Rheumatoid arthritis pain management

While you may not be able to avoid the pain that comes with rheumatoid arthritis (RA), you can take action to limit it. Start with these eight ideas:

  1. Take your pain medication on a schedule and as prescribed. Don’t wait until you are in more pain and have to play “catch-up.”
  2. Use a warm, moist compress to loosen up a stiff joint. Try an ice pack on an inflamed joint. Massage may also help. These tried-and-true treatments are easy and can provide some quick relief for mild symptoms.
  3. Make it a priority every day to relax. If you need ideas for healthy ways to manage stress, ask your doctor or a counselor. You may want to try meditation, too.
  4. Focus on things you enjoy.
  5. Join a support group. It’s a great place to talk with people who know what you are going through because they are, too.
  6. Exercise. It will make your joints feel better, not worse. Even if you’re in pain, there are some exercises you can do. Talk to your doctor or a physical therapist about what’s best for you.
  7. Eat a healthy, balanced diet. Don’t turn to “comfort food,” cigarettes, or alcohol.
  8. Consider talking to a counselor. These professionals are a great source of support. They can help you look for new solutions to make your life better.

Treatment for Rheumatoid Arthritis

Surgical Options

When joint damage becomes permanent and mobility and function are impaired due to severe inflammation and deformities, surgery may be the only option. Since surgery carries its own risks, it’s important to discuss with your doctor whether or not you are a candidate for this intervention.

Joint replacement therapy may provide relief and restore function, replacing damaged parts of a joint with metal and plastic parts and splints. This therapy can be applied to hips, knees, ankles, shoulders, wrists, and elbows, according to the Arthritis Foundation.

Surgery for rheumatoid arthritis may include a variety of minimally invasive procedures around the damaged joint. These include: a synovectomy, which aims to remove the damaged lining of the joint; repairing loose or ruptured tendons around the joint due to excessive damage; and joint fusion to stabilize or realign a joint if replacement isn’t an option, according to the Mayo Clinic.

-Additional reporting by Steven Aliano

Updated on: 10/03/19 Continue Reading: Understanding Rheumatoid Arthritis Symptoms and Causes

299. Pain Management in Patients with Rheumatoid Arthritis

Background: National guidance highlights the importance of pain management in patients with RA. Pain is also an important component of the DAS 28 and may persist despite the absence of inflammation. We were keen to investigate the factors influencing pain within our RA cohort.

Methods: Patients with RA were recruited consecutively from the outpatient clinic. A face to face interview was performed to determine (i) whether their pain had been discussed during the consultation and (ii) their understanding and beliefs about pharmacological and non-pharmacological aspects of pain management. Demographics, past medical history, comorbidities and disease activity were also collated.

Results: 31 patients (12 male and 19 female patients) were recruited with an average age of 66.6 years and a mean disease duration of 9.4 years. Patients had a mean of 3.2 comorbidities and were taking a mean of 8.5 different medications which resulted in an average of 15.4 tablets daily. Despite an overall average DAS28 of 3.1, only 7 patients (22.5%) felt their pain was managed all of the time and 13% said their pain was never controlled. The majority of patients were taking paracetamol (81%), 19% were taking NSAIDs and 58% were taking a weak opioid. Only 48% reported taking their analgesics at regular intervals. 87% said that they were able to discuss their pain in clinic but only 68% recalled having been asked how the pain impacted on their lives. Most patients felt that they had been provided with sufficient information on pain management; however, it was felt that further education about pain medications and non-pharmacological pain management techniques would be helpful. Although no correlation was seen between the numerical pain score and the DAS28, the worst pain was seen in those with poor RA control, rather than in those where pain was felt to be mainly as a result of secondary degenerative change. There was some evidence that those who felt they were given the opportunity to discuss their pain management at every visit and how it affected their life felt that their pain was better managed. The number of comorbidities and number of medications taken did not influence objective measures of pain or how well pain was managed. Although 8 patients had been referred to the pain clinic, only 3 found it helpful; whereas all 3 who had participated in the expert patient programme found it to be of benefit.

