What helps with rheumatoid arthritis?

10 Ways to Get Rheumatoid Arthritis Pain Relief

Chronic pain is the No. 1 symptom of rheumatoid arthritis (RA), a chronic condition that affects about 1.3 million American adults. Rheumatoid arthritis occurs when the immune system begins to attack the synovium, a thin layer of soft tissue inside joints that provides cushioning and lubrication. As the synovium degrades, joints begin to swell and lose their flexibility. People with RA experience inflammation and swelling that causes joint pain and stiffness in the hands, knees, hips, and wrists, making it hard for them to move around, grip objects firmly, and perform many other everyday tasks.

When thinking about rheumatoid arthritis pain relief, it’s helpful to break the pain down into three different classifications, says Nortin M. Hadler, MD, professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill and attending rheumatologist at UNC Hospitals. These categories include:

  • Joint pain. “It runs in a range from mild to quite severe, almost always is waxing and waning, and always tends to be what we consider the biggest problem,” Dr. Hadler says.
  • Joint stiffness. As the disease progresses, you may begin to lose flexibility in the affected joints, and the more flexibility you lose, the more the joints hurt, says Hadler.
  • Emotional pain. All this pain and stiffness can begin to take an emotional toll on you. “It can be the dominant hallmark of the illness,” Hadler says. “It’s a consequence of the compromise in personal effectiveness — as in ‘who am I and how do other people perceive me and what can I accomplish?’ For many people with the disease, it’s this emotional component that’s overwhelming.”

Getting Rheumatoid Arthritis Pain Relief

Here are 10 ways to help manage all the types of pain that accompany rheumatoid arthritis.

  • Medication. There is a wide range of medication available to treat rheumatoid arthritis. Some agents, like over-the-counter NSAIDs and prescription corticosteroids, help relieve pain by reducing inflammation. Anti-rheumatic drugs like methotrexate treat the disease itself.
  • Diet. Losing weight by eating a balanced diet can reduce stress and strain on your joints. Some early research suggests that increasing your intake of omega-3 fatty acids by eating fish or taking supplements may help reduce joint inflammation. On the other hand, limiting your consumption of red meat and saturated fats could help because they contain arachidonic acid, a fatty acid that promotes inflammation.
  • Heat and cold therapy. Applying cold packs or ice bags to an aching joint can numb the pain and reduce inflammation and is particularly useful during an arthritis flare-up. Heat therapy through the use of heating pads, warm baths, or other methods can help relax muscles and stimulate blood flow in the area of the joint.
  • Massage. Hands-on therapy can bring great relief to muscles and joints, helping to relax and warm muscles that have become tense through chronic pain. Massage can also promote the release of endorphins, naturally produced hormones that act as painkillers. You can try self-massage or visit a licensed massage therapist to help soothe your aches and pains.
  • Exercise. It is essential to stay fit, as strong muscles can better support joints racked by arthritis pain. “Most joints on muscle,” Hadler says. “Part and parcel of joint inflammation is that the muscles around the joint get weaker, and then the joint is less effective.” Exercise can also improve flexibility and reduce symptoms of pain. Talk with your doctor about good forms of exercise for your particular arthritis symptoms. Non-impact exercises like water aerobics are often best.
  • Occupational therapy. An occupational therapist can help you avoid pain by coming up with alternative ways to perform household and work tasks that reduce the stress placed on your joints. These can include custom splints that help support particular joints or tools to ease tasks like opening jars.
  • Counseling. Seeing a therapist can help you deal with issues like depression and anxiety that may stem from your arthritis pain. A therapist also can coach you in coping skills that will allow you to better deal with pain from arthritis flare-ups.
  • Meditation. Meditation can shift your attention away from your pain by helping you relax and focus on more pleasant things.
  • Music therapy. Listening to calming or soothing music has been shown to help relieve chronic pain and stress. Choose the music yourself or consult with a credentialed music therapist.
  • Support groups. It’s easy to become something of a hermit when dealing with chronic arthritis pain, as you don’t want to move around too much. Joining a support group can keep you from feeling isolated and lonely. Members of the group can also provide tips on managing pain based on what’s worked for them.

