Managing With Rheumatoid Arthritis

'With No Cure, Good Management IS Good Living'

The Short Answer –

Rheumatoid Arthritis is an incurable auto-immune disease. It can sound like a death sentence. In reality however, managing with Rheumatoid Arthritis should be about a change in direction.

The key to managing successfully is a combination of early diagnosis and making small, deliberate changes to keep the rest of your life on track. Below we look at what those changes could be, and how to manage them best.

Managing With Rheumatoid Arthritis

There are three key aspects to managing with rheumatoid arthritis – coping with the mental side of chronic pain, slowing the progression of your disease and reducing the pain levels to keep living a full life.

It’s important that you try to manage each aspect, since managing the pain is pointless if your disease is allowed to progress unchecked until it gets so bad that eventually the pain becomes unmanageable anyway.

Similarly, slowing it’s progression holds little value if you are so depressed about the potential impacts of your condition that you don’t want to go out and live the life you want to follow.

We will try to go through each strategy separately to provide clarity – but in reality they should all form parts of the same treatment plan, created by your lead doctor (preferably a Rheumatologist) for your medical team to work with (family doctor, physio, pain specialist, occupational therapist and others).

As always though, I have more time than in this article than any normal doctor will have, so you should pick up considerable extra advice for countering this disease.

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Managing The Mental Challenge Of Rheumatoid Arthritis.

This is often ignored by doctors who are more concerned with the obvious pain or disease progression, but is very likely to have an even more significant impact on both your quality of life and disease fighting capacity than any ‘treatment or drug’ can give you.

Coming to terms with a diagnosis such as rheumatoid arthritis is huge and can’t be understated. Take time out for yourself to work it out in your own mind. Join support groups to discuss it with fellow sufferers and undertake counselling.

“I Don’t Need Counselling…”

Even if you don’t think you need to, you may be shocked by how much better you feel in the long run. Finding out you have a disease that will know be with you for the rest of your life is no easy thing to just ‘accept and move on’.

Ultimately, it is a case of finding whatever works for you. But make sure you keep trying until you find some sort of peace.

You are unlikely to ever be ‘fine’ with such a disease, but it is super important that you at least undergo some form of ‘acceptance and commitment therapy’.

If you don’t, if is likely that you will end up suffering with some form of depression, even one you don’t realise, that will enhance the pain reception from your body and make your life a much darker place.

“Even Darker Options…”

There is another option of course – that of anti-depression medications, but the list of side effects and their highly addictive nature makes them a real risk with any long-term condition and as such not really the best option for managing with rheumatoid arthritis.

Managing Rheumatoid Arthritis By Slowing It’s Progression.

When it comes to physically suppressing the development of the disease, most of the proven options are pharmaceutical-based.

DMARDs

We have made recent huge advances in this area though and a relatively new class of medications known as the DMARDs or ‘Disease-Modifying Antirheumatic Drugs’, have come available. These work by trying to suppress your immune system.

As rheumatoid arthritis is an autoimmune disease, it is your own immune system that is effectively attacking you, because it thinks your own white blood cells are now foreign antibodies. DMARDS work by trying to suppress this same immune response.

A Major Downside To DMARD’s…

Unfortunately, this does have one very obvious downside (without taking in to account any drug side effects) – and that is you are also hampering your bodies ability to fight off genuine invaders. This is therefore likely to leave you particularly vulnerable to other infections/ diseases.

Typical examples of DMARDs include Methotrexate (the most widely used), Sulfasalazine, Hydroxychloroquine, Leflunomide and Azathioprine.

There is no guarantee which DMARD will be used if you have rheumatoid arthritis. Frequently you’ll be started on one and if that doesn’t work, you’ll either be changed to another or a second one will be added to provide you with a combination.

Each has different side effects and is ideal for different people. Only your rheumatologist could give you a truly informed opinion on your particular case.

Biologic Agents

Another option if DMARDs don’t work for you at all is another class of medications known as ‘biologic agents’.

