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This page has been written for people affected by osteoarthritis.
It provides general information to help you understand how osteoarthritis affects you and what you can do to manage it. It also tells you where to find further information and advice.
What is osteoarthritis (OA)?

Osteoarthritis (OA) is a condition that affects the joints. In a normal joint, the ends of the bones are covered by a layer of cartilage. artilage helps the joint move smoothly and cushions the ends of the bones. In OA, the cartilage brea!s down and becomes thin. This leaves the ends of the bones unprotected, and the joint loses its ability to move smoothly. OA mainly affects people over the age of "#, but it can develop in younger people. Osteoarthritis is different to osteoporosis. Osteoporosis is a condition where the bones become fragile and brittle, causing them to brea! more easily.
What are the symptoms?

The symptoms of OA vary from person to person. $our symptoms will also depend on which joints are affected. OA tends to come on slowly, over months or even years. The most common symptoms are pain and stiffness of the joints. These feelings are usually worst after resting or not moving the joint for a while. These symptoms may affect your ability to do normal daily activities, such as wal!ing, climbing stairs and opening jars.
What causes it?

In many people there is no clear cause of OA. %esearch shows there are some things that may put you at more ris! of developing OA in certain joints, such as&

!nees& being overweight, having a previous !nee injury, jobs involving !neeling, climbing and s'uatting hips& being overweight, having a previous hip injury, jobs involving lifting heavy loads (including farming) hands& having a history of OA in the family.
How is it diagnosed?
$our doctor will diagnose OA from your symptoms and a physical e(amination. An ()ray may show the narrowing and changes in the shape of your joint. *owever ()rays do not diagnose how much trouble you will have. An ()ray that shows joint damage does not always mean you will have a lot of pain or problems. On the other hand your joint may be very painful despite ()rays being normal. +lood tests are only helpful to rule out other types of arthritis.
What will happen to me?

The impact of OA on your normal activities and lifestyle depends on which joints are affected. *owever the outloo! for most people with OA is very positive. ,or many people OA will be
mild and not cause major problems. OA of the hip and !nee rarely causes severe disability but, when it does, surgery to replace joints is often very effective.
Is there a cure for OA?

urrently there is no cure for OA. -hile there are treatments that can effectively control symptoms, you should be wary of products or therapies that claim to cure OA.
Living with Osteoarthritis

3 Print
-hat treatments are there for OA.

Treatments for OA vary depending on which joints are affected and the severity of your condition. There is no way of predicting exactly which treatment will work best for you. ach treatment has its own benefits and risks. !our doctor may need to trial several different treatments before finding the one that is right for you.
"n general terms# treatment usually includes$

simple pain relief# using medicines such as paracetamol non%steroidal anti%inflammatory drugs &'(A")s* an exercise program designed to suit your needs a weight loss program# if you are overweight joint replacement surgery# if your symptoms are no longer controlled with other therapies.
-hat can I do.

See your doctor for treatment and advice. $our doctor will help you get the right treatment to manage your symptoms. /ee the -or!ing with your healthcare team page. earn a!out OA and play an active role in your treatment. 0ot all information you read or hear about is trustworthy so always tal! to your doctor or healthcare team about treatments you are thin!ing about trying. /elf management courses aim to help you develop s!ills to be actively involved in your healthcare. lic! here for details of these courses. earn ways to manage pain. /ee the 1ealing with pain page for more information.
Stay active. 2(ercise is strongly recommended for people with OA. It !eeps your joints and muscles healthy and fle(ible and prevents other health problems. $ou may find it useful to see a physiotherapist or other health professional for advice. Have a healthy diet. There is no diet that will cure OA, but a well)balanced diet will help you reach and !eep to a healthy weight. "alance your life. 3earn about gadgets that ma!e daily tas!s easier and how to balance rest and activity Ac#nowledge your feelings and see# support. As there is currently no cure for OA, it is natural to feel scared, frustrated, sad and sometimes angry. +e aware of these feelings and get help if they start affecting your daily life.
http$++www.arthritisvic.org.au+,onditions%and%(ymptoms+Osteoarthritis+-iving%with%Osteoarthritis
Osteoarthritis
,ind more resources on living with arthritis by visiting arthritistoday.org
More About
Osteoarthritis
2verything you need to !now about OA Tips to fight osteoarthritis pain an te(ting and other lifestyle factors trigger OA. Osteoarthritis (OA) is one of the most common forms of arthritis. It is a chronic condition in which the material that cushions the joints, called cartilage, brea!s down. This causes the bones to rub against each other, causing stiffness, pain and loss of joint movement. The cause is not fully understood.
People
About 45 million people in America have osteoarthritis. ommon ris! factors include increasing age, obesity, previous joint injury, overuse of the joint, wea! thigh muscles, and genetics.
Symptoms
Osteoarthritis symptoms usually develop gradually. At first, there may be soreness or stiffness that seems more li!e a nuisance than a medical concern. ommon symptoms include&

