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Preventing Joint Damage From Rheumatoid Arthritis
When rheumatoid arthritis flares up, it makes joints feel stiff and achy. That discomfort may go away at times, but there may still be permanent damage. Eventually rheumatoid arthritis can harm joints so they don't work as well even when the disease itself is not active. How does joint damage occur, and how can it be prevented?
Doctors call the active periods of rheumatoid arthritis disease activity. During disease activity, infection-fighting cells (white blood cells) are mistakenly allowed into the joint. No one understands why this happens, but it's clear the infection fighters don't belong there.
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Inside the joint, these cells produce chemicals that they usually use to kill invading microorganisms - only none are there. Instead, the chemicals damage the healthy joint tissue. During high levels of disease activity, you experience a flare - joints become swollen, stiff, and painful. You can also have low levels of disease activity that come and go without your feeling any symptoms.
There are two main ways this process can cause joint damage:
- The infection-fighting chemicals cause cartilage to slowly weaken. Cartilage is the cushion between bones in a joint. Over time, putting stress on the joint or bearing weight on it can wear down the weak cartilage more. This is called degenerative disease, and it is similar to what happens in "regular" arthritis (osteoarthritis) - only it happens faster in people with rheumatoid arthritis.
- The inflammation inside the joint stimulates the joint lining (synovium) to grow and spread where it doesn't belong. If it continues long enough, it can harm healthy cartilage or bone.
The simple rule of thumb is, the "longer" and "stronger" the disease activity, the more joint damage is probably occurring.
- A person with joint swelling and stiffness every day is more likely to have joint damage than a person with these symptoms once a month. (Longer disease activity)
- Someone with a lot of joint swelling is more likely to have damage than a person with just a little bit. (Stronger disease activity)
How can you tell if you are having disease activity? It can sometimes be difficult.
- You can be feeling a lot of pain, yet suffer no damage to your joints.
- Joint damage can also occur without feeling any pain.
- Joint swelling is a reliable sign, though. For the most part, having joint swelling is proof of having ongoing disease activity.
- The length of morning stiffness each day is also useful. Ask yourself, after getting up, "How long does it take until I'm feeling as loose as I'll feel for the day?" The longer you feel stiff, the more likely it is that your rheumatoid arthritis is active.
- Another sign you can look for is a "boggy" joint. When the joint lining begins to grow abnormally, it may give a joint a mushy texture. This boggy condition will remain even when you are not having a flare. If you notice this happening, you should see your rheumatologist.
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Who should NOT take Cymbalta?
You should not take Cymbalta if:
- You have recently taken a type of antidepressant called a monoamine oxidase inhibitor (MAOI)
- You have uncontrolled narrow-angle glaucoma (an eye disease)
- You are taking Mellaril® (thioridazine)
What other important information should I discuss with my healthcare provider?
Before starting Cymbalta, tell your healthcare provider:
- about all of your medical conditions, including kidney problems, glaucoma, or diabetes
- about your alcohol use
- if you are taking nonprescription or prescription medicines, including those for migraine, to address a possible life threatening condition
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While taking Cymbalta, tell your healthcare provider:
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- if you have high fever, confusion, and stiff muscles to address a possible life-threatening condition
- before stopping Cymbalta or changing your dose
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If you have any questions, talk to your healthcare provider before taking Cymbalta.
What are the possible side effects of Cymbalta?
The most common side effect of Cymbalta was nausea. For most people who had it, the nausea was mild to moderate. Other common side effects included dry mouth, sleepiness, constipation, decreased appetite, and, increased sweating. This is not a complete list of side effects.
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