment begins. There is evidence that TNF blockers may halt progression of disease. These medications often are taken with methotrexate. TNF blockers approved for treatment of rheumatoid arthritis are etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira). Potential side effects include injection site irritation (adalimumab and etanercept), worsening congestive heart failure (infliximab), blood disorders, lymphoma, demyelinating diseases, and increased risk of infection. If you have an active infection, don’t take these medications.
* Interleukin-1 receptor antagonist (IL-1Ra). IL-1Ra is another type of biologic response modifier and is a recombinant form of the naturally occurring interleukin-1 receptor antagonist (IL-1Ra). Interleukin-1 (IL-1) is a cell protein that promotes inflammation and occurs in excess amounts in people who have rheumatoid arthritis or other types of inflammatory arthritis. If IL-1 is prevented from binding to its receptor, the inflammatory response decreases. The first IL-1Ra that has been approved by the Food and Drug Administration for use in people with moderate to severe rheumatoid arthritis who haven’t responded adequately to conventional DMARD therapy is anakinra (Kineret). It may be used alone or in combination with methotrexate. Anakinra is given as a daily self-administered injection under the skin. Some potential side effects include injection site reactions, decreased white blood cell counts, headache and an increase in upper respiratory infections. There may be a slightly higher rate of respiratory infections in people who have asthma or chronic obstructive pulmonary disease. If you have an active infection, don’t use anakinra.
* Abatacept (Orencia). Abatacept, a type of costimulation modulator approved in late 2005, reduces the inflammation and joint damage caused by rheumatoid arthritis by inactivating T cells — a type of white blood cell. People who haven’t been helped by TNF blockers might consider abatacept, which is administered monthly through a vein in your arm (intravenously). Side effects may include headache, nausea and mild infections, such as upper respiratory tract infections. Serious infections, such as pneumonia, can occur.
* Rituximab (Rituxan). Rituximab reduces the number of B cells in your body. B cells are involved in inflammation. Though originally approved for use in people with non-Hodgkin’s lymphoma, rituximab was approved for rheumatoid arthritis in early 2006. People who haven’t found relief using TNF blockers might consider using rituximab, which is usually given along with methotrexate. Rituximab is administered as an infusion into a vein in your arm. Side effects include flu-like signs and symptoms, such as fever, chills and nausea. Some people experience extreme reactions to the infusion, such as difficulty breathing and heart problems.
* Antidepressant drugs. Some people with arthritis also experience symptoms of depression. The most common antidepressants used for arthritis pain and nonrestorative sleep are amitriptyline, nortriptyline (Aventyl, Pamelor) and trazodone (Desyrel).

Surgical or other procedures
Although a combination of medication and self-care is the first course of action for rheumatoid arthritis, other methods are available for severe cases:

* Prosorba column. This blood-filtering technique removes certain antibodies that contribute to pain and inflammation in your joints and muscles and is usually performed once a week for 12 weeks as an outpatient procedure. Some of the side effects include fatigue and a brief increase in joint pain and swelling for the first few days after the treatment. The Prosorba column treatment isn’t recommended if you’re taking angiotensin-converting enzyme (ACE) inhibitors or if you have heart problems, high blood pressure or blood-clotting problems.
* Joint replacement surgery. For many people with rheumatoid arthritis, medicines and therapies can’t prevent joint destruction. When joints are severely damaged, joint replacement surgery can often help restore joint function, reduce pain or correct a deformity. You may need to have an entire joint replaced with a metal or plastic prosthesis. Surgery may also involve tightening tendons that are too loose, loosening tendons that are too tight, fusing bones to reduce pain or removing part of a diseased bone to improve mobility. Your doctor may also remove the inflamed joint lining (synovectomy).

More On This Topic

* Steroid use: Balancing the risks and benefits
* Are COX-2 drugs safe for you? An interview with a Mayo Clinic specialist
* Knee replacement: Surgery can relieve pain

Self-care

Treating rheumatoid arthritis typically involves using a combination of medical treatments and self-care strategies. The following self-care procedures are important elements for managing the disease:

*

Exercise regularly. Different types of exercise achieve different goals. Check with your doctor or physical therapist first and then begin a regular exercise program for your specific needs. If you can walk, walking is a good starter exercise. If you can’t walk, try a stationary bicycle with little or no resistance or do hand or arm exercises. A chair exercise program may be helpful. Aquatic exercise is another option, and many health clubs with pools offer such classes.

It’s good to move each joint in its full range of motion every day. As you move, maintain a slow, steady rhythm. Don’t jerk or bounce. Also, remember to breathe. Holding your breath can temporarily deprive your muscles of oxygen and tire them. It’s also important to maintain good posture while you exercise. Avoid exercising tender, injured or severely inflamed joints. If you feel new joint pain, stop. New pain that lasts more than two hours after you exercise probably means you’ve overdone it. If pain persists for more than a few days, call your doctor.
* Control your weight. Excess weight puts added stress on joints in your back, hips, knees and feet — the places where arthritis pain is commonly felt. Excess weight can also make joint surgery more difficult and risky.
* Eat a healthy diet. A healthy diet emphasizing fruit, vegetables and whole grains can help you control your weight and maintain your overall health, allowing you to deal better with your arthritis. However, there’s no special diet that can be used to treat arthritis. It hasn’t been proved that eating any particular food will make your joint pain or inflammation better or worse.
* Apply heat. Heat will help ease your pain, relax tense, painful muscles and increase the regional flow of blood. One of the easiest and most effective ways to apply heat is to take a hot shower or bath for 15 minutes. Other options include using a hot pack, an electric heat pad set on its lowest setting or a radiant heat lamp with a 250-watt reflector heat bulb to warm specific muscles and joints. If your skin has poor sensation or if you have poor circulation, don’t use heat treatment.
* Apply cold for occasional flare-ups. Cold may dull the sensation of pain. Cold also has a numbing effect and decreases muscle spasms. Don’t use cold treatments if you have poor circulation or numbness. Techniques may include using cold packs, soaking the affected joints in cold water and ice massage.
* Practice relaxation techniques. Hypnosis, guided imagery, deep breathing and muscle relaxation can all be used to control pain.
* Take your medications as recommended. By taking medications regularly instead of waiting for pain to build, you will lessen the overall intensity of your discomfort.