Conclusion: Patients benefit from being given the opportunity to discuss pain and its impact on daily life. Pain remains a prominent feature even after inflammation is controlled. Access to pain management resources is therefore important at all stages of disease and should be as important as education on disease modifying drugs.

Disclosure statement: The authors have declared no conflicts of interest.

RA Pain Management: What to Ask Your Doctor

Why does RA hurt?

The inflammation from RA causes painful swelling. Nodules can form at pressure points, such as your elbows. These can occur almost anywhere on your body. These nodules can become tender and painful.

What are my medical options for managing pain?

Your doctor will go over several strategies for managing your pain. These include prescription and over-the-counter drugs as well as other medical treatments. All of these medications have their own set of side effects. Ask your doctor about the risks and benefits.

Pain relievers

You likely already have nonsteroidal anti-inflammatory drugs, or NSAIDs, in your medicine cabinet. These drugs include common over-the-counter pain relievers like ibuprofen (Motrin or Advil) and naproxen (Aleve). These medications are good for relieving pain and inflammation.

Acetaminophen (Tylenol) may also be used to relieve pain, but it will not help with inflammation. It can be used alone or in combination with NSAIDs.

DMARDs and biologics

Disease modifying antirheumatic drugs (DMARDs) work by reducing the inflammation that can cause pain. These drugs actually slow the progression of RA and can prevent permanent damage. Biologic drugs specifically target the cells of the immune system and pro-inflammatory molecules involved in inflammation.

Learn more: Rheumatoid arthritis DMARDs list “

Corticosteroid injections

Corticosteroids can be injected directly into the joint. They can relieve pain and inflammation for weeks at a time. Trigger point injections involve injecting a numbing medication into your muscle. They may help with RA-related muscle pain.

Alternative treatments

Your doctor may refer you to practitioners who specialize in alternative treatment options. Alternative treatments include massage, acupuncture, or topical electrical nerve stimulation. Ask your doctor about any risks involved in alternative treatments. Also ask about the results you might expect from treatment.

What can I do in my day-to-day life to help manage pain?

While medications are often the first line of treatment for RA, there are also things you can do at home to help ease your pain and symptoms. Sometimes, simple changes to your routine can make a big difference in your pain level.

Changing your household gadgets can make daily activities easier on your hands. For example, lever door handles and electric can openers are easier than door knobs and manual can openers. Ask your doctor about other gadgets and tools that can make daily tasks easier for you.

Assistive devices such as canes or walkers can reduce the weight and stress on joints in your lower body. Ask your doctor if one of these is a good option for your lifestyle.

Try rearranging your cabinets and closets. Putting the items that you use most within easy reach means you can get to them without stooping or straining. You can also try changing your schedule. Take advantage of the times of day you feel best and get things done during those times. Take naps during the day to help you avoid fatigue.

Talk with your doctor about what else you can do at home to help manage your pain.

How should I exercise?

You likely know that overdoing any activity can make joints tender and sore. However, it may be a surprise to learn that sitting or lying still for long periods of time can make joints even more stiff and painful. Ask your doctor about what types of exercise are safe for you. Also ask them which forms of fitness would be most effective for your RA.

In general, low-impact or no-impact exercises are good choices for strengthening muscles and loosening joints. Water aerobics and swimming are good options. Look up if there are exercises classes in your area. If not, ask your doctor how you can exercise at home. Gentle stretching may also aid in pain relief. As a bonus, you may even lose some weight. Weight loss could make a big difference in the amount of stress on your joints and could help ease your pain.

Rheumatoid Arthritis: Management and Treatment

How is rheumatoid arthritis treated?

The goals of rheumatoid arthritis treatment are to:

  • Control a patient’s signs and symptoms.
  • Prevent joint damage.
  • Maintain the patient’s quality of life and ability to function.

Joint damage generally occurs within the first two years of diagnosis, so it is important to diagnose and treat rheumatoid arthritis in the “window of opportunity” to prevent long-term consequences.

Treatments for rheumatoid arthritis include medications, rest, exercise, physical therapy/occupational therapy, 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 the severity of the arthritis.

