Arthritis management new pain rheumatoid york

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

This is information from the New York State Department of Aging...While the information is general and somewhat out-dated, there are some nuggets worth keeping. I've added notes in areas that require up-dating and clarification...

Arthritis encompasses over 120 diseases and conditions that affect joints, the surrounding tissues, and other connective tissues. The most common types of arthritis are osteoarthritis, rheumatoid arthritis and fibromyalgia. Other types include lupus, juvenile rheumatoid arthritis, gout, bursitis, rheumatic fever and Lyme disease to mention a few. While anyone can be at risk for developing arthritis, prevalence of this disease is higher among women than among men. Some of the more common types of arthritis are described below.

• Rheumatoid arthritis is an autoimmune disease involving chronic inflammation.

• Osteoarthritis causes degeneration of joint cartilage and changes in underlying bone and supporting tissue, which leads to joint pain and stiffness, movement problems and activity limitation.

The inflammation associated with rheumatoid arthritis begins in the synovial membranes and spreads to other joint tissues. Outgrowths of the inflamed tissue may invade and damage the cartilage in the joints and erode bone, leading to joint deformities. Clinical symptoms include stiffness, pain, swelling of multiple joints, commonly the small joints of the hands and wrists. Although it primarily affects the joints, rheumatoid arthritis can also affect connective tissue throughout the body and cause disease in a variety of organs, including the lungs, heart, and the eyes.

Osteoarthritis is known by many other names including degenerative joint disease, arthrosis, osteoarthrosis or hypertrophic arthritis. Osteoarthritis can affect any joint, but it commonly occurs in the hip, knees and spine. It also affects finger joints, the joint at the base of the thumb and the joint at the base of the big toe. It rarely affects the wrist, elbows, shoulders, ankles or jaw, except as a result of unusual stress or injury.

What Will Happen When You First Visit a Doctor for Your Arthritis Pain?

The doctor will usually do the following:

• Take your medical history and ask questions such as: How long have you had this problem? How intense is the pain? How often does it occur? What causes it to get worse? What causes it to get better?

• Review the medications you are using

• Conduct a physical examination

• Take blood and/or urine samples and request necessary laboratory work

• Ask you to get x-rays taken or undergo other imaging procedures such as a CAT scan (computerized axial tomography) or MRI (magnetic resonance imaging). (NB: CT scanning is rarely done for arthritis... MRI or diagnostic ultrasound are the more frequently used imaging procedures.)

Once the doctor has done these things and reviewed the results of any tests or procedures, he or she will discuss the findings with you and design a comprehensive management approach for the pain caused by your osteoarthritis or rheumatoid arthritis.

Who Can Treat Arthritis Pain?

A number of different specialists may be involved in the care of an arthritis patient -- often a team approach is used. The team may include doctors who treat people with arthritis (rheumatologists), surgeons (orthopaedists), and physical and occupational therapists. Their goal is to treat all aspects of arthritis pain and help you learn to manage your pain. The physician, other health care professionals, and you, the patient, all play an active role in the management of arthritis pain.

How Is Arthritis Pain Treated?

There is no single treatment that applies to all people with arthritis, but rather the doctor will develop a management plan designed to minimize your specific pain and improve the function of your joints. A number of treatments can provide short-term pain relief.

Short-Term Relief:

• Medications -- Because people with osteoarthritis have very little inflammation, pain relievers such as acetaminophen may be effective. Patients with rheumatoid arthritis generally have pain caused by inflammation and often benefit from aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. (NB. These drugs have potential side effects including gastrointestinal ulcers and cardiovascular events such as heart attack and stroke.)

• Heat and cold -- The decision to use either heat or cold for arthritis pain depends on the type of arthritis and should be discussed with your doctor or physical therapist. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed on the painful area of the joint for about 15 minutes may relieve the pain. An ice pack (or a bag of frozen vegetables) wrapped in a towel and placed on the sore area for about 15 minutes may help to reduce swelling and stop the pain. If you have poor circulation, do not use cold packs.

• Joint Protection -- Using a splint or a brace to allow joints to rest and protect them from injury can be helpful. Your physician or physical therapist can make recommendations.

• Transcutaneous electrical nerve stimulation (TENS) -- A small TENS device that directs mild electric pulses to nerve endings that lie beneath the skin in the painful area may relieve some arthritis pain. TENS seems to work by blocking pain messages to the brain and by modifying pain perception.

• Massage -- In this pain-relief approach, a massage therapist will lightly stroke and/or knead the painful muscle. This may increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are very sensitive so the therapist must be very familiar with the problems of the disease.