The pain of rheumatoid arthritis can lead to frustration, but these coping methods can minimize its effects on your daily routine.

Tips for dealing with rheumatoid arthritis flare-ups

There are currently no medications that can cure RA or consistently prevent flares. The goal of treatment is to reduce symptoms, minimize inflammation, and prevent joint damage.

People can try the following techniques and home remedies to relieve their symptoms when they feel an RA flare coming on:

Managing flares at home

Share on PinterestWriting down potential flare triggers and symptoms can help people deal with RA flares.

Being aware of the early symptoms of flares is useful for preventing and dealing with them.

1. Keep a symptoms journal

It can be beneficial to keep a journal of potential flare triggers and symptoms to try to identify when and why the flares happen. Avoiding triggers and resting may be enough to manage a minor flare.

2. Rest more

Once a flare starts, many people will need to reduce their activity levels.

During severe flares, people may need to rest completely. Working from home and having a reliable support system of family and friends in place can help.

3. Exercise gently

Doing gentle range-of-motion exercises and stretches can prevent stiffness when an RA flare occurs.

4. Use hot or cold packs

Hot or cold packs can help reduce joint pain and swelling. People can start using these packs as soon as symptoms appear and continue to use them throughout the flare.

It is essential to avoid placing hot or cold substances directly on the skin. Instead, wrap the pack in a towel before applying it to the affected area.

5. Make dietary changes

Following an anti-inflammatory diet can help prevent flares and improve RA symptoms when they do occur.

People wishing to follow this diet should avoid processed foods, refined sugars, and artificial ingredients, and eat a Mediterranean diet that is rich in whole foods.

Foods that people with RA should incorporate into their diet include:

  • foods rich in omega-3 fatty acids, such as flaxseed, chia seeds, walnuts, salmon, and tuna
  • foods rich in antioxidants, including colorful vegetables, fruits, beans, cacao, and cinnamon
  • extra-virgin olive oil
  • nuts and seeds

6. Try a dietary supplement

According to the Arthritis Foundation, certain herbal supplements can help relieve the symptoms of a flare. These supplements include:

  • curcumin, a chemical in turmeric
  • ginger
  • fish oil or omega-3 with EPA and DHA
  • capsaicin
  • gamma linolenic acid (GLA)

Specific vitamin and mineral supplements may also be helpful, including:

7. Reduce stress

Share on PinterestMeditation can help reduce stress.

Reducing stress is essential for preventing flares or shortening their length and reducing symptoms. People can try the following techniques to reduce stress when they feel a flare coming on:

  • meditation
  • guided imagery
  • deep breathing
  • mind-body exercises, such as yoga and tai chi
  • journaling
  • positive thinking
  • gratitude practice

Medications

It is possible to divide the medications that doctors usually prescribe for RA into three major groups:

  • Medications to treat symptoms. Steroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen are among the medicines that can relieve the inflammation and acute pain that RA may cause.
  • Immunosuppressant drugs. These treatments slow the progression of RA and prevent joint damage by halting the body’s inflammatory response. They are also known as disease-modifying antirheumatic drugs (DMARDs).
  • Biologic response modifiers. These drugs are a newer generation of DMARDs, which mimic human immune molecules. Biologics inhibit the inflammatory response in a more targeted way.

Rheumatoid Arthritis: How to Treat

What is rheumatoid arthritis?

Arthritis is a general term that describes inflammation in joints. Rheumatoid arthritis is a type of chronic (ongoing) arthritis (resulting in pain and swelling) that occurs generally in joints symmetrically (on both sides of the body, such as hands, wrists and knees). This involvement of several joints helps distinguish rheumatoid arthritis from other types of arthritis.