(ore or stiff joints . particularly the hips# knees# and lower back %% after inactivity or overuse (tiffness after resting that goes away after movement Pain that is worse after activity or toward the end of the day.
Osteoarthritis, or OA, may also affect the nec!, small finger joints, the base of the thumb, an!le, and big toe. The pain may be moderate and come and go, without affecting the ability to perform daily tas!s. /ome people6s OA will never progress past this early stage. Others will have their OA get worse. The pain and stiffness of more severe osteoarthritis may ma!e it difficult to wal!, climb stairs, sleep, or perform other daily tas!s.
Diagnosis
If you have symptoms of osteoarthritis, the doctor will as! 'uestions about your medical history and perform a physical e(am and, possibly, ta!e 7)rays to confirm the diagnosis.
Treatment
There is no cure for osteoarthritis, but there are medications to help relieve pain, when needed. The doctor may recommend physical therapy (8T) or occupational therapy (OT) to help improve strength and function. -hen pain is severe and fre'uent or mobility and daily activities become difficult, surgery may be considered.
Self-Care
/taying physically active and maintaining a healthy weight are the !eys to living well with osteoarthritis. Too little movement can lead to stiffness and wea! joints. 3osing one pound can ta!e four pounds of pressure off your !nee joints. Overall fitness improves health in many ways. /trong muscles protect joints. An OA management plan also involves eating a nutritious diet, managing stress and depression, and getting a good balance of rest and activity each day
http$++www.arthritis.org+conditions%treatments+disease%center+osteoarthritis+
Rheumatoid Arthritis
,ind more resources on living with arthritis by visiting arthritistoday.org
More About
Rheumatoid Arthritis
3earn more about rheumatoid arthritis Tips for daily living with rheumatoid arthritis /lideshow& 9: things to !now about rheumatoid arthritis %heumatoid arthritis (%A) is an autoimmune disease in which your body6s immune system ; which protects your health by attac!ing foreign substances li!e bacteria and viruses ; mista!enly attac!s your joints. The abnormal immune response causes inflammation that can damage joints and organs, such as the heart. 2arly diagnosis and prompt treatment is the !ey to preventing joint destruction and organ damage.
People
About 9.# million people in the <nited /tates have rheumatoid arthritis (%A). 0early three times as many women have the disease as men. In women, %A most commonly begins between ages =: and >:. In men, it often occurs later in life.
Symptoms
The severity of the disease can vary from person to person. /ymptoms can change from day to day. /udden increases in symptoms and illness are called flares. A flare can last for days or months. ?ey rheumatoid arthritis symptoms are pain, fatigue and warm, swollen, reddish joints. 3ong periods of joint stiffness in the morning are common. Inflammation in the small joints of the wrist and hand is typical. If a joint on one side of the body is affected, the same one on the other side is usually affected, too.
Treatment
There is no cure for %A, but there are a number of medications available to help ease symptoms, reduce inflammation, and slow the progression of the disease. 0o one drug wor!s for everyone but many people find treatments that are very effective. The goal of treatment is remission, a state when inflammation is gone or is very low. A doctor, li!ely a rheumatologist )) a specialty doctor who treats people with arthritis )) should monitor your levels of disease activity, or inflammation, on a regular basis through e(ams and blood tests that reveal how well treatment is wor!ing. The doctor may add or change your medications or adjust the dosage after a few months, if the disease is still active.
Self-care
/elf)management is an important part of rheumatoid arthritis care. /taying physically active is the !ey to !eeping joints fle(ible. Too little movement can lead to joint stiffness. /trong muscles protect joints. Overall fitness improves health in many ways. @anaging your weight, eating a nutritious diet and getting a good balance of rest and activity each day are important, too.
http$++www.arthritis.org+conditions%treatments+disease%center+rheumatoid%arthritis+
Juvenile Arthritis
,or everything you need to !now about living with AA clic! here.
What is it?
Arthritis is a comple( family of musculos!eletal disorders consisting of more than 9:: different diseases or conditions that destroy joints, bones, muscles, cartilage and other connective tissues, hampering or halting physical movement. Auvenile arthritis (AA) is an umbrella term used to describe the many autoimmune and inflammatory conditions that can develop in children ages 9> and younger. Arthritis typically affects joints )) the word BarthritisC literally means joint inflammation& arth (joint) and itis (inflammation) ; but AA can involve the eyes, s!in and gastrointestinal tract as well. In addition, there are several different types of juvenile arthritis. As AA6s prevalence rises, researchers and doctors ali!e are wor!ing to develop a more sophisticated understanding of the differences between the different forms. The most common type of AA is juvenile idiopathic arthritis (AIA). To receive a diagnosis, a child should be younger than 9> and have initial swelling in one or more joints for at least si( wee!s.
What causes it?
0o !nown cause has been pinpointed for most forms of juvenile arthritis, nor is there evidence to suggest that to(ins, foods or allergies cause children to develop the disease. /ome research points toward a genetic predisposition, which means the combination of genes a child receives from family members may cause the onset of arthritis when triggered by other factors.
What are the effects?
*aving arthritis will affect your entire family, but you can maintain a sense of calm and normalcy. /tic! to as many of your childDs daily routines and comforting habits as possible. *aving arthritis should be part of your child6s life ; not the central focus of his life. oping with a chronic illness diagnosis is difficult for anyone, but especially for children who are not emotionally or physically e'uipped to handle the situation. 2(pect and prepare for your child to sometimes feel sad or angry that he or she has arthritis. It6s important to address, rather than ignore these emotions. *elp your child maintain the attitude that Barthritis is part of who I am, not the only thing I am.C Arthritis is truly a family diagnosis. 8arents e(perience many emotions ; from sadness to guilt to anger that their child has arthritis. It6s tempting to !eep a low profile and avoid participating in too many activities when your child is first diagnosed, but everyone will benefit by !eeping relationships and schedules as consistent as possible. 8arents should be sure to spend time with their other children and ma!e time for one another ; and themselves. /iblings of children with arthritis will feel a full spectrum of emotion from guilt that they6re healthy, to resentment, anger, loneliness and a need for attention. One !ey to minimiEing sibling tensions is to !eep everyone e'ually involved in and informed about your child6s diagnosis and treatment. If your child who doesn6t have arthritis e(hibits signs of clinginess, an(iety or dangerous behaviors, see! help from a counselor who can help ease this transition for your family.
How is it diagnosed?
The most important step in properly treating your child6s AA is getting an accurate diagnosis. The diagnostic process can be long and detailed, but be patient. $our child6s pediatrician will li!ely recommend that you visit a pediatric rheumatologist who will then ta!e a complete health history to determine the length of time and type of symptoms present. There is no single blood test that confirms juvenile arthritis. In fact, blood testing will reveal relatively little in terms of your child6s diagnosis. In children, the !ey to diagnosis is a careful physical e(am, along with ta!ing a medical history. Along with the physical e(am itself, your child6s doctors will ta!e a number of other diagnostic steps ; such as laboratory wor! and ()rays and other imaging tests ) in part to rule out other
potential causes of symptoms. +lood wor!, for e(ample, can rule out the possibility of an underlying infection.
What are the treatment options?
<nfortunately, there is no cure for juvenile arthritis. The goal of treatment for AA is to relieve inflammation, control pain and improve your child6s 'uality of life. @ost treatment plans involve a combination of medication, physical activity, eye care and healthy eating. 2very treatment plan is uni'ue and re'uires that your childDs health care team, which might include a pediatric rheumatologist, dentist, ophthalmologist, nurse practitioner and physical therapist, among others. @edications used to treat AA can be divided into two groups& those that help relieve pain and inflammation (nonsteroidal anti)inflammatory drugs, or 0/AI1s, corticosteroids and analgesics) and those that can alter the course of the disease, put it into remission and prevent joint damage, a category !nown as disease)modifying anti)rheumatic drugs (1@A%1s) and a newer subset !nown as biologic response modifiers (biologics). 2ach child responds to his or her treatment plan differently, so there6s no set course of attac! for AA. $our childDs doctor might try several different medications andFor dosages until your child responds positively to treatment. /ome medications affect the immune system or have other side effects, ma!ing careful and fre'uent monitoring very important.
http$++www.arthritis.org+conditions%treatments+disease%center+juvenile%%arthritis+
RA Treatment Plan
,ind out about the treatment options are for %A and reaching the goal of remission.
Medications Overview
,rom simple analgesics to cutting)edge biologic treatments, a wealth of options is available to treat rheumatoid arthritis.
Treatment Choices
hoosing an %A treatment means understanding all the options, from mediations, to surgeries and even alternative therapies.
Ongoing Medical Care

%A treatment re'uires fre'uent tests and chec!)ins with your doctor. 1on6t s!ip these important milestones.
Remission
The ultimate goal of %A treatment is remission. And yes, it is possible.
http$++www.arthritistoday.org+about%arthritis+types%of%arthritis+rheumatoid%arthritis+treatment%plan+
Signs and Symptoms
1iscover the signs and symptoms of arthritis and what you can do to !eep them at bay.
Arthritis !ow "t !urts

1ifferent types of arthritis cause different types of pain.
"n#lammation and Sti##ness The !allmar$s o# Arthritis

3earning about these symptoms can help you get the right diagnosis.
Arthritis %lares Are &ormal but Still 'i##icult

/udden increase in symptoms can hit at any time.
%atigue
3earn about the effects of fatigue on arthritis and what you can do about it.
%atigue O#ten Comes Along with Arthritis Pain

,eeling tired can ma!e the pain seem worse.
!ow to (eat %atigue

onstantly feeling tired is a serious issue, but you can beat fatigue and feel more energetic than ever.
Coping )ith %atigue

3earn the cause of this troubling symptom and what you can do about it.
)hen to See a 'octor About %atigue

$ou donDt have to be tired all the time.
(oost *our +nergy )ith +asy Steps

There are easy ways to restore your mind, body and spirit in minutes.
http$++www.arthritistoday.org+about%arthritis+signs%and%symptoms+
he (asics o# Osteoarthritis
(hare this$ /ont si0e$ AAA
Arthritis is a general term that means inflammation of the joints. Osteoarthritis, commonly !nown as wear and tear arthritis, is the most common type of arthritis. It is associated with a brea!down of cartilage in joints and can occur in almost any joint in the body. It commonly occurs in the weight bearing joints of the hips, !nees, and spine. It also affects the fingers, thumb, nec!, and large toe. Osteoarthritis )) also called OA )) usually does not affect other joints unless previous injury or e(cessive stress is involved. artilage is a firm, rubbery material that covers the ends of bones in normal joints. Its main function is to reduce friction in the joints and serve as a Gshoc! absorber.G The shoc!)absorbing 'uality of normal cartilage comes from its ability to change shape when compressed (flattened or pressed together). Osteoarthritis causes the cartilage in a joint to become stiff and lose its elasticity, ma!ing it more susceptible to damage. Over time, the cartilage may wear away in some areas, greatly decreasing its ability to act as a shoc! absorber. As the cartilage deteriorates, tendons and ligaments stretch, causing pain. If the condition worsens, the bones could rub against each other.
Who $ets Osteoarthritis?
Osteoarthritis affects an estimated 45 million Americans. The chance of developing the disease increases with age. @ost people over age >: have osteoarthritis to some degree, but its severity varies. 2ven people in their 4:s and =:s can get osteoarthritis. In people over #:, more women than men have osteoarthritis.
What Are the Symptoms of Osteoarthritis?

/ymptoms of osteoarthritis most often develop gradually and include&

1oint aching and soreness# especially with movement Pain after overuse or after long periods of inactivity (tiffness after periods of rest 2ony enlargements in the middle and end joints of the fingers &which may or may not be painful* 1oint swelling
What %auses Osteoarthritis?

There are several factors that increase a personDs chances of developing osteoarthritis. These include&
Heredity. (ome people have an inherited defect in one of the genes responsible for making cartilage. This causes defective cartilage# which leads to more rapid deterioration of joints. People born with joint abnormalities are more likely to develop
osteoarthritis# and those born with an abnormality of the spine &such as scoliosis or curvature of the spine* are more likely to develop osteoarthritis of the spine. Obesity. Obesity increases the risk for osteoarthritis of the knee# hip# and spine. 3aintaining ideal weight or losing excess weight may help prevent osteoarthritis of these areas or decrease the rate of progression once osteoarthritis is established. Injury. "njuries contribute to the development of osteoarthritis. /or example# athletes who have knee%related injuries may be at higher risk of developing osteoarthritis of the knee. "n addition# people who have had a severe back injury may be predisposed to develop osteoarthritis of the spine. People who have had a broken bone near a joint are prone to develop osteoarthritis in that joint. Joint overuse. Overuse of certain joints increases the risk of developing osteoarthritis. /or example# people in jobs re4uiring repeated bending of the knee are at increased risk for developing osteoarthritis of the knee. Other diseases. People with rheumatoid arthritis# the second most common type of arthritis# are more likely to develop osteoarthritis as well. "n addition# certain rare conditions# such as iron overload or excess growth hormone# increase the chance of developing OA
http$++www.webmd.com+osteoarthritis+guide+osteoarthritis%basics
The (asics o# Osteoarthritis

&continued* (hare this$ /ont si0e$ AAA
How Is Osteoarthritis &iagnosed?