Coping skills

The degree to which rheumatoid arthritis affects your daily activities depends in part on how well you cope with the disease. Physical and occupational therapists can help you devise strategies to cope with specific limitations you may experience as the result of weakness or pain. Here are some general suggestions to help you cope:

* Keep a positive attitude. With your doctor, make a plan for managing your arthritis. This will help you feel in charge of your disease. Studies show that people who take control of their treatment and actively manage their arthritis experience less pain and make fewer visits to the doctor.
* Use assistive devices. A painful knee may need a brace for support. You might also want to use a cane to take some of the stress off the joint as you walk. Use the cane in the hand opposite the affected joint. If your hands are affected, various helpful tools and gadgets are available to help you maintain an active lifestyle. Contact your pharmacy or doctor for information on ordering items that may help you the most.
* Know your limits. Rest when you’re tired. Arthritis can make you prone to fatigue and muscle weakness. A rest or short nap that doesn’t interfere with nighttime sleep may help.
* Avoid grasping actions that strain your finger joints. Instead of using a clutch purse, for example, select one with a shoulder strap. Use hot water to loosen a jar lid and pressure from your palm to open it, or use a jar opener. Don’t twist or use your joints forcefully.
* Spread the weight of an object over several joints. For instance, use both hands to lift a heavy pan.
* Take a break. Periodically relax and stretch.
* Maintain good posture. Poor posture causes uneven weight distribution and may strain ligaments and muscles. The easiest way to improve your posture is by walking. Some people find that swimming also helps improve their posture.
* Use your strongest muscles and favor large joints. Don’t push open a heavy glass door. Lean into it. To pick up an object, bend your knees and squat while keeping your back straight.

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Rheumatoid Arthritis (RA), is one of the most debilitating of all 100 or so forms of the disease, causing joints to ache and throb and eventually become deformed. Rheumatoid Arthritis can make simple things like opening a jar or taking a walk excruciating for sufferers.

Unlike osteoarthritis, which is caused by wear and tear on the joints, RA is an inflammatory condition. Its exact cause is unknown, but researchers believe that it is the caused when the body’s immune system attacks the tissue that lines the joints.

Who gets Rheumatoid Arthritis? Women between the ages of 20 and 50 years of age, fall victim to this debilitating disease two to three times more than men. Statistics show that no one is immune from it, however. Even children and the elderly have been diagnosed.

To date, there is no cure for rheumatoid arthritis, but treatments are being used to help sufferers protect joint damage in order to live more productive lives.

The Symptoms:

The signs and symptoms of rheumatoid arthritis may come and go over time, according to Mayo Clinic experts, and may include:

-Pain and swelling of the joints, especially in the hands and feet.

-Generalized aching or feelings of stiffness of the joints and muscles.

-Loss of motion.

-Loss of strength in muscles attached to the affected joints.

-Fatigue, which can be severe during a flare-up.

-Low-grade fever.

-Deformity of the joints.

-General sense of not feeling well.

Rheumatoid arthritis usually causes pain in several joints at the same time. In its early stages, the joints of the wrists, hands, feet and knees are most affected, followed by pain in the shoulders, elbows, hips, jaw and neck as the disease progresses.

Small lumps, called rheumatoid nodules, are also common under the skin of the elbows, hands, feet and Achilles tendons during outbreaks. They can be as small as a pea, or as large as a walnut, and generally aren’t painful.

Considered a chronic disease, rheumatoid arthritis features severe flare-ups featuring severe swelling, pain and weakness, followed by days, weeks or months of normalcy.

What Causes Rheumatoid Arthritis?

Although a specific cause is not known, some researchers suspect that rheumatoid arthritis is triggered by a virus or bacterium infection in some people. Hormones are also being researched as a development factor.

Risk Factors:

With no known cause, it’s hard to know for sure who will get RA, but some risk factors may include:

-Age. The risk of getting rheumatoid arthritis seems to increase with age, until age 80, where it suddenly decreases.

-Sex. Females are more likely to contract RA then men.

-Viral Exposure. Being exposed to an infection, possibly a virus or bacterium that may trigger rheumatoid arthritis.

-Genes. Inheriting specific genes may make some people more susceptible.

When To See A Doctor:

Persistent discomfort and swelling in multiple joints on both sides of the body may be a sign that it’s time to seek medical treatment. Your doctor can work with you to develop a pain management and treatment plan for your rheumatoid arthritis.

Reactive arthritis, referred to also as Reiter’s syndrome although this name is lapsing, is an arthritic condition related to infections such as Salmonella in the gastro-intestinal system and Chlamydia in the genito-urinary system. Reactive arthritis has a strong link with a human leucocyte antigen known as HLAB27 which is well known to be related to another arthritic condition called ankylosing spondylitis. This link puts both these conditions into a group classified as seronegative spondyloarthropathies. The arthritis usually occurs with infections such as urethritis or conjunctivitis but can occur also without them.

Once a person has an infection of the genitourinary system or the gastrointestinal system then the arthritis can come on around two to four weeks later, with a respiratory infection with Chlamydia also a possible causative factor. There may be no apparent preceding infection in around ten percent of patients. Many anatomical structures can be affected by the inflammation, including the mucous membrane, the eyes, the joints, the spine, the ligament-bone and tendon-bone junctions and the gastro-intestinal system. Patients with HLAB27 are fifty times more likely to develop reactive arthritis than those without it.

