Help for rheumatoid arthritis

In a small 2012 study, a curcumin product called BCM-95 proved better at reducing joint pain and swelling in patients with rheumatoid arthritis than a standard anti-inflammatory drug.

What’s more, a small 2016 study found that curcumin may help to prevent bone erosion in people with rheumatoid arthritis. “It’s not a medication you would take like Advil,” Jeter says. “If you have an acute flare-up, it’s probably not going to be helpful. But when taken daily, as part of your normal regimen, curcumin can help smooth out your overall pain.” Adding a dash to your favorite Indian dish won’t do the trick; curcumin needs to be consumed as a supplement. Look for one formulated with pepper, which may help improve absorption.

Grill up some salmon

That orangey-pink fish is chockful of health benefits — now add pain reliever to the list. In a 2017 study published in Arthritis Care & Research, in which participants were asked to eat specific foods from a list, fatty fish got high marks when it came to improving rheumatoid arthritis symptoms. Tuna, sardines and mackerel are also rich in omega-3 fatty acids, which inhibit immune cells called leukocytes as well as cytokines, both of which are involved in the body’s inflammatory response.

To get the full, inflammation-fighting benefits, eat two to three servings of fish a week. If you don’t fancy seafood, consider a fish-oil supplement. “The data on fish oil is quite good,” says Shadick, who notes research showing that it reduced joint tenderness and stiffness.

Whip out the resistance bands

Working out may seem kind of counterintuitive when you’re dealing with achy knees or a sore elbow. But keeping muscles strong, while maintaining flexibility and range of motion, is crucial. Otherwise, underutilized limbs become weak, making it even more painful when you try to move around. In fact, a study published in the Journal of Aging Research concluded that exercise improves overall function in those with rheumatoid arthritis. That same study found that the best exercise program for those with rheumatoid arthritis should include both aerobic and resistance training.

“Muscle strength is especially important because you need muscles to absorb the impact that may occur when you’re walking around or doing other activities,” says Jonathan Samuels, M.D., an associate professor of medicine in the division of rheumatology and the codirector of the Joint Preservation & Arthritis Center at New York University (NYU) Langone Health. “Think of it as maintaining a shock absorber around the joints.” Strengthening exercises are also beneficial for keeping bones strong, since people with rheumatoid arthritis are more prone to getting osteoporosis.

Aerobic heart-pumpers are another important part of the keep-fit equation, since poor cardiovascular health is the main cause of death in rheumatoid arthritis patients. Physicians give high marks to peddling on a stationary bike (a great workout for your knees and your ticker) and pretty much anything water-related — in particular, swimming and water aerobics. The buoyancy of the water helps support body weight, which means these types of exercises don’t impact heavily on the joints. “Plus, many water aerobics classes are done in warm water, which feels wonderful,” Jeter notes.

Stamp out stress

Research shows that stress and pain like to feed off of one another. “Feeling a twinge of pain may make you feel anxious,” Jeter says. “And when you feel anxious, you focus more on the pain.” Biofeedback therapy can help you break the cycle by changing the way your body responds to pain. “Being aware of your body’s stress response, and learning to decrease it, is particularly important for inflammatory arthritis,” says Darcy Mandell, associate staff psychologist in the Chronic Pain Rehabilitation Program at the Cleveland Clinic.

How it works: A trained practitioner attaches sensors to your skin at specific locations to enable you to read measures of your heart rate, blood pressure, muscle activity and body temperature. Looking at a monitor, you can see how these functions change when you’re faced with a stressful situation (for example, your heart rate might go up, your muscles may tighten, and you may start taking faster breaths). Armed with this information, you can learn, through trial and error, which techniques — say, deep breathing or visualization — can best help you “control” the inner workings your body so that you can better cope with pain.

“When you practice these techniques and become good at them, you can actually calm yourself anywhere,” Jeter says. What’s more, research suggests that controlling anxiety can lead to pain relief. “Inability to regulate or decrease the stress response system can lead to activation of autoimmune chemicals that prompt flares,” Mandell says. “Biofeedback can change some of the biological mechanisms that affect how often patients have those flares.”

You can find a certified practitioner at the Biofeedback Certification International Alliance website. One way to measure your stress responses at home, Mandell says, is by using a stress thermometer (available for sale online), which uses your hand temperature. (The warmer your hands are — somewhere around 90 degrees — the more relaxed you are; the cooler your hands are — in the 60- to 79-degree range — the more stressed you are.)

Down an anti-opioid

Here’s an interesting twist: Some physicians are using a powerful medication (naltrexone) that’s normally used to treat opioid addiction, off-label (meaning for a condition it hasn’t officially been approved for) and in very low doses, to treat a host of inflammatory pain conditions — fibromyalgia and rheumatoid arthritis among them.

