Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks the joints producing an inflammatory synovitis that often progresses to destruction of the articular cartilage and ankylosis of the joints. Rheumatoid arthritis can also produce diffuse inflammation in the lungs, pericardium, pleura, and sclera, and also nodular lesions, most common in subcutaneous tissue under the skin. Although the cause of rheumatoid arthritis is unknown, autoimmunity plays a pivotal role in its chronicity and progression.
What most sources don’t tell you clearly is that Rheumatoid Arthritis (RA) is one of the most painful diseases around. RA causes people to lose more days from work than nearly any other disease. The joint pain can be unrelenting, not to mention the stiffness and swelling. As mentioned above, it doesn’t just affect the joints. It can affect any connective tissue in the body. Accompanying all of this is unrelenting fatigue. No medication and no treatments currently available seem to relieve the fatigue. Even on days when a person has little or no joint pain or stiffness or swelling, there frequently is so much fatigue that the person cannot accomplish anything!
There is no “cure” for RA. Some medications may help cause or maintain a “remission” which may last for weeks, months or even years. The problem is, no one medication “works” for all patients. There are multiple medications which fall under several classifications.
Once, it was thought that a patient should be started on the mildest drugs possible – nonsteroidal anti-inflammatory drugs (NSAIDS [aspirin, ibuprofen, naproxen, Celebrex, ) – and kept on them until they no longer “worked.” (Of importance, NSAIDs do not slow RA progression.) Only then were patients moved to stronger drugs. The current trend is to start patients on a class of drugs called Disease-Modifying Anti-Rheumatic Drugs (DMARDS) as soon as RA is diagnosed. DMARDs are further subdivided into traditional small molecular mass drugs synthesised chemically (Ridaura, Imuran, Myochrysine, Plaquenil, Arava, Methotrexate) and newer ‘biological’ agents produced through genetic engineering (Enbrel, Humira, Remicade, Kineret, Rituxan, Orencia, Simponi). All of these drugs may be used singly or in various combinations depending on the individual patient’s response.
Not all patients will respond to DMARDS. For others, DMARDS have too many side-effects. For these patients steroids (Prednisone, Celestone, may be used.
Treatment may also include non-pharmacologic measures such as physical therapy and occupational therapy.
For me, the joint destruction has been slowed, and the pain kept under fair control with a combination of Plaquenil and Methotrexate (MTX). To reduce some of the side effects of MTX, I also take Leukovorin and Folic Acid. After 5 years, however, I am noticing this regimen is not “holding” me as well as it used to. I’m starting to have more pain and stiffness in my feet, ankles, knees, hips. The pain and stiffness in my hands and wrists are getting worse, also, and my shoulders and elbows are beginning to give trouble. My back has been pathologic for several years, but is much worse now, requiring me to wear a rather complicated back brace when being upright for more than an hour at most.
Some days are worse than others. Changes in weather, especially cooling, drops in pressure, and changing from dry to rainy (or other precipitation) will cause me to have swollen, painful joints. This lasts until the weather stabilizes one way or the other.
The fatigue factor probably bothers me more than anything. I can only “push” myself so far, then I will literally collapse. The Ol’ Curmudgeon (AKA my husband) is able to “read” my body better than I can, and will force me to stop working or leave a party or get-together sooner than I would have myself. Shortly after we leave, I realize I am “sinking” into a “lake” of fatigue and am unable to swim out of it! The only on that will work for me at that point is to go to bed and sleep at least 8 – 10 hours!
RA does not define who I am or what my life must be, but it does affect how I approach life and what I can do. There is another entity – Fibromyalgia – that I will describe in another post, later.