The arthritis can last longer and be more severe if the person has a strong history in the family or they are HLAB27 positive. Of those having an infection of the gut between one and four percent may develop a reactive arthritis, but this varies greatly even with the same biological agent responsible. It is not understood how the host body and the antigen react to cause the arthritic condition and the samples of joint fluids do not exhibit the infectious organisms. Antibodies have been isolated in the joints and it is possible an inflammatory condition mediated by the immune system is implicated in the development of this condition.

The self limiting nature of this kind of arthritis means that the condition settles down over a 3-12 month period whether the severity of the symptoms is greater or lower. The chance of the condition recurring is significant, with a higher incidence if a patient is positive for HLAB27, and a new episode is potentially triggered by infections or other agents. The arthritic process can be mild or can cause destructive and disabling changes in the joints in a small group of fifteen percent of sufferers. The usual age range for onset of this condition is between 20 and 40 years, gut infections giving a 50:50 male to female ratio and urogenital infections giving a 9 to 1 ratio.

Reactive arthritis usually comes on quickly as an acute presentation with patients presenting with tiredness, high temperature and a feeling of being unwell. Lower extremity arthritis of a few joints, arranged non symmetrically (unlike rheumatoid arthritis) is common. Heel pain from inflammation of the insertion of the Achilles tendon into the heel bone is common and low back pain is present in half of the patients. Lower limb joints involved in weight bearing are typically affected, with more severely affected patients exhibiting hands and feet symptoms. Back pain symptoms are commonly reported but examination shows few findings apart from a reduction in lumbar flexion.

Reactive arthritis treatment is determined by how difficult the arthritic symptoms are for the patient, with a mainstay of treatment being non-steroidal anti-inflammatory drugs which are taken regularly to keep up a level of anti-inflammatory action. The maintenance and restoration of muscle power, control of pain and protection of joint ranges of motion can be effected by referral to physiotherapy. Intra-articular injections with corticosteroids are a useful treatment and can give long term relief of an inflamed joint. If anti-inflammatory drugs are not effective then systemic corticosteroids can be given and while antibiotic drugs may be prescribed at times they do not affect the disease course.

Chronic and ongoing joint arthritis and poorly limited inflammatory reactions may mean a rheumatologist will prescribe drugs known as DMARDS or disease modifying anti-rheumatoid drugs. These have been tested on conditions such as rheumatoid arthritis or ankylosing spondylitis but their usefulness in reactive arthritis has not been shown. Typical examples are methotrexate and sulphasalazine. The newer biological drug treatments have been effective in some conditions but have not yet been shown to be useful in this condition.

Psoriatic skin disease is a relatively common condition for which the treatments are somewhat unpleasant and not entirely effective. It is known that an arthritic syndrome is associated with this skin disorder but even then the diagnosis may be missed when patients with psoriasis present with joint signs. There are many effects from psoriatic arthritis on the joints and the arthritic damage can lead to disability and compromised quality of life. In the United Kingdom the prevalence of psoriasis itself is around 2%, with 14% of this number exhibiting some signs of involvement in their joints.

Even before the skin condition becomes obvious there can be signs of joint involvement in around fifteen percent of sufferers and even without joint involvement soft tissues can show changes which are typical in the arthritis. Rheumatoid arthritis sufferers typically have a greater number of joints affected than in psoriatic arthritis, with perhaps a similar pattern presentation and in some examples only one or two joints are involved. The most involved anatomical areas are the entheses, which are the connections between the bones and the ligaments and tendons. The Achilles tendon is the largest enthesis in the body and commonly affected by inflammatory changes and pain.

There are a large number of entheses in the body and these may be responsible for the more widely spread symptoms which can occur without joints being involved. There can be individual finger swelling with or without changes in other joints and this is a negative indication for disease progression. Back pain or inflammatory spondylitis can be similar to that of ankylosing spondylitis and the symptoms are worse with resting and better with exercising, significant stiffness in the early mornings, a slow and gradual onset and pain worse at night. About 30% of patients can have anatomical back changes without pain or problems and involvement of the nails and distal finger joints in the disease occurs also.

As people get older they increasingly complain of joint problems so it is easy to miss the signs in a person with psoriasis. A clinician should always be suspicious of the possibility of psoriatic arthritis in any patient with psoriasis who presents with a musculoskeletal complain, particularly if it involves the end finger joints or they have back pain which appears inflammatory. The ESR (erythrocyte sedimentation rate) and the CRP (C-reactive protein) blood tests are routine investigations and both can be elevated in inflammatory conditions. If a joint condition is suspected and there are no signs of psoriasis it is wise to carefully check the person’s body for hidden signs of psoriatic skin lesions to exclude this highly genetic condition.

Typically 30% of people diagnosed with this condition will suffer with non-progressive disease in a few affected joints. This presentation is usually effectively treated with steroid injections into the joints as required and by symptomatic management. Identifying this group initially is important to exclude those with worse disease who are likely to show increased inflammatory blood markers, to be male, to have a larger number of affected joints and to have used steroids previously. If showing these negative factors they are more likely to develop damaging disease to the joints with increased disability and a reduction in their quality of life.

Psoriatic arthritis sufferers have benefited less from research and development that those who have other major arthritic conditions but over the last ten years there has been a large increase in investigations concerning this disease. Development of the recent biological treatment agents has stimulated new treatment methods. Despite this there is still a lack of evidence for treatments and when to apply them.

Research and development in rheumatoid arthritis has historically been well ahead of that for psoriatic arthritis but this picture is changing quickly with large numbers of published papers over the last ten years. The instigation of the biological treatment drugs has also encouraged new diagnostic and treatment options. We have however not achieved clear treatment protocols or good evidence for some treatments.