How researchers suspect low-dose naltrexone (LDN) works: In certain chronic pain conditions, glial cells, the main cells in the nervous system, get overactivated and secrete a storm of cytokines, which triggers inflammation and increases pain sensitivity. “We think that low-dose naltrexone slowly into the central nervous system and calms down the glial cells so they stop secreting so many cytokines,” Jeter says. “Over time, pain improves because the central nervous system isn’t so revved up and irritated.”

Two reasons why the medication is attractive to physicians: There are few side effects, and the drug doesn’t seem to lead to dependency. “It’s being studied for use in a number of conditions,” says Jeter, who prescribes the drug in order to avoid adding an opioid to treat chronic pain.

The 4 Stages of Rheumatoid Arthritis Progression

Disease-modifying anti-rheumatic drugs (DMARDs) are usually the first line in medication. “Methotrexate is the anchor drug for rheumatoid arthritis,” Dr. Bhatt says. “Some patients are scared because methotrexate is also used for cancer chemotherapy so they don’t want to take a ‘chemo pill,’ but those we use for RA are a very small dose with lesser chance of side effects.” Your doctor will reassess in a month or so and see if it’s necessary to add in other drugs.

“If after three to six months they have still not responded then we progress to medications called biologics,” Dr. Bhatt says. These genetically engineered drugs target the inflammation process specifically, and are usually self-injected or infused via IV in your doctor’s office or a medical center. “There are sub-classes and different types,” Dr. Bhatt says. Your doctor will try various medications to see which you respond best to.

Understanding a “Treat-to-Target” Approach

Rheumatologists follow a “treat-to-target” strategy when it comes to how to manage the disease and prevent progression. This means treating the disease aggressively until a treatment target, such as low disease activity, is reached.

“The concept of treat to target is a partnership between patient and physician to get RA into a state of low disease activity or remission,” Dr. Lally says. “This approach requires routine examinations usually every three months. If there is evidence that the RA is not adequately controlled, the medication regimen is changed in an attempt to get to the target of remission.”

But, Dr. Bhatt says. “there’s a balance — if we treat RA too aggressively it can cause side effects; at the same time we do not want to leave persistent joint inflammation.” Working with the level of RA control the patient wants, the ultimate goal is normal joints and minimal disease activity within a specified time frame.

RA Progression Isn’t Inevitable

Thanks to the newer treatments available — and more on the horizon — RA doesn’t have to mean a life of eventual disability or even limited mobility. “It’s not an inevitable thing nowadays,” says Dr. Bhatt. “People can have a normal life.”

But patients do have to be sure to follow their treatment plan and doctor’s recommendations. “Routine follow-up with a rheumatologist who performs joint exams, follows levels of systemic inflammation in the blood and can assess function is the best way to ensure RA is being controlled and is not progressing,” Dr. Lally says.

Keep Reading

  • Is It Safe to Taper Biologics in Rheumatoid Arthritis Once You Achieve Low Disease Activity?
  • Almost Half of People with RA Stay on Their Current Medication, Even If They’re Not Meeting Treatment Goals
  • How Should You Decide What RA Medication to Take Next?

Foods You Should Avoid with Rheumatoid Arthritis

Clinical Contributors to this Story

Halyna Kuzyshyn, M.D. contributes to topics such as Arthritis, Men’s Health, Women’s Health.

By Brianna McCabe

Roughly 54 million adults have been doctor-diagnosed with arthritis – and according to the Arthritis Foundation, the number of people battling this disease by 2040 is projected to soar to over 78 million.

Arthritis is a general term that encompasses conditions of joint pain and functional limitations. Symptoms of joint swelling, pain, stiffness, and a decreased range of motion mark the illness.

There are many different types of arthritis, divided into two main categories: inflammatory and non-inflammatory. The most common form of non-inflammatory arthritis is osteoarthritis, while the most common inflammatory arthritis is rheumatoid arthritis.

Rheumatoid arthritis is an autoimmune inflammatory illness that occurs when joints and other tissues are mistakenly attacked by the immune system. Halyna Kuzyshyn, M.D., board certified in rheumatology and internal medicine, explains that if the tissue remains inflamed it can lead to the loosening of tendons and ligaments while also destructing joints with cartilage damage, bone erosion, and loss of function.

Early diagnosis and aggressive treatment with disease-modifying anti-rheumatic drugs is critical to reducing inflammation and pain, improving physical functions, and preventing further joint damage. However, Dr. Kuzyshyn advises that a person’s diet can be complimentary to medication and can help to control inflammation. “After all, we are what we eat,” she says.

