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House Calls: Managing rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects small joints in your hands and feet. Rheumatoid arthritis affects the lining of joints, causing pain and swelling. This form of arthritis can result in destruction of the joint. RA occurs when your body attacks itself. It can not only attack the joints but can also attack the skin, eyes, lungs and blood vessels. RA usually occurs after age 40. It is more common in women. It can also run in families.

Signs of RA include tender, swollen joints, morning stiffness, nodules under the skin of your joints, fatigue, fever and weight loss. RA usually affects your smaller joints first. As disease spreads it can progress to your knees, ankles, elbows, hips and shoulders. Over time, it can cause joints to deform and shift out of place.

RA increases your risk of developing osteoporosis, a condition that weakens your bones and makes them more prone to fracture. If RA affects your wrist it can cause carpal tunnel, a condition that causes numbness of your first 3 fingers. It can also cause hardening of the arteries in your heart causing heart attacks and pericarditis, an inflammation of the sac of your heart. RA can also cause scarring of your lungs which can cause progressive shortness of breath.

RA is difficult to diagnosis. Your doctor will do a physical exam which will look for swelling, redness and warmth of the joints. The doctor may order an ESR and rheumatoid factor which will help in the diagnosis. X-rays may also be ordered to help with showing the amount of deterioration of the joints and to determine the progression of the illness.

There is no cure for RA.

Medications can reduce inflammation of the joints and reduce pain and slow joint damage. NSAIDS such as Ibuprofen, Advil and Motrin may be recommended. Steroids such as Prednisone help in reducing inflammation and slows joint damage. Disease modifying anti-rheumatic drugs (DMARDs) slow the progression of the disease. Methotrexate and Plaquenil are examples of DMARDs. TNF-alpha inhibitors reduce inflammatory substances in the body. An example of medicine in this class is Humira.

Many of these medicines have side effects such as nausea, diarrhea, liver damage, bone marrow suppression, severe lung infections, cataracts, weight gain and many other. Some of these medicines increase your risk of infections. Your doctor may also prescribe physical therapy to show you exercises to help keep your joints flexible. If medicines and therapy fail, surgery may be warranted to repair damaged joints. Total joint replacement, tendon repair and joint fusion are just a few of the surgeries that may be needed.

You can take several steps to care for your body if you have RA. These steps can help you manage your signs and symptoms. Regular exercise helps strengthen your muscles around the joints. Apply heat or cold. Heat can help relieve some of the pain and relax tension. Cold may dull sensation of pain. Find ways to cope with pain and stress.

RA can be a very frustrating and life changing illness. But many things can help in combination. Consult your physician if you think you may have RA. Early diagnosis can help prevent deterioration of the joints.

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