According to the National Institutes of Health (NIH), Reactive arthritis is a form of arthritis, or joint inflammation, which occurs as a “reaction” to an infection elsewhere in the body. Besides joint inflammation, reactive arthritis is associated with two other symptoms: redness and inflammation of the eyes (conjunctivitis) and inflammation of the urinary tract (urethritis). These symptoms may occur alone, together, or not at all.

Reactive arthritis is also known as Reiter’s syndrome, and your doctor may refer to it by yet another term, as a seronegative spondyloarthropathy. The seronegative spondyloarthropathies are a group of disorders that can cause inflammation throughout the body, especially in the spine. (Examples of other disorders in this group include psoriatic arthritis, ankylosing spondylitis, and the kind of arthritis that sometimes accompanies inflammatory bowel disease.)

The symptoms of reactive arthritis usually last 3 to 12 months, although symptoms can return or develop into a long-term disease in a small percentage of people.

What Causes Reactive Arthritis?

Reactive arthritis typically begins about 1 to 3 weeks after infection. The bacterium most often associated with reactive arthritis is Chlamydia trachomatis, commonly known as chlamydia. It is usually acquired through sexual contact. Some evidence also shows that respiratory infections with Chlamydia pneumoniae may trigger reactive arthritis.

Infections in the digestive tract that may trigger reactive arthritis include Salmonella, Shigella, Yersinia, and Campylobacter. People may become infected with these bacteria after eating or handling improperly prepared food, such as meats that are not stored at the proper temperature.

Doctors do not know exactly why some people exposed to these bacteria develop reactive arthritis and others do not, but they have identified a genetic factor, human leukocyte antigen (HLA) B27, that increases a person’s chance of developing reactive arthritis. Approximately 80 percent of people with reactive arthritis test positive for HLA-B27.

Who Gets Reactive Arthritis?

Overall, men between the ages of 20 and 40 are most likely to develop reactive arthritis. However, evidence shows that although men are nine times more likely than women to develop reactive arthritis caused by sexually acquired infections, women and men are equally likely to develop reactive arthritis as a result of food-borne infections. Women with reactive arthritis often have milder symptoms than men.

What Are the Symptoms of Reactive Arthritis?

Reactive arthritis most typically results in inflammation of the urogenital tract, the joints, and the eyes. Less common symptoms are mouth ulcers and skin rashes. Any of these symptoms may be so mild that patients do not notice them. They usually come and go over a period of several weeks to several months.

The arthritis associated with reactive arthritis typically involves pain and swelling in the knees, ankles, and feet. Wrists, fingers, and other joints are affected less often. People with reactive arthritis commonly develop inflammation of the tendons (tendinitis) or at places where tendons attach to the bone (ethesitis). In many people with reactive arthritis, this results in heel pain or irritation of the Achilles tendon at the back of the ankle. Some people with reactive arthritis also develop heel spurs, which are bony growths in the heel that may cause chronic (long-lasting) foot pain. Approximately half of people with reactive arthritis report low-back and buttock pain.

What Natural Anti Inflammatory Remedies are Available for Treating Reactive Arthritis?

CM8™ is an all-natural ingredient in natural supplements” target=”_blank”>natural supplements that functions in three different ways. First, it acts as a highly effective lubricant in the joints, muscles and other tissues, allowing them to move smoothly. Decrease or loss of morning stiffness is commonly noted shortly after commencing treatment. Next, CM8™ functions as a natural anti-inflammatory. Relief from swollen joints is often seen after the 4th or 5th week of treatment. Third, it is also an immune system modulator, which can be effectual against autoimmune diseases, such as arthritic conditions. CM8™ relieves joint pain at its source, reducing inflammation and irritation of the joints and tissues. It also has been helpful for many sufferers of muscle tension and fibromyalgia.

What Is the Prognosis for People Who Have Reactive Arthritis?

Most people with reactive arthritis recover fully from the initial flare of symptoms and are able to return to regular activities 2 to 6 months after the first symptoms appear. In such cases, the symptoms of arthritis may last up to 12 months, although these are usually very mild and do not interfere with daily activities. Approximately 20 percent of people with reactive arthritis will have chronic (long-term) arthritis, which usually is mild. Studies show that between 15 and 50 percent of patients will develop symptoms again sometime after the initial flare has disappeared. It is possible that such relapses may be caused by reinfection. Back pain and arthritis are the symptoms that most commonly reappear. A few patients will have chronic, severe arthritis that is difficult to control with treatment and may cause joint damage.

Most of this information was taken from the National Institutes of Health website.

A sudden twinge in an elbow, shoulder, knee or another joint is probably not arthritis. Most forms of arthritis develop slowly, striking first in the hands.

Instead, you’ve probably irritated the soft tissue around the joint. This ailment–really a family of ailments including bursitis, tendinitis and carpal tunnel syndrome–calls for a slightly different approach to treatment than arthritis.

Arthritis sufferers endure more days in severe pain, experience more days with limited ability to perform daily activities, and have more difficulty performing personal-care routines than people without arthritis. As with other chronic pain conditions, arthritis has negative effects on mental health.

Soft-tissue inflammation is not a natural consequence of aging. Most cases can be traced to excessive exercise…or to a job-related activity involving repetitive motion. The pain is usually apparent within 24 hours of overuse. It can range from a dull ache to shooting pain.

COMMON SOFT-TISSUE INJURIES

Rotator cuff tendinitis affects the tendons that hold the shoulder joint in place. Common among swimmers and other athletes, this ailment can make it hard to get dressed or lie down.

Shoulder bursitis–very common among gardeners and house painters–is caused by repeated pressure on shoulder bursae, fluidfilled “cushions” that protect the joints. It becomes painful to move the arm away from the body.