The diagnosis of osteoarthritis is based on a combination of the following factors&

!our description of symptoms The location and pattern of pain Physical exam
$our doctor may use 7)rays to help confirm the diagnosis and ma!e sure you donDt have another type of arthritis. 7)rays show how much joint damage has occurred. An @%I may be necessary to get a better loo! at the joint and surrounding tissues if the 7)ray results do not clearly point to arthritis or another condition. /ometimes blood tests will be given to determine if you have a different type of arthritis.
If fluid has accumulated in the joints, your doctor may remove some of the fluid (called joint aspiration) for e(amination under a microscope to rule out other diseases.
How Is Osteoarthritis 'reated?

Osteoarthritis usually is treated by a combination of treatments, including e(ercise, weight loss if needed, medications, physical therapy with muscle strengthening e(ercises, hot and cold compresses to the painful joint, removal of joint fluid, injection of medications into the joint, and use of supportive devices such as crutches or canes. /urgery may be helpful to relieve pain when other treatment options have not been effective. The type of treatment will depend on several factors including your age, activities and occupation, overall health, medical history, location of your osteoarthritis, and severity of the condition.
How &oes Weight and ()ercise Impact Osteoarthritis?

/taying at your recommended weight helps prevent osteoarthritis of the !nees, hips, and spine, reduces the stress on these weight)bearing joints, and reduces pain in joints already affected. Once you have osteoarthritis, losing weight also can relieve the stress and pain in your !nees. 2(ercise is important to improve joint movement and to strengthen the muscles that surround the joints. Hentle e(ercises, such as swimming or wal!ing on flat surfaces, are recommended because they are less stressful on your joints. Avoid activities that increase joint pain, such as jogging or high impact aerobics. 2(ercises that strengthen the muscles reduce pain in patients wihttp&FFwww.webmd.comFosteoarthritisFguideFosteoarthritis)basics.pageI4th osteoarthritis, particularly with osteoarthritis of the !nee.

What *edications Are +sed to 'reat Osteoarthritis?

The first step with medication is often over)the)counter pain relievers as needed. These include acetaminophen (Tylenol), ibuprofen (Advil, @otrin), and napro(en (Aleve). 1onDt ta!e over)the) counter medications for more than 9: days without chec!ing with your doctor. Ta!ing them longer than that increases the chance of side effects. If over)the)counter treatments arenDt effective, your doctor may decide to prescribe a stronger anti)inflammatory drug or other medication to help ease the pain. /ome medications in the form of creams, rubs, or sprays may
be applied over the s!in of affected areas to relieve pain. ,or some people with persistent pain despite these pills or creams, steroids can be injected directly into the joint. These injections can be given several times a year, though some e(perts believe this may ultimately accelerate joint damage. Injections of hyaluronic acid directly into the !nee joint can relieve pain in some people with osteoarthritis. -hen osteoarthritis pain is severe and other treatments are not wor!ing, some doctors will give stronger pain pills, such as narcotics. <nfortunately, none of these will reverse or slow the progression of joint damage caused by osteoarthritis.
Are 'here Alternative 'reatments for Osteoarthritis?

-hile recent research has 'uestioned their usefulness, some medical research has shown that the supplements glucosamine and chondroitin may relieve pain in some people with osteoarthritis, especially in the !nee. There is no evidence that glucosamine can help rebuild cartilage. /A@e is another supplement with potential benefits for osteoarthritis. In fact, some research has shown it may be as effective an anti)inflammatory drugs. %emember to always let your doctor !now about any supplements youDre ta!ing as they can have side effects and interact with medications. Acupuncture has also been shown to provide significant and immediate pain relief in some people with osteoarthritis.
What Supportive &evices Are Availa!le to Help With Osteoarthritis?

/upportive or assistive devices can help to decrease pressure on the joints with osteoarthritis. ?nee supports may be helpful for some people to stabiliEe the ligaments and tendons and decrease pain. anes or crutches may be helpful to ta!e pressure off certain joints. In addition to pain relief, assistive devices improve function and prevent falls. A licensed physical therapist or other health care professional is needed to recommend what devices are best for you. There are also many available devices to help you perform routine daily activities that may be difficult, such as housewor! or coo!ing. As! your doctor about tal!ing to an occupational therapist to give you ideas about which devices may help.
Is 'here a Surgery for Osteoarthritis?

-hen osteoarthritis pain is not controlled with other treatments, or when the pain prevents you from participating in your normal activities, you may want to consider surgery. There are several types of surgery for osteoarthritis. They include&
Arthroscopy to clean out the damaged cartilage or repair tissues. "t is most commonly performed on the knee and shoulder. 5ecent evidence has 4uestioned its effectiveness for osteoarthritis. 1oint replacement surgery to replace the damaged joint with an artificial one. 1oint replacement surgery should be considered when the severity of the joint pain significantly interferes with a person6s function and 4uality of life. ven under the best of circumstances# surgery cannot return the joint to its normal state &artificial joints do not have all of the motion of a normal joint*# but movement and function are significantly improved. "n addition# an artificial joint will greatly diminish pain. The two joints most often replaced are the hip and the knee. Artificial joints are now also available to replace shoulders# fingers# elbows# ankles# and back joints to treat severe pain that has not responded to other treatments. 1oint fusion to remove the damaged joint and fuse the two bones on each side of the joint. This is done more often in areas in which joint replacement is not effective.
http$++www.webmd.com+osteoarthritis+guide+osteoarthritis%basics7page83

Is 'here a Surgery for Osteoarthritis? continued...

Tal! to your doctor to determine if any of these treatment options are right for you.
+,ercises #or OA o# the -nee
Hamstring Stretch
/tretching improves range of motion and !eeps you limber. -arm up with a five)minute wal!. To stretch, lie down. 3oop a bed sheet around your right foot. <se the sheet to pull the leg up and stretch it. *old for 4: seconds, then lower the leg. %epeat twice. /witch legs and repeat twice.
%alf Stretch
/tretching e(ercises also help prevent pain and injury. To do a calf stretch, hold onto a chair for balance. +end your right leg. /tep bac! with your left leg, slowly straightening it behind you. 8ress your left heel towards the floor. $ou should feel the stretch in the calf of your bac! leg. *old for 4: seconds. 1o the stretch twice, then switch legs. ,or more stretch& 3ean forward, bending the right !nee deeper. 1on6t let the right !nee go past your toes. 8revious page 0e(t page
Straight eg ,aise
+uilding muscle strength helps stabiliEe wea! joints. 3ie on the floor, upper body supported by your elbows. +end your left !nee, foot on the floor. ?eep the right leg straight, toes pointed up. /lowly use your thigh muscles, not your bac!, to raise your right leg. 8ause, as shown, for five seconds. -ith the thigh muscles still tight, slowly lower your leg to the ground. %ela(. %epeat 9: times. %est. 1o another set of 9: liftsJ then switch legs. 8revious page 0e(t page
-uad Set
Is the straight leg raise too tough. 1o 'uad sets instead. -ith these you don6t raise your leg. /imply tighten the thigh muscles, called the 'uadriceps. /tart by lying on the floor. ?eep both legs on ground, rela(ed (left photo). ,le( and hold the left leg tense for five seconds (right photo). %ela(. 1o two sets of 9:. /witch to the other leg. 8revious page 0e(t page
"
Seated Hip *arch

