MANAGING RHEUMATOID ARTHRITIS

For rheumatoid arthritis, an accurate diagnosis is the first step in determining an appropriate treatment. The earlier this happens the more options available to effectively treat symptoms and prevent damage to joints.

Rheumatoid arthritis is an autoimmune disorder caused by the immune system mistakenly attacking the body’s tissues. It affects the lining of the joints, causing painful swelling that can eventually result in bone erosion and joint deformity.

According to the Arthritis Foundation, you should see a health care provider if you have the following symptoms:

• Joint pain, tenderness, swelling, or stiffness that lasts for six weeks or longer.
• Morning stiffness that lasts for 30 minutes or longer.
• Symptoms affecting more than one joint.
• Symptoms affecting the small joints (wrists, certain joints in the hands and feet), these are typically affected first.
• Symptoms affecting the same joints on both sides of the body.
• Fatigue and a low-grade fever.

HOW IS RHEUMATOID ARTHRITIS DIAGNOSED?

There are many ways to treat and manage rheumatoid arthritis (RA) and no single test to determine if you have it. If you have signs and symptoms of RA, your doctor will examine your joints and take your medical history. Your health care provider may also order blood tests that detect inflammation or X-rays to look for signs of joint damage. If RA is suspected, you will be referred to a specialist called a rheumatologist.

In its early stages, effects from RA may not appear on an X-ray, but at this time they can be helpful for identifying a baseline for your condition and measuring its progression. Your health care practitioner might order X-rays of your hands, a common area where RA can develop. On the X-ray image, the radiologist will look for:

• Bone damage, such as erosions.
• Bony growths called bone spurs or osteophytes.
• Cysts, fluid-filled spots that form in bone.
• Narrowing of the joint space, which occurs when the cartilage degrades and the bones in the joint get closer together.
• Thickening and hardening of the bone underneath the cartilage in a joint, called subchondral sclerosis.
• Swelling of the joints between the hand and fingers (metacarpophalangeal joints) and malalignment.
• Soft tissue swelling and calcification.

Other medical imaging exams that may be ordered to investigate RA, could include magnetic resonance imaging (MRI) or ultrasound. They can help provide information about cartilage, tendons, and other structures in the joint, as well as showing the presence of swelling caused by too much fluid in your tissue (edema).

WHAT ARE THE TREATMENT OPTIONS FOR RHEUMATOID ARTHRITIS?

Initial treatments for rheumatoid arthritis often start with exercise and weight loss or diet changes. Other treatments can include anti-rheumatic and anti-inflammatory medication, as well as intra-articular corticosteroid injections.

Steroid injections may be an option for when the bones show damage and the space between the bones begins to narrow. The procedure locally introduces a corticosteroid (an anti-inflammatory medication) to decrease inflammation and reduce pain. A small dose of steroids is injected into the joint under image guidance to keep potential side effects of any systemic medication to a minimum. Results can last from weeks to months depending on the joint involved, severity of the arthritis, and the specific cause of pain. Some patients get complete relief after a single injection. These injections must be ordered and monitored by your health care practitioner since steroids may become less effective with repeated injections and may have effects on the rest of your body over time.

Viscosupplement injections may also be a treatment option. This procedure involves the injection of hyaluronic acid (HA) – a viscose substance normally present in healthy joints. When injected into affected joints, these gel-like substances improve mobility, reduce pain, and lubricate the joint. They also have a mild anti-inflammatory effect. They are best performed under image guidance to ensure the solution is delivered exactly where you need it and are generally reserved for larger joints such as the hip, knee, ankle, wrist, or shoulder. The relief may take a few weeks. Occasionally, patients may experience a post-injection flare after HA with increased pain and stiffness. This could be due to the viscosity of the injection and settles with oral anti-inflammatories or a subsequent steroid injection.

Surgery may also be an option to address damage caused by RA. The type of surgery depends on which joint is affected and what is needed. Surgery may be needed to replace a joint, remove debris or inflamed tissue from a joint, or relieve pressure on nerves.

Arthritis conditions are chronic (long-term) and, although there is no cure, treatment can help reduce your symptoms and make it possible for you to lead a full and active life. Studies suggest treatment in early stages of the disease is the most effective way to prevent progression. In most cases, you can manage mild to moderate arthritis symptoms for many years with a treatment plan. It’s also important to thoroughly discuss all your options with your health care practitioner, especially in the later stages of the disease.

For more information on pain management injections, please speak to your health care practitioner.

REFERENCES

American College of Rheumatology (2024) “Hyaluronic Acid.” rheumatology.org. Accessed June 25, 2024.

Arthritis Foundation (2021) “Rheumatoid Arthritis: Causes, Symptoms, Treatments and More.” arthritis.org. Accessed June 25, 2024.

Arthritis Society Canada (2023) “Rheumatoid Arthritis Treatment Options.” arthritis.ca. Accessed June 25, 2024.

Edwards, J. M. (2023) “What You See on X-Rays When You Have Rheumatoid Arthritis.” healthline.com. Accessed June 25, 2024.

Frank, J. (2021) “Rheumatoid Arthritis (RA) Diagnosis.” arthritis-health.com. Accessed June 25, 2024.

Government of Canada (2020) “Rheumatoid arthritis in Canada.” Canada.ca. Accessed June 25, 2024.

Healthwise Staff (2023) “Rheumatoid Arthritis.” myhealth.alberta.ca. Accessed June 25, 2024.

Mayo Clinic Staff (2023) “Rheumatoid arthritis.” mayoclinic.org. Accessed June 25, 2024.