Pain Management and Rheumatoid Arthritis
How Is Rheumatoid Arthritis Diagnosed?
The diagnosis of rheumatoid arthritis is based on a combination of factors, including:
- The specific location and symmetry of painful joints
- The presence of joint stiffness in the morning
- Presence of bumps and nodules under the skin (rheumatoid nodules)
- Results of X-ray tests that suggest rheumatoid arthritis
- Positive results of blood tests called the rheumatoid factor and the anti-CCP antibody
Most, but not all, people with rheumatoid arthritis have one or both antibodies in their blood. The rheumatoid factor may be present in people who do not have rheumatoid arthritis. Other diseases also can cause the rheumatoid factor to be produced in the blood. Therefore, the diagnosis of rheumatoid arthritis is based on a combination of several factors and not just the presence of the rheumatoid factor in the blood.
People with RA may have a mild anemia. Blood tests may also reveal an elevated erythrocyte sedimentation rate (ESR), a marker of inflammation.
How Is Rheumatoid Arthritis Treated?
There are many different ways to treat rheumatoid arthritis. Treatments include medications, rest and exercise, and surgery to correct damage to the joint.
The type of treatment will depend on several factors including the person's age, overall health, medical history, and severity of the arthritis.
Rheumatoid Arthritis Drugs
There are many drugs available to decrease joint pain, swelling and inflammation, and possibly prevent or minimize the progression of the disease.
Medications that offer relief of arthritis symptoms (joint pain, stiffness, and swelling) include:
- Anti-inflammatory painkiller drugs, such as aspirin, ibuprofen, or naproxen
- Topical (applied directly to the skin) pain relievers
- Corticosteroids, such as prednisone. They can be injected directly into joints.
- Narcotic pain relievers
There are also many strong medications called disease-modifying antirheumatic drugs (DMARDs) that are used to treat RA. These drugs usually work by interfering with or suppressing the immune system attack on the joints. They include:
- Anti-malaria medications, such as hydroxychloroquine
- Chemotherapy drugs, such as methotrexate, Imuran, and Cytoxan
- Organ rejection drugs, such as cyclosporine
- Biologic treatments, such as Actemra, Cimzia, Enbrel, Humira, Kineret, Remicade, Orencia, Rituxan, and Simponi
- Miscellaneous drugs, such as Azulfidine, penicillamine, gold, and minocycline
Some of these medications are traditionally used to treat other conditions such as cancer or inflammatory bowel disease, or to reduce the risk of rejection of a transplanted organ. However, when chemotherapy drugs (such as methotrexate or Cytoxan) are used to treat rheumatoid arthritis, the doses are significantly lower and the risks of side effects tend to be considerably less than when prescribed in higher doses for cancer treatment.
The biologic treatments in particular have greatly improved the long-term outcomes for many people with RA. However, they are very expensive and are given either by self injection or by intravenous infusion. By altering the immune system, they also can increase the risk of serious infection and so are often chosen for those with more severe disease.