In addition to affecting the joints, rheumatoid arthritis may occasionally affect the skin, eyes, lungs, heart, blood, nerves or kidneys.

What are the goals of treating rheumatoid arthritis?

The most important goal of treating rheumatoid arthritis is to reduce joint pain and swelling and to maintain and/or improve joint function.

The long-term goal of treatment is to slow or stop the disease process, particularly joint damage, which can be seen on X-rays. Once joint inflammation is controlled, pain will be reduced.

Normal joint (left) and joint affected by rheumatoid arthritis

In the past, many doctors did not believe that drugs for rheumatoid arthritis changed the likelihood of eventual disability from the disease. Therefore, drugs with the fewest side effects were prescribed to decrease pain. Stronger drugs were avoided because of doctors’ concerns about dangerous side effects.

Now, however, doctors know that early treatment with certain drugs can improve the long-term outcome for most rheumatoid arthritis patients. Numerous drugs that have been shown to be effective are being used soon after the patient is diagnosed. Combinations of drugs are proving to be more effective than a single drug therapy and, in recent studies, have been found to be just as safe as single-drug treatment.

What drugs are used to treat rheumatoid arthritis?

The drugs used to treat rheumatoid arthritis can be divided into three groups:

  • Drugs that decrease pain and inflammation. These products include non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin®), naproxen (Aleve®), and other similar products. Another type of drug – the COX-2 inhibitor – also falls into this drug category, providing relief of the signs and symptoms of rheumatoid arthritis. Celecoxib (Celebrex®), one COX-2 inhibitor, is available and used in the United States. The COX- 2 inhibitors were designed to have fewer bleeding side effects on the stomach.
  • Disease-modifying antirheumatic drugs (DMARDs). Unlike other NSAIDs, DMARDs can actually slow the disease process by modifying the immune system. Older DMARDs include methotrexate (Trexall®), gold salts, penicillamine (Cuprimine®), hydroxychloroquine (Plaquenil®), sulfasalazine (Azulfidine®), cyclosporine (Sandimmune®), cyclophosphamide (Cytoxan®) and leflunomide (Arava®). Currently, methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine are the most commonly used. (Cyclosporine, cyclophosphamide, gold salts, and penicillamine are not used any more.) Many of these drugs were first used to treat other medical conditions – such as malaria, transplant rejection, cancer, psoriasis and inflammatory bowel disease – but have now also found a role in treating rheumatoid arthritis.

DMARDs are used both alone and in combination. Methotrexate, for example, is often used as a major part of a combination drug regimen, which includes low doses of corticosteroids (such as prednisone or cortisone) as well as other drugs. Treatment to improve symptoms may require four to six weeks of methotrexate, one to two months of sulfasalazine, and two to three months of hydroxycholoroquine.

  • Biologics. Beyond these more “traditional” DMARDs, newer medications have been approved. Currently, there are seven different classes of medications and, in some cases, there are different kinds in each class. (Some of them, such as the class anti-TNFs, have been used since 2000.) Collectively, these DMARDs are known by another name – biologic agents (or biologic response agents). Compared with the traditional DMARDs, these products target the molecules that cause inflammation in rheumatoid arthritis.

Inflammatory cells in the joints are involved in the development of rheumatoid arthritis itself. The biologic agents cut down the inflammatory process that ultimately causes the joint damage seen in rheumatoid arthritis. The older DMARDs work one step further out than the biologics; they work by modifying the body’s own immune response to the inflammation. By attacking the cells at a more specific level of the inflammation itself, biologics are considered to be more effective and more specifically targeted. The biologic agents include etanercept (Enbrel®), infliximab (Remicade®), adalimumab (Humira®), anakinra (Kinaret®), abatacept (Orencia®), rituximab (Rituxan®), certolizumab pegol (Cimzia®), golimumab (Symponi®), tocilizumab (Actemra®) and tofacitinib (Xeljanj®). Some of the biologics are used in combination with the traditional DMARDs, especially with methotrexate.