Tennis elbow strikes carpenters, gardeners, mechanics, dentists…and tennis players who use poor form or a tightly strung racket. The pain makes it hard to shake hands or ligt a briefcase.

Carpal tunnel syndrome is an inflammation of tissue surrounding the median nerve of the hand. Symptoms include weakness, pain, burning or aching in the wrist and/or hand. Usually caused by repeated hand motions, like those used by checkout clerks, seamstresses and computer operators.

Prepatellar bursitis involves inflammation of the bursa in front of the kneecap (patella). It is common in people who must stand or kneel for extended periods. The pain is rarely severe.

Shin splints involve pain in the front of the lower leg. Most cases are caused by repetitive exercise–especially running on hard surfaces. This can injure muscle and tendon tissue.

Achilles tendinitis–inflammation of the Achilles tendon–is common among basketball and squash players and runners(especially those who run on concrete or in flimsy shoes). Symptoms include pain, swelling and tenderness in the heel.

Plantar fascitis involves a tear in the ligament connecting the arch to the heel. It causes a burning pain on the sole of the foot and the heel, making it painful to walk or stand on your toes. Common among runners.

Trochanteric bursitis is inflammation of the bursa near the hip. Symptoms include pain in the hip and thigh, especially when you walk, rise from a chair or lie on the affected side.

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Best Arthritis Remedies.

How does Rheumatoid Arthritis affect a person’s feet? When a Rheumatoid Arthritis victim’s joints become swollen or irritated, the synovium membrane becomes very thick and can develop a lot of joint fluid. This excessive amount of fluid coupled with inflammatory chemicals released by the immune system can cause swelling to the joint’s cartilage and bones.

Foot problems normally associated with Rheumatoid Arthritis can happen in the ball of a person’s foot, close to the toe area. Symptoms include the appearance of deformities, swelling, joint stiffness and intense pain when walking or standing for a long period of time. The following are a few common foot deformities and other foot problems linked to Rheumatoid Arthritis:

A Bunions
B Heel pain
C Achilles tendon pain
D Flatfoot
E Pain in the ankle
F Dislocated toes
G Hammertoes

Another common foot problem that many people with Rheumatoid Arthritis suffer from is called Rheumatoid Nodules or lumps. This condition can cause intense pain when Rheumatoid Nodules rub up against your shoes. These lumps may also appear on the bottom of the foot and cause pain when walking or standing. To help relieve pain caused by foot problems, it is important that you wear comfortable specialty shoes.

What could be worse that this awful joint pain and stiffness, you wonder as you try to will yourself out of bed. While the pain and fatigue that goes along with rheumatoid arthritis can be excruciating and is without a doubt a possibly debilitating condition, there is actually a form of arthritis that is worse. Psoriatic arthritis is a form of the disease that affects not only the joints, but also the skin, and possibly the tendons, eyes, spine, heart and lungs.

In most people who suffer from psoriatic arthritis, the first sign that something is wrong is the inflammation of the skin. Patients can develop psoriasis on their elbows, knees, scalp, and area around the navel and around the anus or genitals. Psoriasis causes red, raised areas of scaly skin. The signs of the skin disease are first seen in the forties or fifties and generally precede joint pain by several months to years. Once the joint pain starts, it generally involves the joints in the feet, ankles and knees. Inflammation can cause the joints to become red, hot and swollen. Often toes and fingers swell so badly they can resemble sausages. Psoriatic arthritis can also affect the spine.

In addition to skin inflammation and joint pain, psoriatic arthritis also attacks the ligaments and tendons of the body. One of the most common tendons to become affected it the Achilles tendon. This Achilles tendonitis causes the patient to have pain when walking and when climbing steps. Along with affecting the tendons in the heels, the arthritis can also inflame the chest wall and the cartilage that links the breast bone and ribs. This inflammation can cause chest pain and shortness of breath.

Along with the joints and tendons, psoriatic arthritis can also affect the major organs of the body such as the heart and lungs. The lungs can become inflamed causing both shortness of breath and chest pain, especially with deep breathing. If the heart becomes inflamed by the disease, the aortic valve can leak. This leak could result in breathing trouble as well as heart failure.

In its rampage on the body, psoriatic arthritis can also damage the eyes. Redness and itching are common results of the condition. The iris or colored area of the eye can also become painfully inflamed, especially when exposed to bright light. Often the only way to relieve this irisitis is to inject cortisone directly into the eye.

Psoriatic arthritis can often be difficult to diagnose especially in the early stages. One common symptom of this form of arthritis, however, is the pitting of finger or toe nails. Sometimes the disorder can cause the nails to turn loose and fall off completely.

Like rheumatoid arthritis, psoriatic arthritis results from the body’s own immune system turning against itself. Unlike the rheumatoid variety, however, psoriatic arthritis can affect not only the joints, but also the skin, eyes and many of the major organs of the body. Left untreated this disease can progress until it become debilitating and sometimes even life threatening.

Unlike osteoarthritis, which results from wear and tear on your joints, rheumatoid arthritis is an inflammatory condition. The exact cause of rheumatoid arthritis is unknown, but it’s believed to be the body’s immune system attacking the tissue that lines your joints (synovium).

Rheumatoid arthritis is two to three times more common in women than in men and generally strikes between the ages of 20 and 50. But rheumatoid arthritis can also affect young children and adults older than age 50.

There’s no cure for rheumatoid arthritis. But with proper treatment, a strategy for joint protection and changes in lifestyle, you can live a long, productive life with this condition.