/trengthening hips and thigh muscles can help with daily activities li!e wal!ing or rising from a chair. /it up straight in a chair. ?ic! your left foot bac! slightly but !eep your toes on the floor. 3ift your right foot off the floor, !nee bent. *old the right leg in the air five seconds. /lowly lower your foot to the ground. %epeat 9: times. %est and do another set of 9:, then switch legs. Too hard. <se your hands to help raise your leg. 8revious page 0e(t page
.illow S/uee0e
This move helps strengthen the inside of your legs to better support your !nee. 3ie on your bac!, both !nees bent. 8lace a pillow between the !nees. /'ueeEe the !nees together, s'uishing the pillow between them. *old for five seconds. %ela(. %epeat 9: times. %est, then do another set of 9:. Too hard. $ou can also do this e(ercise while seated.
8revious page 0e(t page
>
Heel ,aise
/tand tall and hold the bac! of a chair for support. 3ift your heels off the ground and rise up on the toes of both feet. *old for five seconds. /lowly lower both heels to ground. %epeat 9: times. %est. 1o another set of 9:. Too hard. 1o the same e(ercise while sitting in a chair. 8revious page 0e(t page
Side eg ,aise
/tand and hold the bac! of a chair for balance. 8lace your weight on your left leg. 3ift the right leg out to the side. ?eep the right leg straight and outer leg muscles tensed. 1on6t slouch. 3ower the right leg and rela(. %epeat 9: times. %est. 1o another 9:, then repeat with the left leg. Too hard. Increase leg height over time. After a few wor!outs, you6ll be able to raise your leg higher. 8revious page 0e(t page
Sit to Stand
8ractice this move to ma!e standing easier. 8lace two pillows on a chair. /it on top, with your bac! straight, feet flat on the floor (see left photo). <se your leg muscles to slowly and smoothly stand up tall. Then slowly lower again to sit. +e sure your bent !nees don6t move forward of your toes. Try with your arms crossed or loose at your sides. Too hard. Add pillows. Or use a chair with armrests and help push up with your arms. 8revious page 0e(t page
One eg "alance
This move helps you bend over or get out of cars. ,irst, shift your body weight to one leg without loc!ing your !nee straight. /lowly raise the other foot off the ground, balancing on your standing leg. *old for 4: seconds, then lower. 1o this twice, then switch legs. /teady yourself on a chair, if needed. $our goal is to do this hands)free. Too easy. +alance for a longer time. Or try it with your eyes closed. 8revious page 0e(t page
9:
Step +ps
1o this to strengthen your legs for climbing stairs. ,ace a stable step, both feet on the ground. /tep up with your left foot. ,ollow with your right foot. /tand tall on the step with both feet flat. limb down in reverse& right foot down first, then left. %epeat 9: times. %est, then do another set of 9:. 0ow do two more sets, starting with your right leg. Too hard. <se a railing or wall for balance. Or try a lower step. 8revious page 0e(t page
99
Wal#ing
2ven if you have stiff or sore !nees, wal!ing is still one of the best e(ercises for !nee arthritis. /tart slow and !eep at it. -al!ing can reduce joint pain, strengthen leg muscles, and improve fle(ibility. ItDs also good for your heart. Hood form is !ey. 3oo! forward and !eep your bac! straight and your arms rela(ed. If youDre not active now, chec! in with your doctor before starting a new e(ercise program. 8revious page 0e(t page
94
ow1Impact Activities
Other e(ercises that are easy on the !nees include bi!ing, swimming, and water aerobics. -ater e(ercise ta!es weight off painful joints. @any community and hospital wellness centers, gyms, and pools offer classes for people with arthritis. +eing active may also help you lose weight, which ta!es pressure off joints. ,or favorite activities, li!e golf, as! your doctor or physical therapist about how to modify painful moves. 8revious page 0e(t page
9=
How *uch ()ercise?

Aim for =: minutes a day. /tart small, with what feels O?. If the pain doesnDt bother you, do more ne(t time. Over time you6ll build your leg muscles to support your !nee and increase fle(ibility. /ome muscle soreness is normal when you wor! out. *urting or swollen joints need rest, though. Ice painful joints and ta!e acetaminophen or an anti)inflammatory pain reliever, li!e ibuprofen or napro(en, if your doctor says these are O? for you. 8revious page 0e(t page
9"
.. -nee Pain 'os and 'on/ts

There are many things you can do to help !nee pain, whether itDs due to a recent injury or arthritis youDve had for years. ,ollow these 99 dos and don6ts to help your !nees feel their best. &on2t rest too much. Too much rest can wea!en your muscles, which can worsen joint pain. ,ind an e(ercise program that is safe for your !nees and stic! with it. If youDre not sure which motions are safe or how much you can do, tal! with your doctor or a physical therapist. &o e)ercise. ardio e(ercises strengthen the muscles that support your !nee and increase fle(ibility. -eight training and stretching do, too. ,or cardio, some good choices include wal!ing, swimming and water aerobics, stationary cycling and elliptical machines. Tai chi may also help ease stiffness and improve balance. &on2t ris# a fall. A painful or unstable !nee can ma!e a fall more li!ely, which can cause further !nee damage. urb your ris! of falling by ma!ing sure your home is well lit, using handrails on staircases, and using a sturdy ladder or foot stool if you need to reach something from a high shelf. &o use 3,I%(.G %est, ice, compression, and elevation (%I 2) is good for !nee pain caused by a minor injury or an arthritis flare. Hive your !nee some rest, apply ice to reduce swelling, wear a compressive bandage, and !eep your !nee elevated.
&on4t overloo# your weight. If youDre overweight, losing weight reduces the stress on your !nee. $ou don6t even need to get to your GidealG weight. /maller changes still ma!e a difference. &on4t !e shy a!out using a wal#ing aid. A crutch or cane can ta!e the stress off your !nee. ?nee splints and braces can also help you stay stable. &o consider acupuncture. This form of traditional hinese medicine, which involves inserting fine needles at certain points on the body, is widely used to relieve many types of pain and may be useful for !nee pain. &on4t let your shoes ma#e matters worse. ushioned insoles can reduce stress on your !nees. ,or !nee osteoarthritis, doctors often recommend special insoles that you put in your shoe. To find the appropriate insole, spea! with your doctor or a physical therapist. &o play with temperature. ,or the first "K to 54 hours after a !nee injury, use a cold pac! to ease swelling and numb the pain. A plastic bag of ice or froEen peas wor!s well. <se it for 9# to 4: minutes three or four times a day. -rap your ice pac! in a towel to be !ind to your s!in. After that, you can heat things up with a warm bath, heating pad, or warm towel for 9# to 4: minutes, three or four times a day. &on2t 5ar your 5oint(s). *igh)impact e(ercises can further injure painful !nees. Avoid jarring e(ercises such as running, jumping, and !ic!bo(ing. Also avoid doing e(ercises such as lunges and deep s'uats that put a lot of stress on your !nees. These can worsen pain and, if not done correctly, cause injury. &o get e)pert advice. If your !nee pain is new, get a doctor to chec! it out. ItDs best to !now what youDre dealing with A/A8, so you can prevent any further damage.
"n0ectable Medications #or -nee Osteoarthritis

-eb@1 ,eature +y 2ric @etcalf, @8* %eviewed +y 1avid Melman, @1 If you have !nee osteoarthritis, doctors can offer a variety of treatments to relieve your symptoms. One option is to inject medication into your !nee. There are different types of injections, and theyDre an important part of treating !nee osteoarthritis for many people, says %oy Altman, @1, an osteoarthritis e(pert at < 3A. Injections can be especially helpful for people who haven6t gotten relief from 0/AI1s li!e ibuprofen, or people who can6t ta!e those drugs due to side effects.
Osteoarthritis (OA) is a common form of arthritis that often affects the !nees. It develops when the cartilage )) the smooth covering that protects the bones in the joint )) brea!s down. The surface of the bones becomes damaged, causing pain, swelling, stiffness, and disability.
How 6nee In5ections Wor#

,irst, your doctor will give you a shot of anesthetic to numb your !nee. 0e(t, your doctor may use a needle to draw out any e(tra fluid thatDs in your !nee. After that, youDll get the pain)relieving injection, usually just below your !neecap. The shot shouldnDt hurt, and the drug will wor! throughout the joint, says Aohn %ichmond, @1, an orthopedic surgeon at the 0ew 2ngland +aptist *ospital in +oston. 1ifferent treatments have side effects that you should discuss with your doctor beforehand. The two most common types of !nee injection for OA are corticosteroids and hyaluronic acid.
,educe Inflammation With Steroids

orticosteroid injections are useful for treating flare)ups of OA pain and swelling with fluid buildup in the !nee, %ichmond says. These injections help relieve symptoms by reducing inflammation in the joint. +ut they6re not a perfect solution in every case. If youDre considering this treatment, !eep this in mind& 'hey wor# /uic#ly. These injections offer Bvery rapidC relief, usually within 4" to "K hours, %ichmond says. 'he !enefit is short1term. On average, the pain relief lasts from > to94 wee!s, %ichmond says. Often, that6s long enough to get you through a flare)up of osteoarthritis until your symptoms subside. 7ou shouldn2t use them fre/uently. A corticosteroid shot often wor!s best the first time, Altman says. After that, they tend to give less relief. In most cases, %ichmond tells his patients they can use these shots two to three times a year. <sing them too often may damage cells in the !nee that ma!e cartilage.
Hyaluronic Acid
@ost of the fluid in a healthy !nee is hyaluronic acid, Altman says. +ut when you have !nee OA, the hyaluronic acid in your !nee thins. $our doctor can inject more hyaluronic acid into your !nee to boost the supply.
/tudies have shown that hyaluronic acid injections may help more than pain)relief medications for some people with OA. Other studies have shown they may improve symptoms as well as corticosteroid injections do. If youDre considering hyaluronic acid injections, !eep these in mind&
"n0ectable Medications #or -nee Osteoarthritis
Hyaluronic Acid continued...