These are also referred to sometimes as ‘biologic DMARDs’ or ‘Anti-Tumor Necrosis Factor (TNF)-a therapy’.

This is another whole class of drugs including etanercept, adalimumab, infliximab, certolizumab pegol, golimumab, anakinra, abatacept, rituximab, and tocilizumab, that can also be used in isolation or in combination with a DMARD to slow down the progression of your rheumatoid arthritis.

The individual drug(s) selected for you by your rheumatologist will depend on many factors, not least the stage that your current disease is at. I seem to be always shouting about how important it is to get a diagnosis of rheumatoid arthritis early – BUT IT REALLY IS!

As a clinical paper published in ‘Best Practice & Research Clinical Rheumatology’ pointed out

“There is increasing evidence that the first few months after symptom onset represent a pathologically distinct phase of disease. This very early phase may translate into a therapeutic window of opportunity during which it may be possible to permanently switch off the disease process.”

In other words, catching rheumatoid arthritis early may be your ONLY chance of stopping it’s progression. After that, it’s back to just trying to slow the progression.

Managing With Rheumatoid Arthritis Pain

I have covered more specific pain treatments for rheumatoid arthritis based on where it presents itself in other sections (rheumatoid arthritis in the hands etc). I did this because there are very specific treatments/ remedies for pain relief in the feet that are not applicable to the hands or the spine and so on.

However, there are also a range of treatments that will help you when managing with rheumatoid arthritis and these can be split into the pharmaceutical drugs or more natural options.

With Drugs…

Managing with rheumatoid arthritis pain can be achieved both with natural remedies or, to some extent, with the use of drugs.

In the case of finding pharmaceutical solutions, it is likely you will be offered an NSAID as a painkiller. This stands for Non Steroidal Anti Inflammatory Drug. These include aspirin and ibuprofen, as over the counter options, but also have stronger variants available by prescription such as Naproxen.

I have covered the dangers of taking these for long-term use here and specifically the dangers of taking aspirin or ibuprofen on a daily basis.

As with everything though, it’s a risks vs benefits decision and depending how bad your pain is and what it is stopping you doing, will define how far down the line towards the ultimate painkillers (opioid narcotics), your doctor is likely to want to go.

More Natural Options…

Sleep

All Pain Can Be Related To Sleep according to the National Rheumatoid Arthritis Society and there is a lot of truth in this statement.

Certainly, a lack of sleep not only makes a huge difference to your bodies’ interpretation of the pain signals, but also leaves you sufficiently vulnerable that exactly the same pain stimulus will have significantly more effect on a tired mind/ body, than a refreshed one.

Follow An Anti-Inflammatory Diet

Inflammation around your joints is a key part of how rheumatoid arthritis attacks your body. An anti-inflammatory diet is one that specifically reduces foods that are rich in antioxidants and therefore helps to control inflammation.

The purpose of the NSAIDs above is to control the inflammation as one aspect that causes pain. Removing all or most of the parts of your diet proven to enable further inflammation will have the same basic effect, without the potential side effects. Learn more about the specifics of following ‘an anti inflammatory diet plan’.

Hot And Cold Therapies

These are universal treatments for pain, successful because the while the heat relaxes muscles around your joints, the cold stimulates blood flow and the healing process. Hot/ cold baths can do the job or just buy relatively cheap compresses to save on water bills.

Mind Over Matter

This has a variety of applications. I recently wrote an article on something I do strongly believe in – self hypnosis for pain relief. If you imagine that cigarettes are one of the most addictive substances known to humans, but many people have given up completely over a course of hypnosis, then it must have potential.

Indeed when it comes to pain relief, there is a surprising amount of evidence to greatly support it’s use. But it doesn’t end there – CBT or cognitive behavioural therapy is another practice that can teach your brain new ways of thinking about problems.