While there is no concrete research on diets that can treat rheumatoid arthritis, researchers have identified certain pro-inflammatory foods. Dr. Kuzyshyn advises that the following six foods should be avoided – or at least limited – to help reduce inflammation and joint pain:

  1. Grilled, broiled, or fried meats (and other fried foods). “Meats contain high levels of advanced glycation end products (AGEs), a toxin that generates inflammatory reactions and leads to tissue damages within the body,” explains Dr. Kuzyshyn. “When cooking meats at particularly high heat levels, such as frying, grilling or broiling, more AGEs are formed in foods and trigger an inflammatory response.” Instead, it is recommended to steam, simmer, or braise lean proteins.
  2. Fatty foods full of omega-6 fatty acids. Trans fat, also known as trans-unsaturated fatty acids or trans fatty acids, are typically found in packaged goods, margarine, and vegetable oils and are used to reduce the chance of food spoilage and increase the shelf life. “Research has shown that the consumption of trans fats can increase inflammation,” says Dr. Kuzyshyn. “Additionally, trans fats can increase the risk of insulin resistance and obesity, which is a known risk factor for rheumatoid arthritis.” Trans fats can also raise bad cholesterol and lower good cholesterol, which increases the risk of heart disease.
  3. Sugars and refined carbohydrates. Digesting these molecules triggers the release of cytokines, or inflammatory messengers in the body. “Sodas, juices, and pastries are full of sugars that lead to inflammation,” notes Dr. Kuzyshyn. Individuals should also be on the lookout for sugar substitutes and foods that end in –ose: fructose, sucrose, glucose. “I’m not telling you to cut out cookies and cakes forever,” she reassures. “But definitely just have them on occasion. While they may satisfy your taste buds, your joints may not be so happy.”
  4. Gluten. If a person already has a sensitivity to gluten, foods containing the substance should be avoided.
  5. Preservatives and flavor enhancers. Monosodium glutamate (MSG), a chemical ingredient added to many foods as a flavor enhancer, has been shown to trigger inflammation. “Make sure to really pay attention to your food labels,” advises Dr. Kuzyshyn.
  6. Alcohol. “Alcohol in moderation might be okay,” says Dr. Kuzyshyn. “In fact, red wine contains resveratrol which has been found to have anti-inflammatory effects. On the other hand, though, too much alcohol can cause liver damage, enhance medication-induced liver toxicity (particularly if you take methotrexate), and cause inflammation.” It is recommended that women consume no more than one glass of wine per day, and men consume no more than two. If you are taking non-steroidal anti-inflammatory drugs or acetaminophen, alcohol can increase your risk of stomach bleeding and liver problems, respectively. “Be mindful of your medications and talk with your doctor about any potential side effects,” she warns.

Dr. Kuzyshyn practices at Hackensack Meridian Health Medical Group – Rheumatology. If you would like to schedule an appointment with Dr. Kuzyshyn, call 732-897-3985. To find a provider near you, visit HackensackMeridianHealth.org.

The material provided through Health Hub is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.

10 Ways to Find Relief From Chronic Rheumatoid Arthritis Pain

Getting a massage can help reduce muscle tension and joint pain. Jon Feingersh/Getty Images

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From fatigue to loss of appetite, rheumatoid arthritis (RA) can impact your life in a number of ways, but the most limiting symptom for many people is pain. Because that pain comes in different forms, you may need more than one strategy to relieve it.

“The primary cause of RA pain is inflammation that swells joint capsules,” says Yousaf Ali, MBBS, a professor of medicine at the Icahn School of Medicine and chief of the division of rheumatology at Mount Sinai West Hospital in New York City. Joint capsules are thin sacs of fluid that surround a joint, providing lubrication for bone movement. In RA, the body’s immune system attacks those capsules.

The first goal of pain relief is the control of inflammation, Dr. Ali explains. “Inflammation can cause acute (short-term) pain or longer-lasting, smoldering pain,” he says. “Chronic erosion of joint tissues over time is another cause of chronic pain. But there are many options for pain relief.”

Getting RA pain under control may take some work. You may need to take several drugs — some to slow joint damage and some to alleviate joint pain — as well as experiment with lifestyle adjustments and alternative therapies to find relief. It may take some time, too.

Treatments and Strategies to Help Relieve Chronic RA Pain

Try the following strategies — with your doctor’s supervision — to discover which are most effective for you.