It2s often not the first approach. +ecause hyaluronic acid treatments are more e(pensive, Bwe most often don6t use them as first)line therapy as much as steroids,C Altman says. *owever, hyaluronic acid injections are often covered by insurance. $our doctor may suggest hyaluronic acid if&

!our symptoms aren9t improved by pain%relief medications or non%drug treatments such as heat or ice. !ou can9t take pain relievers such as Advil or 3otrin &ibuprofen*# Aleve &naproxen sodium*# or Tylenol &acetaminophen*. A steroid shot doesn6t help enough# or you or your doctor are concerned about its side% effects.
It may wor# in different ways. After an injection, hyaluronic acid helps cushion and lubricate the moving parts within your !nee, Altman says. This effect is fairly short)lived. +ut the treatment seems to also provide more long)term benefit by relieving pain and inflammation. 7ou may need more than one in5ection. ,ive versions of hyaluronic acid injections are available in the <./. /ome types re'uire only one injection. Others re'uire up to five injections, usually within a five)wee! period. If needed, you can get another shot after si( months, Altman says.
.latelet1,ich .lasma8 %an It Help OA?

Another treatment getting attention is platelet)rich plasma (8%8). This re'uires drawing a sample of your blood and processing it to create a fluid that contains a higher)than)normal amount of platelets, tiny dis!s that help clot the blood. The doctor then injects the fluid bac! into your injured area. The platelets in your blood contain natural chemicals that help heal injuries. 1octors have been treating other problems ; li!e tendon damage ; for more than a decade with 8%8. *owever, e(perts still !now little about whether it wor!s for !nee osteoarthritis. It6s e(pensive, Altman says, and most insurance plans don6t cover it. As a result, this injection isn6t a common treatment for OA
-nee Osteoarthritis )hen to Consider Surgery

?nee osteoarthritis (OA) can affect your every move& wal!ing, climbing stairs, even sitting or lying down. /urgery can help bring relief, but doctors almost always advise trying other treatment options first. These include& *edications you ta#e !y mouth. Over)the)counter options include Tylenol (acetaminophen) as well as nonsteroidal anti)inflammatory drugs (0/AI1s) such as Advil or @otrin (ibuprofen) or Aleve (napro(en sodium). /tronger 0/AI1s are available by prescription. %reams or ointments you ru! onto the s#in. 1ifferent forms are sold over)the)counter. /tronger versions are available with a prescription. *edications in5ected into the 5oint. orticosteroid injections fight inflammation and can offer fast pain relief that may last up to several months. Injections of hyaluronic acid boost the natural joint fluid that !eeps !nees moving smoothly. ()ercise and physical therapy. 2(ercise strengthens the muscles that support your !nee. 8hysical therapy also helps. A physical therapist can design the program for you and see if you need supportive braces, splints, or canes. If youDre overweight, e(ercise can help you lose weight and ta!e some of the pressure off your !nees. Weight loss. 2very pound you gain puts an e(tra = pounds of pressure on your !nees. If you eventually need !nee replacement surgery, your chances of success are much greater if you first lose e(tra weight. 9utritional supplements. /ome people ta!e glucosamine and chondroitin for OA. /tudies on how well they wor! have had mi(ed results. Another substance, called /A@e, has been shown to wor! as well as non)prescription pain relievers and may have fewer side effects. It wor!s more slowly, though. +efore you start ta!ing any supplements, even if theyDre natural, tell your doctor so they can chec! on side effects. These treatment options may provide enough relief to !eep you moving comfortably. If they donDt relieve your pain well enough, they become less effective, or you canDt tolerate them, your doctor may suggest surgery. The two types of surgery most often recommended for !nee OA are arthroscopic surgery and !nee replacement surgery.
Arthroscopic Surgery
In this type of surgery, the surgeon inserts a thin tube with a tiny camera on the end through a small opening in your s!in to view the inside of your !nee. The surgeon can then remove damaged cartilage )) the smooth covering that protects the bones in the joint. The !nee can be cleaned or flushed to remove loose bone or cartilage pieces that may be causing pain. @ost people can get bac! to their usual activities a few days later. The recovery usually isnDt painful.
Arthroscopic surgery may provide short)term relief from pain. It can also delay the need for more comple( surgery.
6nee ,eplacement Surgery

If you have tried all other osteoarthritis treatment options and still have !nee pain, your doctor may suggest !nee replacement. It can help reduce your pain and improve your ability to move. ?nee replacement surgery involves removing all or part of the !nee joint and replacing the damaged parts with an artificial joint. These are made of metals and plastics. It may ta!e months to recover fully, but the relief can last many years or even a lifetime. It may be time to have !nee replacement surgery if you have&

(evere knee pain that limits your everyday activities 3oderate or severe knee pain while resting# day or night ,hronic knee inflammation and swelling that doesn6t improve with rest or medications :nee deformity$ a bowing in or out of your leg :nee stiffness$ inability to bend and straighten your knee 'o pain relief from '(A")s &or can9t tolerate them* or other conservative measures
Corticosteroid "n0ections #or Osteoarthritis

2ven in a small joint, osteoarthritis (OA) can have a big impact on your life. ,or instance, OA in your fingers can !eep you from holding a pen or opening a jar. A stiff or sore !nee can ma!e it hard to wal!. Hetting a shot of corticosteroids (sometimes called a steroid shot) directly into a sore joint can ease pain 'uic!ly. orticosteroids help fight inflammation )) the heat, redness, pain, and swelling in an injured or infected part of the body. orticosteroid shots ease pain faster than anti)inflammatory pills. A single injection doesn6t cause stomach upset the way pills can. -hen corticosteroids are injected into a joint, their effects are mostly limited to that joint.
What to ()pect
@ost corticosteroid injections into your !nee or a smaller joint, li!e the base of your thumb, can be done in a doctor6s office.
,irst, the doctor cleans your s!in with an antiseptic. If the joint is puffy and filled with fluid, the doctor may insert a needle into the joint to remove the e(cess fluid. This 'uic!ly relieves some of the pain, because it reduces pressure in the joint. %emoving e(tra fluid may also speed healing. 0e(t, the doctor uses a different syringe to inject the corticosteroid into the joint. %elief is almost instant, because the corticosteroid is usually mi(ed with a pain!iller. The corticosteroid begins to curb inflammation within a few hours. The relief usually lasts from several wee!s to several months. Injecting a large joint, such as your hip, or in the spine is more comple(. $our doctor may use imaging technology to help guide the needle into place.
What Are the ,is#s?

orticosteroids can have side effects. /ome can be dangerous, such as a greater ris! of infection, weight gain, ulcers in your digestive tract and bleeding, osteoporosis, increases in blood pressure and blood glucose levels, and eye problems such as cataracts and glaucoma. Injecting corticosteroids directly into a joint lessens or removes most of these side effects. There are, however, some special, if uncommon, ris!s of joint injection. They include&

"njury to the joint tissues# mainly with repeated injections Thinning of cartilage# the smooth covering that protects the bones in the joint ;eakening of the ligaments of the joint 3ore inflammation in the joint caused by a corticosteroid that has crystalli0ed "rritation of the nerves# by the needle or the medication itself "nfecting the joint ;hitening or thinning of skin at the injection site
$ou should not have this type of treatment if you have an infection in or around a joint or you6re allergic to any of the drugs used.
imits in 'reating OA
Although corticosteroid injections can ease arthritis symptoms, they have limits. They can6t repair damaged cartilage or slow the progression of arthritis. Their relief is only temporary. @ost e(perts say you should limit injections to no more than once every three or four months. Het no more than about four shots in any one joint. If you still have joint pain after corticosteroid injections, tal! with your doctor about other treatments. 1epending on the joints involved, other treatment options could include joint replacement.
!yaluronic Acid "n0ections #or Osteoarthritis

$our body ma!es hyaluronic acid. ItDs a natural part of the fluid that helps lubricate your joints and !eeps them wor!ing smoothly. It also acts li!e a shoc! absorber. It !eeps your bones from bearing the full force of impact when you wal!. -hen you have osteoarthritis (OA), the hyaluronic acid in the affected joint thins. *yaluronic acid injections add to your bodyDs natural supply. $ou may hear your doctor refer to these injections as Gviscosupplementation,G which literally means they help the fluid in your joints.
Should 7ou 'ry Hyaluronic Acid In5ections?

1octors canDt predict who will benefit from hyaluronic acid injections. +ut many doctors give them to people with !nee OA whose symptoms don6t get better with pain!illers or non)drug treatments such as heat or ice. *yaluronic injections are also often tried by people who canDt ta!e pain!illers li!e Advil or @otrin (ibuprofen), Aleve (napro(en sodium), or Tylenol (acetaminophen), or canDt have (or arenDt ready for) total !nee replacement surgery.
How (ffective Are Hyaluronic Acid In5ections for Osteoarthritis?