Signs and symptoms

The signs and symptoms of rheumatoid arthritis may come and go over time. They include:

* Pain and swelling in your joints, especially in the smaller joints of your hands and feet

* Generalized aching or stiffness of the joints and muscles, especially after sleep or after periods of rest

* Loss of motion of the affected joints

* Loss of strength in muscles attached to the affected joints

* Fatigue, which can be severe during a flare-up

* Low-grade fever

* Deformity of your joints over time

* General sense of not feeling well (malaise)

Rheumatoid arthritis usually causes problems in several joints at the same time. Early in rheumatoid arthritis, the joints in your wrists, hands, feet and knees are the ones most often affected. As the disease progresses, your shoulders, elbows, hips, jaw and neck can become involved. It generally affects both sides of your body at the same time. The knuckles of both hands are one example.

Small lumps, called rheumatoid nodules, may form under your skin at pressure points and can occur at your elbows, hands, feet and Achilles tendons. Rheumatoid nodules may also occur elsewhere, including the back of your scalp, over your knee or even in your lungs. These nodules can range in size – from as small as a pea to as large as a walnut. Usually these lumps aren’t painful.

In contrast to osteoarthritis, which affects only your bones and joints, rheumatoid arthritis can cause inflammation of tear glands, salivary glands, the linings of your heart and lungs, your lungs themselves and, in rare cases, your blood vessels.

Although rheumatoid arthritis is often a chronic disease, it tends to vary in severity and may even come and go. Periods of increased disease activity – called flare-ups or flares – alternate with periods of relative remission, during which the swelling, pain, difficulty sleeping, and weakness fade or disappear.

Swelling or deformity may limit the flexibility of your joints. But even if you have a severe form of rheumatoid arthritis, you’ll probably retain flexibility in many joints.
Illustration comparing rheumatoid arthritis and osteoarthritis

Osteoarthritis, the most common form of arthritis, involves the wearing away of the cartilage that caps the bones in your joints. With rheumatoid arthritis, the synovial membrane that protects and lubricates joints becomes inflamed, causing pain and swelling. Joint erosion may follow.
More On This Topic

* Osteoarthritis

Causes

As with other forms of arthritis, rheumatoid arthritis involves inflammation of the joints. A membrane called the synovium lines each of your movable joints. When you have rheumatoid arthritis, white blood cells – whose usual job is to attack unwanted invaders, such as bacteria and viruses – move from your bloodstream into your synovium. Here, these blood cells appear to play an important role in causing the synovial membrane to become inflamed (synovitis).

This inflammation results in the release of proteins that, over months or years, cause thickening of the synovium. These proteins can also damage cartilage, bone, tendons and ligaments. Gradually, the joint loses its shape and alignment. Eventually, it may be destroyed.

Some researchers suspect that rheumatoid arthritis is triggered by an infection – possibly a virus or bacterium – in people with an inherited susceptibility. Although the disease itself is not inherited, certain genes that create an increased susceptibility are. People who have inherited these genes won’t necessarily develop rheumatoid arthritis. But they may have more of a tendency to do so than others. The severity of their disease may also depend on the genes inherited. Some researchers also believe that hormones may be involved in the development of rheumatoid arthritis.
Illustration showing inflammation of rheumatoid arthritis

Rheumatoid arthritis typically strikes joints, causing pain, swelling and deformity. As your synovial membranes become inflamed and thickened, fluid builds up and joints erode and degrade.
Risk factors

The exact causes of rheumatoid arthritis are unclear, but these factors may increase your risk:

* Getting older, because incidence of rheumatoid arthritis increases with age. However, incidence begins to decline in women over the age of 80.

* Being female.

* Being exposed to an infection, possibly a virus or bacterium, that may trigger rheumatoid arthritis in those with an inherited susceptibility.

* Inheriting specific genes that may make you more susceptible to rheumatoid arthritis.

* Smoking cigarettes over a long period of time.

When to seek medical advice

See your doctor if you have persistent discomfort and swelling in multiple joints on both sides of your body. Your doctor can work with you to develop a pain management and treatment plan. Also seek medical advice if you experience side effects from your arthritis medications. Side effects may include nausea, abdominal discomfort, black or tarry stools, changes in bowel habits, constipation and drowsiness.
Screening and diagnosis

If you have signs and symptoms of rheumatoid arthritis, your doctor will likely conduct a physical examination and request laboratory tests to determine if you have this form of arthritis. These tests may include:

* Blood tests. A blood test that measures your erythrocyte sedimentation rate (ESR or sed rate) can indicate the presence of an inflammatory process in your body. People with rheumatoid arthritis tend to have elevated ESRs. The ESRs in those with osteoarthritis tend to be normal.

Another blood test looks for an antibody called rheumatoid factor. Most people with rheumatoid arthritis eventually have this abnormal antibody, although it may be absent early in the disease. It’s also possible to have the rheumatoid factor in your blood and not have rheumatoid arthritis.

* Imaging. Doctors may take X-rays of your joints to differentiate between osteoarthritis and rheumatoid arthritis. A sequence of X-rays obtained over time can show the progression of arthritis.

Complications

Rheumatoid arthritis causes stiffness and pain and may also cause fatigue. It can lead to difficulty with everyday tasks, such as turning a doorknob or holding a pen. Dealing with the pain and the unpredictability of rheumatoid arthritis can also cause symptoms of depression.

Rheumatoid arthritis may also increase your risk of developing osteoporosis, especially if you take corticosteroids. Some researchers believe that rheumatoid arthritis can increase your risk of heart disease. This may be because the inflammation that rheumatoid arthritis causes can also affect your arteries and heart muscle tissue.

In the past, people with rheumatoid arthritis may have ended up confined to a wheelchair because damage to joints made it difficult or impossible to walk. That’s not as likely today because of better treatments and self-care methods.
More On This Topic

* Osteoporosis

Treatment

Treatments for arthritis have improved in recent years. Most treatments involve medications. But in some cases, surgical procedures may be necessary.