1. Inflammation medication “In the case of RA, all other pain-relief strategies are secondary to controlling inflammation,” Ali says. That means treating with medications that alter the course of the disease — such as disease-modifying anti-rheumatic drugs (DMARDs), biologics, or janus kinase (JAK) inhibitors. “Steroids may be used to bridge the gap during an acute flare,” adds Ali, though they’re typically only used for a short period of time, due to the side effects they’re associated with.

These drugs each work differently to suppress the body’s overactive immune system response and are also used to prevent joint damage and slow the progression of the disease. They’re often prescribed shortly after an RA diagnosis in order to prevent as much joint damage as possible — though it may take up to six months or so to fully feel the drug’s benefits. It can also take time to find the right treatment — or combination of treatments — to help you gain control of your RA.

2. Pain medication The best drugs for acute pain, Ali says, are nonsteroidal anti-inflammatory drugs, called NSAIDs. While NSAIDs help treat joint pain, research has shown that they don’t prevent joint damage.

“Stronger pain relievers, called opioids, may be used for severe pain, but we try to avoid them if possible,” says Ali. “These drugs must be used cautiously because of the potential to build up tolerance, which can lead to abuse.”

3. Diet Although some diets may be touted to help RA symptoms, they aren’t backed by the medical community. “There is no evidence that any special diet will reduce RA pain,” Ali says. But there is some evidence that omega-3 fatty acids can help reduce inflammation — and the joint pain that results from it. Omega-3s can be found in cold-water fish and in fish oil supplements. According to findings presented at the 2019 annual meeting of the American College of Rheumatology, people with RA who took omega-3 supplements might have less painful and swollen joints, and lower disease activity scores. However, fish oil supplements aren’t a substitute for following your RA treatment plan.

4. Weight management Maintaining a healthy weight may help alleviate joint pain. A study published in March 2018 in the International Journal of Clinical Rheumatology found that clinically relevant weight loss — defined as at least 11 pounds — was associated with improved RA symptoms, including less tender and swollen joints.

5. Massage A massage from a therapist (or even a DIY massage) can be a soothing complementary therapy to help reduce muscle and joint pain. According to the Arthritis Foundation (AF), it’s best to first check with your doctor to get the green light to try massage, as certain techniques apply a lot of pressure to your muscles and joints. Once you have your doctor’s approval, be sure to tell your massage therapist that you have RA. And remember: Massage should make you feel better, not worse.

6. Exercise Although you may not feel like exercising when you have RA, and it might seem that being active could put stress on your joints, gentle exercises can actually help reduce muscle and joint pain. “Non-impact or low-impact exercise is a proven way to reduce pain,” Ali says. “I recommend walking, swimming, and cycling.” In fact, one of the best exercises you can do for RA is water aerobics in a warm pool, as the buoyancy of exercising in water reduces stress on your joints.

The AF also recommends yoga as another option to help reduce RA pain, and traditional yoga poses can be modified to your abilities. Yoga may also help improve the coordination and balance that is sometimes impaired when you have the disease. When it comes to exercise, though, be sure to use caution. Talk with your doctor if any workouts are making your pain worse, and in general, put any exercise plan on hold during an RA flare.

7. Orthoses These mechanical aids can help support and protect your joints. Examples include padded insoles for your shoes and splints or braces that keep your joints in proper alignment. You can even get special gloves for affected hand and finger joints. A physical therapist can help you determine the best orthoses options for you.

8. Heat and cold Heat helps to relax muscles, while cold helps to dull the sensation of pain. You might find that applying hot packs or ice packs, or alternating between hot and cold, helps reduce your joint pain. Relaxing in a hot bath can also bring relief, as can exercising in a warm pool.

9. Acupuncture This Eastern medicine practice has been around for centuries and is thought to work by stimulating the body’s natural painkillers through the use of fine needles gently placed near nerve endings. “Acupuncture can be helpful for some patients, but the pain relief is usually not long-lasting,” says Ali.

10. Transcutaneous electrical nerve stimulation (TENS) This form of therapy uses low-voltage electric currents to stimulate nerves and interfere with pain pathways. “TENS is usually used for stubborn, chronic pain and not as a first-line treatment for RA,” Ali says. One of the benefits of this treatment is the low occurrence of side effects. If you’re interested in trying TENS for pain relief, talk with your physical therapist. If you have a pacemaker, a heart problem, or epilepsy — or you’re pregnant — get your doctor’s approval first before trying TENS.

Remember, you’re not alone — your RA care team can help you find relief from chronic pain. If you’re experiencing more pain than before, or if pain is interfering with your ability to get things done, don’t hesitate to talk to your doctor. Ask your rheumatologist about pain relief options, like exercise, massage, yoga, and acupuncture; but remember that your first priority should be to get RA inflammation under control.

Additional reporting by Erica Patino

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