/tudies show hyaluronic acid injections may wor! better than pain!illers for some people with OA. Other studies have shown they also may wor! as well as corticosteroid !nee injections. *yaluronic acid injections seem to wor! better in some people than others. They may be less effective in older adults and people with severe OA.
$etting a Hyaluronic Acid In5ection8 What to ()pect

,ive brands of hyaluronic acid are approved for !nee OA&

uflexxa <yalgan Orthovisc (upart0 (ynvisc# (ynvisc%One
1epending on which type your doctor uses, you may get a single shot. Or youDll get three to five injections spaced a wee! apart. The injection is given the same way for all types. ,irst, the doctor cleans the area. If your !nee is swollen with e(cess fluid, your doctor may inject a local pain!iller, then insert a needle into the
joint to withdraw e(cess fluid. -ith the same needle still in place, the doctor can usually inject the hyaluronic acid into the !nee joint. After an injection, you shouldnDt do hard weight)bearing activity for one or two days. Otherwise, you should be able to resume normal activities. @ost insurance companies cover hyaluronic acid injections.
Side (ffects
The most common short)term side effects are minor pain at the injection site and minor buildup of joint fluid. These get better within a few days. Infre'uently the injected joint may flare up with increased inflammation.
)hat "s Rheumatoid Arthritis1

Arthritis means inflammation in a joint. Aoint inflammation causes redness, warmth, swelling, and pain within the joint. %heumatoid arthritis is a type of chronic arthritis that occurs in joints on both sides of the body (such as both hands, both wrists, or both !nees). This symmetry helps distinguish rheumatoid arthritis from other types of arthritis.
%heumatoid arthritis may also affect the s!in, eyes, lungs, heart, blood, or nerves.
What Are the Symptoms of ,heumatoid Arthritis?

/ymptoms of rheumatoid arthritis are&

1oint pain and swelling (tiffness# especially in the morning or after sitting for long periods /atigue
%heumatoid arthritis affects everyone differently. ,or some, joint symptoms develop gradually over several years. In others, rheumatoid arthritis may develop 'uic!ly, while other people may have rheumatoid arthritis for a short time and then have a time with no symptoms, called remission.
Who $ets ,heumatoid Arthritis?

About 9N of Americans have rheumatoid arthritis. It is an autoimmune disease, meaning the bodyDs immune system attac!s its own healthy tissues. %heumatoid arthritis is two to three times more common in women than in men, but men tend to have more severe symptoms. It usually happens in middle age, but young children and the elderly also can get rheumatoid arthritis.
What %auses ,heumatoid Arthritis?

The cause of rheumatoid arthritis is un!nown. It is thought to be due to a combination of genetic, environmental, and hormonal factors. -ith rheumatoid arthritis, something seems to trigger the immune system to attac! the joints and sometimes other organs. /ome theories suggest that a virus or bacteria may alter the immune system, causing it to attac! the joints. Other theories suggest that smo!ing may lead to rheumatoid arthritis. %esearch hasnDt found e(actly what role genetics plays in rheumatoid arthritis. /ome people do seem to have a genetic or inherited factor that increases their chance of developing rheumatoid arthritis.
How &oes ,heumatoid Arthritis Affect the "ody?

Once the immune system is triggered, immune cells migrate from the blood into the joints and joint)lining tissue, called synovium. There the immune cells ma!e inflammatory substances that cause irritation, wearing down of cartilage (the cushioning material at the end of bones), and swelling and inflammation of the joint lining. As the cartilage wears down, the space between the bones narrows. As it gets worse, the bones could rub against each other.
Inflammation of the joint lining causes fluid to build up with the joint. As the lining e(pands, it may damage the bone. All of these things cause the joint to become very painful, swollen, and warm to the touch.
How Is ,heumatoid Arthritis &iagnosed?

%heumatoid arthritis is diagnosed from a combination of things, including&

The location and symmetry of painful joints# especially the hand joints 1oint stiffness in the morning 2umps and nodules under the skin &rheumatoid nodules* 5esults of =%ray tests 2lood tests
)hat "s Rheumatoid Arthritis1

How Is ,heumatoid Arthritis &iagnosed? continued...

@ost, but not all, people with rheumatoid arthritis have the rheumatoid)factor (%,) antibody in their blood. %heumatoid factor may sometimes be present in people who do not have rheumatoid arthritis. Therefore, the diagnosis of rheumatoid arthritis is based on a combination of joint problems, as well as test results. A newer, more specific blood test for rheumatoid arthritis is the cylic citrulline antibody test, also called anti) 8. The presence of anti) 8 antibodies suggests a tendency toward a more aggressive form of rheumatoid arthritis. 8eople with rheumatoid arthritis may have mild anemia. +lood tests may also show an elevated erythrocyte sedimentation rate (2/%) or elevated )reactive protein ( %8) levels, which are signs of inflammation. /ome people with rheumatoid arthritis may also have a positive antinuclear antibody test (A0A), which indicates an autoimmune disease. +ut the test cannot tell which autoimmune disease.
How Is ,heumatoid Arthritis 'reated?

There are many ways to treat rheumatoid arthritis. Treatments include medications, rest and e(ercise, and surgery to correct damage to the joint. The type of treatment will depend on several things, including the personDs age, overall health, medical history, and severity of the arthritis.
,heumatoid Arthritis *edications

There are many rheumatoid arthritis medications available to lower joint pain, swelling, and inflammation. /ome of these drugs prevent or slow the progression of the disease. 1rugs that offer relief of arthritis symptoms (joint pain, stiffness, and swelling) include&

Anti%inflammatory painkillers# such as aspirin# ibuprofen# or naproxen Topical &applied directly to the skin* pain relievers ,orticosteroids# such as prednisone 'arcotic pain relievers
There are also many strong medications called disease)modifying antirheumatic drugs (1@A%1s), which wor! by interfering with or suppressing the immune systemDs attac! on the joints. They include&

Pla4uenil &originally used to treat malaria* "mmune suppression drugs# such as methotrexate# "muran# and ,ytoxan 2iologic treatments# such as nbrel# <umira# 5emicade# Orencia# and 5ituxan Other drugs# such as A0ulfidine# Arava# and =eljan0
Why Are ,est and ()ercise Important for ,heumatoid Arthritis?

A balance of rest and e(ercise is important in treating rheumatoid arthritis. 1uring flare)ups, when joint inflammation gets worse, it is best to rest the joints. <sing a cane or joint splints can help during flare)ups. -hen joint inflammation gets better, e(ercise is necessary to !eep joints fle(ible and to strengthen the muscles that surround the joints. doing range)of)motion e(ercises will help !eep joints healthy.
When Is Surgery 9ecessary for ,heumatoid Arthritis?

-hen joint damage from the rheumatoid arthritis has become severe or pain is not controlled with drugs, surgery may help.
%an ,heumatoid Arthritis "e %ured?

Although there isnDt a cure for rheumatoid arthritis, early, aggressive treatment has been shown to help prevent disability.
Rheumatoid Arthritis Progression

Although there have been cases of remission without rheumatoid arthritis treatment, these are not common. @ost people with rheumatoid arthritis e(perience some progression of their disease during their lives. +ut there are treatments that can help, and each person responds to the disease differently. -hat can you e(pect. That depends on many factors.

<ow advanced your rheumatoid arthritis is at the time you are diagnosed !our age at the time you are diagnosed <ow >active> your disease is
2ach personDs rheumatoid arthritis is uni'ue, and the disease affects each person differently. Over the long)term, though, there are a few common patterns.
Long remissions. 5emission means near%disappearance of symptoms without an actual cure. About ?@ to AB@ of people diagnosed with rheumatoid arthritis have a sudden onset of the illness# but then have no symptoms for many years# even decades. Intermittent symptoms. About A?@ of people with rheumatoid arthritis have disease that waxes and wanes slowly. They have periods of low or no symptoms that can last months between flare%ups. Progressive rheumatoid arthritis. Cnfortunately# that leaves the majority of people# who have the most common and serious form of rheumatoid arthritis. 2ecause it9s progressive# it re4uires a long%term treatment plan and a coordinated medical team to manage the treatment and slow or stop progression.
*ow can you tell which !ind of rheumatoid arthritis you have and whether it will progress. There is no easy way, but there are some general signs that suggest you might have the progressive form of rheumatoid arthritis. $ou might have progressive %A if you&

<ave long duration or high intensity of disease activity &flares* ;ere diagnosed at a young age# which means the rheumatoid arthritis has more time to become active in your body <ave rheumatoid nodules %% bumps under the skin that most often appear on the elbows <ave active inflammation that shows up in tests of joint fluid or in blood tests <ad a lot of damage already on =%rays when you were diagnosed <ave elevated blood tests for rheumatoid factor or citrulline antibody
-hatDs the most important thing you can do to follow the progression of rheumatoid arthritis. /ee a rheumatologist. $our doctor will do a complete joint e(am, lab tests, and 7)rays to see if your disease has progressed. At later visits, your doctor can rechec! your joints, tests, and 7)ray films and see if any further progression has occurred. If your rheumatoid arthritis is progressing, there are good treatment options to slow it down. A Gfunctional 'uestionnaireG may also help you trac! the progression of your rheumatoid arthritis. The *ealth Assessment Ouestionnaire (*AO) is a commonly used tool to !eep trac! of rheumatoid arthritis progression, and itDs available for free on the Internet.
A. )ownload the <AD. E. /ill it out# get a copy in your medical record# and recheck it periodically. !our rheumatologist# or another member of your treatment team# will suggest a schedule. 3. 'ote any changes in your level of function and discuss them with your treatment team.
1onDt overloo! the affect your rheumatoid arthritis has on your mental health. If you are having trouble coping, see! help. 8sychologists, social wor!ers, and psychiatrists can help you deal with the struggle of living with the long)term uncertainty and limitations of rheumatoid arthritis. There is good news for people with rheumatoid arthritis. Treatment is improving and, in many cases, can delay progression of this disease. -hat does this mean for you. Today, patients may have less progression in their lifetimes than patients of the past.
What is ,heumatoid Arthritis (,A)?