Medications

Medications for rheumatoid arthritis can relieve its symptoms and slow or halt its progression. They include:

* Nonsteroidal anti-inflammatory drugs (NSAIDs). This group of medications, which includes aspirin, helps relieve both pain and inflammation if you take the drugs regularly. NSAIDs that are available over-the-counter include aspirin, ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve). These are available at higher dosages, and other NSAIDs are available by prescription – such as ketoprofen, naproxen (Anaprox, Naprosyn), tolmetin (Tolectin), diclofenac (Voltaren), nabumetone (Relafen) and indomethacin (Indocin). Taking NSAIDs can lead to side effects such as indigestion and stomach bleeding. Other potential side effects may include damage to the liver and kidneys, ringing in your ears (tinnitus), fluid retention and high blood pressure. NSAIDs, except aspirin, may also increase your risk of cardiovascular events such as heart attack or stroke.

* COX-2 inhibitors. This class of NSAIDs may be less damaging to your stomach. Like other NSAIDs, COX-2 inhibitors – such as celecoxib (Celebrex) – suppress an enzyme called cyclooxygenase (COX) that’s active in joint inflammation. Other types of NSAIDs work against two versions of the COX enzyme that are present in your body: COX-1 and COX-2. However, there’s evidence that by suppressing COX-1, NSAIDs may cause stomach and other problems because COX-1 is the enzyme that protects your stomach lining. Unlike other NSAIDs, COX-2 inhibitors suppress only COX-2, the enzyme involved in inflammation. Side effects may include fluid retention and causing or exacerbating high blood pressure. Furthermore, this class of drugs has been linked to an increased risk of heart attack and stroke.

* Corticosteroids. These medications, such as prednisone and methylprednisolone (Medrol), reduce inflammation and pain, and slow joint damage. In the short term, corticosteroids can make you feel dramatically better. But when used for many months or years, they may become less effective and cause serious side effects. Side effects may include easy bruising, thinning of bones, cataracts, weight gain, a round face and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.

* Disease-modifying antirheumatic drugs (DMARDs). Physicians prescribe DMARDs to limit the amount of joint damage that occurs in rheumatoid arthritis. Taking these drugs at early stages in the development of rheumatoid arthritis is especially important in the effort to slow the disease and save the joints and other tissues from permanent damage. Because many of these drugs act slowly – it may take weeks to months before you notice any benefit – DMARDs typically are used with an NSAID or a corticosteroid. While the NSAID or corticosteroid handles your immediate symptoms and limits inflammation, the DMARD goes to work on the disease itself. Some commonly used DMARDs include hydroxychloroquine (Plaquenil), the gold compound auranofin (Ridaura), sulfasalazine (Azulfidine), minocycline (Dynacin, Minocin) and methotrexate (Rheumatrex). Other forms of DMARDs include immunosuppressants and tumor necrosis factor (TNF) blockers.

* Immunosuppressants. These medications act to tame your immune system, which is out of control in rheumatoid arthritis. In addition, some of these drugs attack and eliminate cells that are associated with the disease. Some of the commonly used immunosuppressants include leflunomide (Arava), azathioprine (Imuran), cyclosporine (Neoral, Sandimmune) and cyclophosphamide (Cytoxan). These medications can have potentially serious side effects such as increased susceptibility to infection.

* TNF blockers. These are a class of DMARDs known as biologic response modifiers. TNF is a cytokine, or cell protein, that acts as an inflammatory agent in rheumatoid arthritis. TNF blockers, or anti-TNF medications, target or block this cytokine and can help reduce pain, morning stiffness and tender or swollen joints – usually within one or two weeks after treatment begins. There is evidence that TNF blockers may halt progression of disease. These medications often are taken with methotrexate. TNF blockers approved for treatment of rheumatoid arthritis are etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira). Potential side effects include injection site irritation (adalimumab and etanercept), worsening congestive heart failure (infliximab), blood disorders, lymphoma, demyelinating diseases, and increased risk of infection. If you have an active infection, don’t take these medications.

* Interleukin-1 receptor antagonist (IL-1Ra). IL-1Ra is another type of biologic response modifier and is a recombinant form of the naturally occurring interleukin-1 receptor antagonist (IL-1Ra). Interleukin-1 (IL-1) is a cell protein that promotes inflammation and occurs in excess amounts in people who have rheumatoid arthritis or other types of inflammatory arthritis. If IL-1 is prevented from binding to its receptor, the inflammatory response decreases. The first IL-1Ra that has been approved by the Food and Drug Administration for use in people with moderate to severe rheumatoid arthritis who haven’t responded adequately to conventional DMARD therapy is anakinra (Kineret). It may be used alone or in combination with methotrexate. Anakinra is given as a daily self-administered injection under the skin. Some potential side effects include injection site reactions, decreased white blood cell counts, headache and an increase in upper respiratory infections. There may be a slightly higher rate of respiratory infections in people who have asthma or chronic obstructive pulmonary disease. If you have an active infection, don’t use anakinra.

* Abatacept (Orencia). Abatacept, a type of costimulation modulator approved in late 2005, reduces the inflammation and joint damage caused by rheumatoid arthritis by inactivating T cells – a type of white blood cell. People who haven’t been helped by TNF blockers might consider abatacept, which is administered monthly through a vein in your arm (intravenously). Side effects may include headache, nausea and mild infections, such as upper respiratory tract infections. Serious infections, such as pneumonia, can occur.

* Rituximab (Rituxan). Rituximab reduces the number of B cells in your body. B cells are involved in inflammation. Though originally approved for use in people with non-Hodgkin’s lymphoma, rituximab was approved for rheumatoid arthritis in early 2006. People who haven’t found relief using TNF blockers might consider using rituximab, which is usually given along with methotrexate. Rituximab is administered as an infusion into a vein in your arm. Side effects include flu-like signs and symptoms, such as fever, chills and nausea. Some people experience extreme reactions to the infusion, such as difficulty breathing and heart problems.