How well do the drugs work? Are they dangerous?

All the drugs used to treat rheumatoid arthritis have been tested and have been proven useful in patients who have the disease. However, they all work on a different aspect of the inflammatory process seen in rheumatoid arthritis and their use – as well as their side effects — depends on the current disease status of each patient and any associated medical problems that a patient may have. The effectiveness and the risks of drugs are considered when your rheumatologist plans your treatment.

If a drug is very effective in treating an illness but causes a lot of side effects, it is not an ideal treatment for long-term use. For example, high doses (15 to 20 mg or more per day) of corticosteroids can make people with rheumatoid arthritis feel dramatically better. However, high doses of corticosteroids may cause serious side effects when taken over many months or years. Steroids have many possible side effects, including weight gain, worsening diabetes, promotion of cataracts in the eyes, thinning of bones (osteopenia and osteoporosis), and an increased risk of infection. Thus, when steroids are used, the goal is to use the lowest possible dose for the shortest period of time.

  • NSAIDs. All of the NSAIDs are similarly effective, making it difficult for doctors to strongly recommend one over the other. These drugs can cause irritation of the stomach and kidney damage as side effects. Therefore, their use in people with severe stomach and kidney problems should be closely supervised by doctors.
  • COX-2 anti-inflammatory agents. These drugs work by restraining a certain enzyme in the body (cyclooxygenase 2, i.e., COX-2), which in turn reduces the amount of bad prostaglandins. Thus, inflammation is reduced, leaving the other good prostaglandins that protect the stomach and kidneys alone. COX-2 inhibitors are sometimes used in patients who cannot take ordinary NSAIDs, such as those who are concerned about stomach ulcers and gastric irritation.
  • DMARDs. The “traditional” DMARDs work by a different mechanism than NSAIDs and work well. For example, methotrexate is widely used and most effective in providing benefits for people with rheumatoid arthritis. It is often referred to as the “cornerstone of therapy” and is used alone or in combination with other drugs. However, traditional DMARDs act slowly after starting the drug for several weeks.
  • Biologic agents. Biologic agents are more specifically targeted at the inflammatory process seen in rheumatoid arthritis. This leads to another big advantage of using the biologics: they tend to be better tolerated and sometimes able to work faster than traditional DMARDs. However, all of the biologic agents can have side effects and will need to be used under the supervision of your rheumatologist.

(Note: DMARDs and biologic agents interfere with the immune system’s ability to fight infection and should not be used in people with serious infections.)

  • Anti-TNF agents: 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 in the past; 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 necessary before starting anti-TNF therapy. People who have evidence of an earlierTB infection should be treated because there is an increased risk of developing active TB while receiving anti-TNF therapy.

How will my doctor choose drugs that are right for me?

Your doctor will work with you to develop a treatment program. The drugs your doctor prescribes will match the seriousness of your condition.

Your doctor will combine the results of your medical history, physical exam, X-rays and blood tests to create your treatment program. The doctor will also consider your age, sex, physical activity, other medications you are taking and any other medical conditions you may have.

It is important to meet with your doctor regularly so that he or she can closely monitor you for any side effects and change your treatment, if necessary. Your doctor may periodically order blood tests or other tests to determine the effectiveness of your treatment and any side effects.

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RA Pain: What is the Best Pain Relief for Rheumatoid Arthritis?

Hugh Duckworth MD

Doctor of Medicine (M.D.) in 1984 from University of Tennessee School of Medicine

Oct 7, 2018 4 min read

Rheumatoid arthritis is a chronic disease that can cause severe and debilitating symptoms for patients of many ages. Fortunately, there are several treatment options available today to help control the disease and reduce inflammation, which is the primary cause of pain.