• Acupuncture -- This procedure should only be done by a licensed acupuncture therapist. In acupuncture, thin needles are inserted at specific points in the body. Scientists think that this stimulates the release of natural, pain-relieving chemicals produced by the brain or the nervous system.

Osteoarthritis and rheumatoid arthritis are chronic diseases that may last a lifetime. Learning how to manage your pain over the long term is an important factor in controlling the disease and maintaining a good quality of life. Following are some sources of long- term pain relief.

Long-Term Relief:

Medications --

Non-steroidal anti-inflammatory drugs (NSAIDs): These are a class of drugs including aspirin and ibuprofen that are used to reduce pain and inflammation and may be used for both short-term and long-term relief in people with osteoarthritis and rheumatoid arthritis. (NB. See the caution earlier about this group of drugs.)

Disease-modifying anti-rheumatic drugs (DMARDs): These are drugs used to treat people with rheumatoid arthritis who have not responded to NSAIDs. Some of these include methotrexate, hydroxychloroquine, penicillamine, and gold injections. These drugs are thought to influence and correct abnormalities of the immune system responsible for a disease like rheumatoid arthritis. Treatment with these medications requires careful monitoring by the physician to avoid side effects. (NB. Penicillamine and gold are rarely if ever used anymore. Biologic therapy is the "gold standard now.)

Corticosteroids: These are hormones that are very effective in treating arthritis. Corticosteroids can be taken by mouth or given by injection. Prednisone is the corticosteroid most often given by mouth to reduce the inflammation of rheumatoid arthritis. In both rheumatoid arthritis and osteoarthritis, the doctor also may inject a corticosteroid into the affected joint to stop pain. Because frequent injections may cause damage to the cartilage, they should only be done once or twice a year.

Weight reduction -- Excess pounds put extra stress on weight-bearing joints such as the knees or hips. Studies have shown that overweight women who lost an average of 11 pounds substantially reduced the development of osteoarthritis in their knees. In addition, if osteoarthritis has already affected one knee, weight reduction will reduce the chance of it occurring in the other knee.

Exercise -- Swimming, walking, low-impact aerobic exercise, and range-of- motion exercises may reduce joint pain and stiffness. In addition, stretching exercises are helpful. A physical therapist can help plan an exercise program that will give you the most benefit.

Surgery -- In select patients with arthritis, surgery may be necessary. The surgeon may perform an operation to remove the synovium (synovectomy), realign the joint (osteotomy), or in advanced cases replace the damaged joint with an artificial one. Total joint replacement has provided not only dramatic relief from pain but also improvement in motion for many people with arthritis.

What Alternative Therapies May Relieve Arthritis Pain?

Many people seek other ways of treating their disease, such as special diets or supplements. Although these methods may not be harmful in and of themselves, no research to date shows that they help. Nonetheless, some alternative or complementary approaches may help you to cope or reduce some of the stress of living with a chronic illness. If the doctor feels the approach has value and will not harm you, it can be incorporated into your treatment plan. However, it is important not to neglect your regular health care or treatment of serious symptoms. (NB. I disagree. Many ciomplementary therapies have been shown to help people with arthritis. Remember. This information is rather dated.)

How Can You Cope With Arthritis Pain?

The long-term goal of pain management is to help you cope with a chronic, often disabling disease. You may be caught in a cycle of pain, depression, and stress. To break out of this cycle, you need to be an active participant with the doctor and other health care professionals in managing your pain. This may include physical therapy, cognitive-behavioral therapy, occupational therapy, biofeedback, relaxation techniques (for example, deep breathing and meditation), and family counseling therapy.

Another technique is to substitute distraction for pain. Focus your attention on things that you enjoy. Imagine a peaceful setting and wonderful physical sensations. Thinking about something that is enjoyable can help you relax and become less stressed. Find something that will make you laugh -- a cartoon, a funny movie, or even a new joke. Try to put some joy back into your life. Even a small change in your mental image may break the pain cycle and provide relief.

Get more information about arthritis and related conditions as well as...

• Insider arthritis tips that help you erase the pain and fatigue of rheumatoid arthritis almost overnight!

• Devastating ammunition against low back pain... discover 9 secrets!

• Ignored remedies that eliminate fibromyalgia symptoms quickly!

• Obsolete treatments for knee osteoarthritis that still are used... and may still work for you!

• The stiff penalties you face if you ignore this type of hip pain...

• 7 easy-to-implement neck pain remedies that work like a charm!

• And much more...

Click here Second Opinion Arthritis Treatment Kit

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