* Antidepressant drugs. Some people with arthritis also experience symptoms of depression. The most common antidepressants used for arthritis pain and nonrestorative sleep are amitriptyline, nortriptyline (Aventyl, Pamelor) and trazodone (Desyrel).

Surgical or other procedures

Although a combination of medication and self-care is the first course of action for rheumatoid arthritis, other methods are available for severe cases:

* Prosorba column. This blood-filtering technique removes certain antibodies that contribute to pain and inflammation in your joints and muscles and is usually performed once a week for 12 weeks as an outpatient procedure. Some of the side effects include fatigue and a brief increase in joint pain and swelling for the first few days after the treatment. The Prosorba column treatment isn’t recommended if you’re taking angiotensin-converting enzyme (ACE) inhibitors or if you have heart problems, high blood pressure or blood-clotting problems.

* Joint replacement surgery. For many people with rheumatoid arthritis, medicines and therapies can’t prevent joint destruction. When joints are severely damaged, joint replacement surgery can often help restore joint function, reduce pain or correct a deformity. You may need to have an entire joint replaced with a metal or plastic prosthesis. Surgery may also involve tightening tendons that are too loose, loosening tendons that are too tight, fusing bones to reduce pain or removing part of a diseased bone to improve mobility. Your doctor may also remove the inflamed joint lining (synovectomy).

More On This Topic

* Steroid use: Balancing the risks and benefits
* Are COX-2 drugs safe for you? An interview with a Mayo Clinic specialist
* Knee replacement: Surgery can relieve pain

Self-care

Treating rheumatoid arthritis typically involves using a combination of medical treatments and self-care strategies. The following self-care procedures are important elements for managing the disease:

* Exercise regularly. Different types of exercise achieve different goals. Check with your doctor or physical therapist first and then begin a regular exercise program for your specific needs. If you can walk, walking is a good starter exercise. If you can’t walk, try a stationary bicycle with little or no resistance or do hand or arm exercises. A chair exercise program may be helpful. Aquatic exercise is another option, and many health clubs with pools offer such classes.

It’s good to move each joint in its full range of motion every day. As you move, maintain a slow, steady rhythm. Don’t jerk or bounce. Also, remember to breathe. Holding your breath can temporarily deprive your muscles of oxygen and tire them. It’s also important to maintain good posture while you exercise. Avoid exercising tender, injured or severely inflamed joints. If you feel new joint pain, stop. New pain that lasts more than two hours after you exercise probably means you’ve overdone it. If pain persists for more than a few days, call your doctor.

* Control your weight. Excess weight puts added stress on joints in your back, hips, knees and feet – the places where arthritis pain is commonly felt. Excess weight can also make joint surgery more difficult and risky.

* Eat a healthy diet. A healthy diet emphasizing fruit, vegetables and whole grains can help you control your weight and maintain your overall health, allowing you to deal better with your arthritis. However, there’s no special diet that can be used to treat arthritis. It hasn’t been proved that eating any particular food will make your joint pain or inflammation better or worse.

* Apply heat. Heat will help ease your pain, relax tense, painful muscles and increase the regional flow of blood. One of the easiest and most effective ways to apply heat is to take a hot shower or bath for 15 minutes. Other options include using a hot pack, an electric heat pad set on its lowest setting or a radiant heat lamp with a 250-watt reflector heat bulb to warm specific muscles and joints. If your skin has poor sensation or if you have poor circulation, don’t use heat treatment.

* Apply cold for occasional flare-ups. Cold may dull the sensation of pain. Cold also has a numbing effect and decreases muscle spasms. Don’t use cold treatments if you have poor circulation or numbness. Techniques may include using cold packs, soaking the affected joints in cold water and ice massage.

* Practice relaxation techniques. Hypnosis, guided imagery, deep breathing and muscle relaxation can all be used to control pain.

* Take your medications as recommended. By taking medications regularly instead of waiting for pain to build, you will lessen the overall intensity of your discomfort.

Coping skills

The degree to which rheumatoid arthritis affects your daily activities depends in part on how well you cope with the disease. Physical and occupational therapists can help you devise strategies to cope with specific limitations you may experience as the result of weakness or pain. Here are some general suggestions to help you cope:

* Keep a positive attitude. With your doctor, make a plan for managing your arthritis. This will help you feel in charge of your disease. Studies show that people who take control of their treatment and actively manage their arthritis experience less pain and make fewer visits to the doctor.

* Use assistive devices. A painful knee may need a brace for support. You might also want to use a cane to take some of the stress off the joint as you walk. Use the cane in the hand opposite the affected joint. If your hands are affected, various helpful tools and gadgets are available to help you maintain an active lifestyle. Contact your pharmacy or doctor for information on ordering items that may help you the most.

* Know your limits. Rest when you’re tired. Arthritis can make you prone to fatigue and muscle weakness. A rest or short nap that doesn’t interfere with nighttime sleep may help.

* Avoid grasping actions that strain your finger joints. Instead of using a clutch purse, for example, select one with a shoulder strap. Use hot water to loosen a jar lid and pressure from your palm to open it, or use a jar opener. Don’t twist or use your joints forcefully.

* Spread the weight of an object over several joints. For instance, use both hands to lift a heavy pan.

* Take a break. Periodically relax and stretch.

* Maintain good posture. Poor posture causes uneven weight distribution and may strain ligaments and muscles. The easiest way to improve your posture is by walking. Some people find that swimming also helps improve their posture.

* Use your strongest muscles and favor large joints. Don’t push open a heavy glass door. Lean into it. To pick up an object, bend your knees and squat while keeping your back straight.