One of the most important aspects of treatment is rheumatoid arthritis pain management. For patients who suffer from chronic pain or frequent flare-ups, knowing how to manage pain on an ongoing basis and as needed is an important part of improving quality of life.

Rheumatoid Arthritis Pain Management

While the overall goal of rheumatoid arthritis therapy is to prevent disease progression and further joint damage, pain management is a necessary daily practice for patients, in order to maximize their quality of life. Chronic pain can adversely affect a patient’s ability to work, participate in physical and social activities, and can generally interrupt day-to-day life.

Despite medications and aggressive forms of treatment, many rheumatoid arthritis patients experience ongoing pain and stiffness. The reality is, it may never completely go away. But there are specific things patients can do to manage pain and limit its impact on their lives.

Pain Management Strategies

Pain management practices must be included in a patient’s overall treatment strategy. There are many different rheumatoid arthritis pain management practices for patients to incorporate into their treatment.

Some of the most effective and widely used rheumatoid arthritis pain management practices include:

  • Choosing the right medications
  • Heat and cold packs
  • Physical and occupational therapy
  • Following the right diet
  • Getting enough exercise
  • Attending pain clinics

Rheumatoid Arthritis Medications

Finding the right rheumatoid arthritis medication for your unique case is critical in treating the disease, reducing inflammation, and alleviating pain.

Rheumatoid arthritis patients are typically placed on an aggressive medical treatment plan that includes conventional disease-modifying antirheumatic drugs (DMARDs) and immunotherapy drugs called biologic response modifiers.

Between specialized rheumatoid arthritis medications and nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics and corticosteroids, patients have several medication options available, which all help to reduce inflammation and alleviate pain.

Heat and Cold

Alternating between heat and cold packs can help to ease pain from inflammation for rheumatoid arthritis patients. Cold packs help to numb the feelings of pain, and heat relaxes muscles and joints. A hot water bath can also help soothe joint pain. By using heat and cold regularly, it can help to manage painful symptoms as they arise.

Physical and Occupational Therapy

Physical therapy helps you to restore joint function through specific exercise. This can help alleviate pain for many patients. Activities like cooking and bathing can sometimes be difficult to perform and may cause pain. Occupational therapy will help you to learn how to change some of your daily behaviors so they aren’t painful.

Other professional therapy services that can help alleviate pain include massage therapy and acupuncture.

Diet can help play a role in rheumatoid arthritis pain management. It is important to maintain a healthy weight when suffering from rheumatoid arthritis. Obesity and its related healthcare issues can significantly impact the management of your RA.

There are also certain foods that have anti-inflammatory properties such as omega-3 fatty acids which are found in fish oils. Consult a medical professional about the option to take fish oil supplements to possibly control your inflammation levels.

A key component of rheumatoid arthritis pain management and treatment is moderate and regular exercise. Staying physically active helps maintain and improve joint function and range of motion.

Exercises like running, cycling, swimming, and walking can all improve your physical health, give you more energy, and elevate your mood. Consult your doctor about the types of exercises that will help your unique case of rheumatoid arthritis.

Pain Clinics

Some patients don’t respond to their treatments and still suffer from chronic pain. In these cases, doctors may recommend looking at other therapeutic options in conjunction with their medical treatments.

Pain clinics offer a variety of rheumatoid arthritis pain management services including physical and occupational therapy, as well as other complementary and alternatives medicines. These may include acupuncture, massage, meditation, mindfulness, and other healing therapies.

Tips for Rheumatoid Arthritis Pain Management

Other than the pain itself, rheumatoid arthritis can cause many other problems and disruptions in life. There are some things you can do to stay healthy and reduce your pain. These are in addition to your regular treatments.

Here are some tips to help you with your rheumatoid arthritis pain management and coping with the disease:

Don’t smoke: Smoking can have serious health consequences on rheumatoid arthritis patients. Smoking causes inflammation, which can complicate these disease and cause more pain.