Non-pharmacologic therapies

Non-pharmacologic therapy is the first step in treatment for all people who have rheumatoid arthritis. Non-pharmacologic therapies include the following:

Rest

When joints are inflamed, the risk of injury to the joint and to nearby soft tissue structures (such as tendons and ligaments) is high. This is why inflamed joints should be rested. However, physical fitness should be maintained as much as possible. Maintaining a good range of motion in your joints and good fitness overall are important in coping with the overall features of the disease.

Exercise

Pain and stiffness often prompt people with rheumatoid arthritis to become inactive. However, inactivity can lead to a loss of joint motion, contractions, and a loss of muscle strength. These, in turn, decrease joint stability and increase fatigue.

Regular exercise, especially in a controlled fashion with the help of physical therapists and occupational therapists, can help prevent and reverse these effects. Beneficial workouts include: range-of-motion exercises to preserve and restore joint motion; exercises to increase strength, and; exercises to increase endurance (walking, swimming, and cycling).

Physical and occupational therapy

Physical and occupational therapy can relieve pain, reduce inflammation, and help preserve joint structure and function for patients with rheumatoid arthritis.

Specific types of therapy are used to address specific problems of rheumatoid arthritis:

  • The application of heat or cold can relieve pain or stiffness.
  • Ultrasound can help reduce inflammation of the sheaths surrounding tendons (tenosynovitis).
  • Exercises can improve and maintain range of motion of the joints.
  • Rest and splinting can help reduce joint pain and improve joint function.
  • Finger-splinting and other assistive devices can prevent deformities and improve hand function.
  • Relaxation techniques can relieve secondary muscle spasm.

Occupational therapists also focus on helping people with rheumatoid arthritis continue to actively participate in work and recreational activity, with special attention to maintaining good function of the hands and arms.

Nutrition and dietary therapy

Weight loss may be recommended for overweight and obese people to reduce stress on inflamed joints.

People with rheumatoid arthritis have a higher risk of developing coronary artery disease. High blood cholesterol (a risk factor for coronary artery disease) can respond to changes in diet. A nutritionist can recommend specific foods to eat or avoid in order to reach a desirable cholesterol level.

Changes in diet have been investigated as treatments for rheumatoid arthritis, but no diet has been proven to cure it. No herbal or nutritional supplements, such as cartilage or collagen, can cure rheumatoid arthritis. These treatments can be dangerous and are not usually recommended.

Medications

There are many medications to decrease joint pain, swelling, and inflammation, and prevent or slow down the disease. The type of drugs that your doctor recommends will depend on how severe your arthritis is and how well you respond to the medications.

These medications include:

It may take four to six weeks of treatment with methotrexate, one to two months with sulfasalazine, and two to three months with hydroxycholoroquine to see an improvement in symptoms.

Biologics tend to work rapidly, within two weeks for some medications and within four to six weeks for others. Biologics may be used alone or in combination with other DMARDs. Usually they are reserved for patients who do not adequately respond to DMARDs, or if the prognosis (outlook) for the patient is problematic.

Other precautions to note with these drugs:

  • DMARDs and biologic agents interfere with the immune system’s ability to fight infection and should not be used by people who have serious infections.
  • Anti-TNF agents such as infliximab, etanercept, adalimumab, certolizumab and golimumab are not recommended for people who have lymphoma or who have been treated for lymphoma. People with rheumatoid arthritis–especially those with severe disease–have an increased risk of lymphoma, regardless of what treatment is used. Anti-TNF agents have been associated with a further increase in the risk of lymphoma in some studies but not others. More research is needed to define this risk.
  • Testing for tuberculosis (TB) is needed before starting anti-TNF therapy. People who have evidence of earlier TB infection should be treated for TB, because there is an increased risk of developing active TB while receiving anti-TNF therapy.

Some of these medications are traditionally used to treat other conditions, such as cancer, inflammatory bowel disease and malaria. When these drugs are used to treat rheumatoid arthritis, the doses are much lower and the risks of side effects tend to be considerably less. However, the risk of side effects from treatment must be weighed against the benefits on an individual basis.

When you are prescribed any medication, it is important to meet with your physician regularly so he or she can watch for any side effects.

Surgery

When bone damage from the arthritis has become severe or pain is not controlled with medications, surgery is an option to restore function to a damaged joint.

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