The Placebo Effect…

One of the main reasons I know that mind over matter does work is the numerous trials with placebo medications. It is accepted scientific fact that if I gave 100 patients a pill for pain relief that does absolutely nothing (it’s a placebo with no chemicals in whatsoever), then percentage of people (maybe 20%, maybe 40%) will report back that it worked.

They do this because they believe their symptoms will reduce strongly enough that it convinces their brain to re-interpret the pain signals to what they think they SHOULD be feeling.

There is also now even further scientific background to this in that our understanding of chemical ‘receptors’ in the brain has changed as well. I won’t go in to this in too much detail here (I’ll cover the facts in a later article), but in short most medicines only work because we have receptors that respond to them in our brain.

We only have these receptors however, because our body can naturally reproduce the same chemicals and therefore the same effect.

Adding this to our knowledge that the brain can control how much of various hormones/ chemicals the body produces, it follows that if we can alter our brain to produce more of a certain substance, then we don’t need a painkiller to do the same thing.

That may be a different debate altogether, because you then have to factor in the power/ influence of the pharmaceutical sector as a whole, but the takeaway is that we can now PROVE that the body is capable of treating itself if you learn how to switch it on.

The brain is the most powerful tool we have in our bodies and, even the most hardened of doctors, knows the power of a different mindset.

Balancing Work With Rest

This is vital because rest is when your body can recover. But not only that – it is also your route to living the fullest life possible.

There are two key aspects to balancing work with rest…

1) Make sure you get as much undisturbed, unbroken restorative sleep as possible to allow your muscles around aching joints to recover. I’ve written in more length about this in ‘sleeping with pain’, but suffice to say for all chronic pain, getting deep sleep is essential.

2) Plan your days accordingly. Rheumatoid Arthritis can get worse as the day progresses, so to make sure that it doesn’t ruin any potential important events for you (such as putting children to bed or attending sports days etc). Plan you activities well in advance.

Even just surfing social media can leave your fingers in agony and suffering a headache. All of this may seem ok, but if it means you cant play with your children/ grandchildren when they come round because you are in too much pain, then it could be better managed.

Exercise

As always, keeping your joints and the ligaments, tendons and muscles around them, as active as possible is very important.

One major benefit to exercise is that it helps to build strength in supporting tissues to help protect your affected joints, while some of the other benefits include the natural endorphin-induced high you get from exercise, the overall benefit to your health and a great escape from the day to day drudgery of managing your rheumatoid arthritis.

Supplements

I will be covering this in a separate article, but suffice to say there are a range of supplements that claim to be able to help your management, either through pain reduction or slowing the rheumatoid onset.

Each has pros and cons, some supplements have much more evidence behind their use than others. It really just depends.

Some people swear by certain ones, others label them a waste of money. We are conducting our own research, and from that you can make up your own mind.

Supportive Equipment

From special utensils to walking canes and crutches, there are a whole range of dedicated support tools, designed to help you continue to remain mobile – no matter where your rheumatoid arthritis strikes.

Rheumatoid arthritis can strike in even the smallest actions – from opening a can of beans to standing up. 

Getting the correct specialized equipment is absolutely essential in enabling you to keep doing everything you enjoy and maintaining your independence. We will be reviewing exactly what to look for in your supportive equipment sometime in mid-May 2020, so check back here for a dedicated section of supportive equipment and where to look for it.

The Final Word –

Managing with rheumatoid arthritis really comprises three fundamental goals – managing the mental side of having an incurable disease, developing a strategy to slow down or even stop the progression of your autoimmune disease and finally a strategy for reducing the pain of arthritis.

Hopefully, you will have received a good insight in to how each one of these can be achieved. Feel free to ask any questions below if you require more information…

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References –

1. Karim Raza MRCP PhD, Caitriona E. Buckley MRCP, Mike Salmon FRCPath PhD, and Christopher D. Buckley. (Oct 2006). Treating very early rheumatoid arthritis. Best Practice & Research Clinical Rheumatology.
2. ‘Managing the pain of rheumatoid arthritis’. National Rheumatoid arthritis Society.

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