Be conscious of your use of joints: Try reducing the stress on your joints by being conscious of your daily activities. Picking up items and turning door handles can add pressure to your joints causing them to feel sore. Look for ways to adjust your daily habits and limit the aggressive use of your joints.

Talk to your doctor and rheumatologist: If you still feel pain despite treatment, or you notice new pain, be sure to communicate with your physician and your rheumatologist. There may be additional pain relieving options available.

Seek emotional support: Deal with any stress or trauma you may feel by joining a support group of other rheumatoid arthritis patients. Professional counseling may also help improve your mood and help you to remain positive.

Practice deep breathing: Deep breathing and relaxation exercises can help you to feel more relaxed and can help take your mind off feelings of pain. Spend one to minutes breathing deeply to help deal with any stress or emotions that occur with chronic pain.

Stay well rested: Rest is a critical component of remaining healthy, keeping your energy levels up, and improving your immune system function. It also can help to relax muscles and joints, limit your stress levels, and fight fatigue.

If you continue to experience chronic pain, there are several options for you to try. Talk to your rheumatologist about rheumatoid arthritis pain management options that are right for your individual case.

Rheumatoid Arthritis Medication List

NSAIDs are among the most commonly used RA drugs. Unlike other pain relievers, NSAIDs seem to be more effective in treating symptoms of RA. This is because they prevent inflammation.

Some people use OTC NSAIDs. However, stronger NSAIDs are available with a prescription.

Side effects of NSAIDs include:

  • stomach irritation
  • ulcers
  • erosion or burning a hole through your stomach or intestines
  • stomach bleeding
  • kidney damage

In rare cases, these side effects can be fatal (cause death). If you use NSAIDs for a long time, your doctor will monitor your kidney function. This is especially likely if you already have kidney disease.

Ibuprofen (Advil, Motrin IB, Nuprin)

OTC ibuprofen is the most common NSAID. Unless instructed by your doctor, you should not use ibuprofen for more than several days at a time. Taking this drug for too long can cause stomach bleeding. This risk is greater in seniors.

Ibuprofen is available in prescription strengths as well. In prescription versions, the dosage is higher. Ibuprofen may also be combined with another type of pain drug called opioids. Examples of these prescription combination drugs include:

  • ibuprofen/hydrocodone (Vicoprofen)
  • ibuprofen/oxycodone (Combunox)

Naproxen sodium (Aleve)

Naproxen sodium is an OTC NSAID. It’s often used as an alternative to ibuprofen. This is because it causes slightly fewer side effects. Prescription versions of this drug offer stronger dosages.

Aspirin (Bayer, Bufferin, St. Joseph)

Aspirin is an oral pain reliever. It’s used to treat mild pain, fever, and inflammation. It can also be used to prevent heart attack and stroke.

Prescription NSAIDs

When OTC NSAIDs don’t relieve your RA symptoms, your doctor may prescribe a prescription NSAID. These are oral drugs. The most common options include:

Other NSAIDs include:

Diclofenac/misoprostol (Arthrotec)

Diclofenac/misoprostol (Arthrotec) is an oral drug that combines the NSAID diclofenac with misoprostol. NSAIDs can cause stomach ulcers. This drug helps prevent them.

Topical capsaicin (Capsin, Zostrix, Dolorac)

Capsaicin topical OTC cream can relieve mild pain caused by RA. You rub this cream on painful areas on your body.

Diclofenac sodium topical gel (Voltaren 1%)

Voltaren gel 1% is an NSAID for topical use. This means you rub it on your skin. It’s approved to treat joint pain, including in your hands and knees.

This drug causes similar side effects to oral NSAIDs. However, only about 4 percent of this drug is absorbed into your body. This means that you may be less likely to have side effects.

Diclofenac sodium topical solution (Pennsaid 2%)

Diclofenac sodium (Pennsaid 2%) is a topical solution used for knee pain. You rub it on your knee to relieve the pain.

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