%A is an autoimmune disorder that causes inflammation of the lining of the joints. The body tissue is mista!enly attac!ed by its own immune system. %A may also affect the s!in, eyes, lungs, heart, blood, or nerves. %heumatoid arthritis is a chronic disorder, meaning that although there may be occasional symptom)free periods, the disease can worsen over time and may never go away. 2arly, aggressive treatment is !ey to slowing or
,A Symptoms
Aoint inflammation from %A comes with pain, warmth, and swelling. The inflammation is typically symmetrical, occurring on both sides of the body at the same time (such as the wrists, !nees, or hands). Other symptoms of %A include joint stiffness, particularly in the morning or after periods of inactivityJ ongoing fatigue, and low)grade fever. /ymptoms typically develop gradually over years, but can come on rapidly for some people.
Who $ets ,heumatoid Arthritis?

Affecting about 9N of the <./. population, %A usually stri!es between ages =:)>:, but younger and older people can also be affected. %A occurs three times more often in women than in men. Other ris! factors include cigarette smo!ing and family history.
,heumatoid Arthritis %auses

Immune cells normally protect the body from foreign invaders. -hat causes them to target healthy joints and tissue is un!nown. %esearchers believe some combination of genetics and environmental factors may play a role. There may be a genetic tendency in some people who, if they develop an infection with a particular bacterium or virus, go on to develop the condition. +ut to date, no specific infection has been identified.
,A4s 'oll on the :oints

Inflammation of the lining of the joints can destroy cartilage and bone, causing deformity of the joints. As the condition progresses, joints can develop considerable pain and loss of function.
,A4s 'oll on the "ody

%A can affect organs and areas of the body other than the joints, including&

%heumatoid nodules (shown here)& firm lumps under the s!in and in internal organs /jogrenDs syndrome& inflammation and damage of the glands of the eyes and mouthJ other parts of the body can also be affected 8leuritis& inflammation of the lung lining 8ericarditis& inflammation of lining surrounding the heart Anemia& reduction of red blood cells ,elty syndrome& reduction of white blood cells, associated with enlarged spleen Pasculitis& blood vessel inflammation, which can impair blood supply to tissues
:uvenile ,heumatoid Arthritis (:,A)

Auvenile %A is the most common type of arthritis in !ids. 3i!e adult %A, it causes joint inflammation, stiffness, and damage. *owever, it can also affect a childDs growth. Auvenile %A is also !nown as juvenile idiopathic arthritis. GIdiopathicG means no !nown cause.
,A and .regnancy
/urprisingly, rheumatoid arthritis improves in up to K:N of women during pregnancy. It will li!ely flare up after delivery. *ow and why this happens is still unclear. If you are trying to get pregnant, as! your doctor which %A medications are safe for you to ta!e. hanges in your medication may be necessary before you become pregnant and during pregnancy.
&iagnosing ,A8 (valuating Symptoms

+ecause symptoms may come and go, diagnosing %A in its early stages is challenging. If you have these symptoms, your doctor may order further tests&

@orning joint stiffness /wellingFfluid around several joints at the same time /welling in the wrist, hand, or finger joints /ame joints affected on both sides of your body ,irm lumps under the s!in (rheumatoid nodules)
8revious LF95 0e(
&iagnosing ,A8 "lood 'ests
If %A is suspected, your doctor may order blood tests to chec! for mar!ers of inflammation in the body. Other common tests are for rheumatoid factor (%,) and anti)cyclic citrullinated peptide (anti) 8), which is present in most people with %A.

8revious 9:F95 0e(
&iagnosing ,A8 Imaging 'ests

7)rays are helpful in diagnosing %A, to provide a baseline for comparison later as the disease progresses. An @%I or ultrasound may also be done to help detect joint damage and inflammation.
'reating ,A
There is no !nown cure for %A. The goal of treatment is to reduce joint inflammation and pain, prevent joint damage, and ma(imiEe joint function. Aggressive treatment should be started as early as possible. Treatment includes a combination of medication and e(ercises to strengthen supporting muscles around the joints. Treatment may also include surgery. Treatment is tailored to the individual, ta!ing into account their age, affected joints, and the progression of the disease.
,A *edications
@edications used to treat %A include disease)modifying antirheumatic drugs (1@A%1s) which include biologics, nonsteroidal anti)inflammatory drugs (0/AI1s), steroids, and pain relievers. 1@A%1s slow progression of disease and are usually used with 0/AI1s and steroids in treatment.
Is Surgery an Option?
After significant joint damage has occurred or when pain or disability becomes unbearable, some people choose surgery to improve function and relieve pain. Aoint replacement is the most fre'uently performed surgery for %A patients )) with the !nee and hip joints most often replaced. Other types of surgery, such as arthroscopy (inserting a tube)li!e instrument into the joint to see and repair abnormal tissues) and tendon reconstruction, can be performed as well.
Other 'reatments for ,A

/ome %A patients find relief in the following& moist heat, rela(ation remedies, and acupuncture. /upplements that have been shown to possibly help %A are fish oil, borage seed oil, and catDs claw. hec! with your doctor before ta!ing supplements as they can cause side effects and may interact with your medications.
,A and &iet
The most important diet is a healthy one that is balanced in nutrients. Although thereDs no Garthritis dietG per se, many %A sufferers report that eating or avoiding certain foods helps their symptoms. ,oods high in saturated fats (bacon, stea!, butter) have been shown to increase inflammation in the body. /ome people with %A find a diet high in omega)= fatty acids (salmon, tofu, walnuts) helpful. /ome people feel that other foods )) such as tomatoes, citrus fruits, white potatoes, peppers, coffee, and dairy )) worsen %A symptoms.

'he Importance of ()ercise

It may seem counterintuitive, but regularly e(ercising those stiff, painful joints can reduce the overall pain of %A. 8lus, it can !eep bones and muscles strong, and help reverse joint stiffness. hoose e(ercises such as stretching, resistance training, and low)impact aerobics (swimming, water aerobics). <se caution with any e(ercise that puts pressure on the joints, li!e jogging and heavy weight lifting. And if youDre having a flare, ta!e a short brea! from e(ercise. Tal! to your doctor before starting an e(ercise program.

-eb@1 @edical %eference
Symptoms o# Rheumatoid Arthritis

%heumatoid arthritis (%A) is a chronic (long)term) disease. %heumatoid arthritis symptoms can come and go, and each person with %A is affected differently. /ome people have long periods of remission. Their rheumatoid arthritis is inactive, and they have few or no symptoms during this time. Other people might have near)constant rheumatoid arthritis symptoms for months at a stretch. Although rheumatoid arthritis can involve different parts the body, joints are always affected. -hen the disease acts up, joints become inflamed. Inflammation is the bodyDs natural response to infection or other threats, but in rheumatoid arthritis inflammation occurs inappropriately and for un!nown reasons.
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,heumatoid Arthritis and :oint Inflammation

Aoint inflammation is a hallmar! of rheumatoid arthritis. That includes&
#tiffness. The joint is harder to use and might have a limited range of motion. >3orning stiffness> is one of the hallmark symptoms of rheumatoid arthritis. ;hile many people with other forms of arthritis have stiff joints in the morning# it takes people with rheumatoid arthritis more than an hour &sometimes several hours* before their joints feel loose. #$e!!ing. /luid enters into the joint and it becomes puffyI this also contributes to stiffness. Pain. "nflammation inside a joint makes it sensitive and tender. Prolonged inflammation causes damage that also contributes to pain. Redness and $armth. The joints may be somewhat warmer and more pink or red than neighboring skin.
-hich joints does %A affect. The hands are almost always affected, although literally any joint can be affected with rheumatoid arthritis symptoms& !nees, wrists, nec!, shoulders, elbows, even the jaw. Aoints are usually affected in a symmetrical pattern )) the same joints on both sides of the body.
,heumatoid Arthritis Symptoms 'hat Affect the (ntire "ody

%heumatoid arthritis can affect many areas of the body. These effects all result from the general process of inflammation, leading to a wide variety of symptoms of rheumatoid arthritis&

/atigue 3alaise &feeling ill* -oss of appetite# which can lead to weight loss 3uscle aches
These feelings have been compared to having the flu, although they are usually less intense and longer lasting. %heumatoid arthritis may affect other areas of your body. Involvement of multiple areas of the body occurs is more common with moderate to severe rheumatoid arthritis.

5heumatoid nodules are bumps under the skin that most often appear on the elbows. (ometimes they are painful. -ung involvement# due to either damage to the lungs or inflammation of the lining around the lungs# is common but usually causes no symptoms. "f shortness of breath develops# it can be treated with drugs that reduce inflammation in the lungs. 5heumatoid arthritis can even affect a joint in your voice box or larynx &cricoarytenoid joint*# causing hoarseness. 5heumatoid arthritis can cause inflammation in the lining around the heart# but it usually has no symptoms. "f symptoms do develop# it may cause shortness of breath or chest pain. "n addition# people with rheumatoid arthritis are more likely to develop clogged arteries in their heart# which can lead to chest pain and heart attack. The eyes are affected in less than ?@ of people with rheumatoid arthritis. ;hen the eyes are affected# symptoms can include red# painful eyes or possibly dry eyes.
-hen you have symptoms of rheumatoid arthritis, early and aggressive treatment can help prevent further symptoms as well as stop progression of rheumatoid arthritis.
Joint Sti##ness and Rheumatoid Arthritis

Aoint stiffness is a hallmar! of rheumatoid arthritis (%A), a chronic disease that affects 9.= million adult Americans. %esulting from an abnormal response of the immune system, rheumatoid arthritis inflames the soft tissue that lines the surface of joints (called the synovium). It is a systemic disease that not only ma!es joints stiff and painful, but can also affect other parts of your body, such as internal organs. +y noting symptoms such as joint stiffness and see!ing early treatment, you can feel better, slow or stop progression of the disease, and minimiEe joint damage. This allows you to live a more active, full life.
#e!f%Assessment& Are 'ou oing A!! 'ou (an to Manage 'our Rheumatoid Arthritis)
:oint Stiffness8 (arly Sign of ,heumatoid Arthritis
*ow well you can move an arm, leg, or finger in different directions reflects the jointDs range of motion. If you develop joint stiffness, your range of motion is reduced. $our joint doesnDt move as well as it once did. Aoint stiffness may occur with or without joint pain. Other signs and symptoms in addition to the joint stiffness will help your doctor figure out what !ind of arthritis you have. -ith rheumatoid arthritis, joint stiffness and other symptoms such as pain or fatigue tend to develop and worsen over several wee!s or months. Aoint stiffness is most noticeable in the morning and may not improve for an hour or two. /ometimes it lasts throughout the day. Aoint stiffness from %A often affects these areas&

1oints of the fingers and hands ;rists lbows :nees Ankles /eet
/houlders, hips, and jaw may also be affected. At least two or three different joints are involved on both sides of the body. Three different processes occur as %A progresses..
In the first* the lining of the joint becomes inflamed. This causes stiffness# pain# warmth# redness# and swelling around the joint. (evere morning stiffness# which can limit your ability to function# is often the very first sign of the disease. In the se"ond* the rapid division and growth of cells causes the synovium to thicken. In the third* the inflamed cells release en0ymes that may digest bone and cartilage. This often causes$ more pain# loss of joint shape and alignment# and loss of movement.
:oint Stiffness8 ,is# ;actor for (arly :oint &amage

*ow 'uic!ly joint damage occurs with rheumatoid arthritis varies from person to person and depends on many factors. In addition to signs such as inflammation or certain antibodies that can be measured with tests, ris! factors for early joint damage may include&

(tiffness# pain# and swelling in many joints 1oint stiffness and swelling every day
The more ris! factors you have, the more important it is to get early treatment.
'rac#ing Symptoms of :oint Stiffness and .ain

/ymptoms such as joint stiffness and pain can tell your doctor a lot about your type and e(tent of arthritis. ThatDs why itDs so important for you to !eep trac! of your symptoms. ?eeping a symptom chart for a few wee!s can help confirm a diagnosis of rheumatoid arthritis.
(e#ore you see your doctor2 ma$e a list o# your symptoms and describe when they occur3 'o they occur a#ter a particular activity or #irst thing in the morning1 &ote when 0oint sti##ness and other symptoms #irst began2 whether they came on suddenly or have recurred2 and whether thMost Common Types o# Arthritis
1id you !now there is more than one type of arthritis. In fact, there are more than 9:: types of arthritis. ItDs a condition that affects more than "> million <./. adults )) a number thatDs e(pected to increase to >5 million adults by the year 4:=:. The false notion that all arthritis is ali!e has led people to try treatments that have little effect on their arthritis symptoms. /ince each type of arthritis is different, each type calls for a different approach to treatment. That means an accurate diagnosis is crucial for anyone who has arthritis. -ith the proper diagnosis, youDll !now what causes the pain. Then, you can be sure youDre ta!ing the proper steps to relieve the pain and continue to be active.
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What Are the %ommon 'ypes of Arthritis?

There are two major types of arthritis )) osteoarthritis, which is the Gwear and tearG arthritis, and rheumatoid arthritis, an inflammatory type of arthritis that happens when the bodyDs immune system does not wor! properly. Hout, which is caused by crystals that collect in the joints, is another common type of arthritis. 8soriatic arthritis, lupus, and septic arthritis are other types of the condition.
What Is Osteoarthritis?
Osteoarthritis is also called degenerative joint disease or degenerative arthritis. It affects about == million Americans and is the most common chronic joint condition. Osteoarthritis results from overuse of joints. It can be the conse'uence of demanding sports, obesity, or aging. If you were an athlete or dancer in high school or college, you may be wondering why your !nee or hip aches when you climb out of bed in the morning. As! your doctor about osteoarthritis. It can stri!e earlier in life with athletes or those who suffered an injury in young adulthood. Osteoarthritis in the hands is fre'uently inherited and often happens in middle)aged women. Osteoarthritis is most common in joints that bear weight )) such as the !nees, hips, feet, and spine. It often comes on gradually over months or even years. 2(cept for the pain in the affected joint, you usually do not feel sic!, and there is no unusual fatigue or tiredness as there is with some other types of arthritis. -ith osteoarthritis, the cartilage gradually brea!s down. artilage is a slippery material that covers the ends of bones and serves as the bodyDs shoc! absorber. As more damage occurs, the cartilage starts to wear away, or it doesnDt wor! as well as it once did to cushion the joint. As an e(ample, the e(tra stress on !nees from being overweight can cause damage to !nee cartilage. That, in turn, causes the cartilage to wear out faster than normal.
As the cartilage becomes worn, cushioning effect of the joint is lost. The result is pain when the joint is moved. Along with the pain, sometimes you may hear a grating sound when the roughened cartilage on the surface of the bones rubs together. 8ainful spurs or bumps may appear on the end of the bones, especially on the fingers and feet. -hile not a major symptom of osteoarthritis, inflammation may occur in the joint lining as a response to the brea!down of cartilage. eyDve changed in intensity over time or moved to new joints.
Rheumatoid &odules
%heumatoid nodules are firm lumps located under the s!in. The nodules grow close to the affected joints. %heumatoid nodules can be as large as a walnut or as small as a pea. Twenty percent to =#N of adults with rheumatoid arthritis (%A) get rheumatoid nodules. /ometimes the nodules are movable. Or, they can be firmly connected to tendons or fascia under the s!in. %heumatoid nodules are often found at pressure points, including&

hands fingers knuckles elbows
The nodules can also form on the vocal cords, causing hoarseness. %heumatoid nodules may appear in the lungs, heart, and other internal organs. @any people with %A have no pain or symptoms with the nodules. +ut some patients find the nodules painful. /ometimes rheumatoid nodules interfere with daily activities, put pressure on nerves, and limit movement. %heumatoid nodules in areas such as the heart and lungs may affect organ function.
What are the causes of rheumatoid nodules?

%heumatoid nodules usually occur in patients with severe %A. 0early all %A patients with nodules test positive for rheumatoid factor. /tudies show that when %A is lin!ed with a positive rheumatoid factor test, it may indicate more aggressive disease. Other factors may increase the chance of %A nodules. One study found that cigarette smo!ing increases nodules in patients with %A. @ethotre(ate, a commonly used %A drug, has also been lin!ed to increased development of rheumatoid nodules.
Are there treatments for rheumatoid nodules?
/ometimes disease)modifying antirheumatic drugs (1@A%1s) can reduce the siEe of rheumatoid nodules. +ut patients who ta!e methotre(ate may develop an increase in siEe and number of nodules. If nodules are thought to be a result of methotre(ate treatment, a change in medication regimen may helpJ however, this decision must be carefully made on an individual basis. Injections of glucocorticoids (steroids) may help shrin! nodules. /ometimes surgery is necessary if rheumatoid nodules become infected or cause severe symptoms. /eeing your doctor regularly is important to avoid serious problems with rheumatoid nodules.
!and and %inger Rheumatoid Arthritis

%heumatoid arthritis (%A) is a painful inflammatory disease that causes swelling, stiffness, joint destruction, and deformity. This autoimmune disease has an effect on the cells that coat and lubricate joints (synovial tissue). Although osteoarthritis (the Gwear and tearG arthritisG) may affect one joint, such as hand arthritis or finger arthritis, rheumatoid arthritis usually happens symmetrically. ,or instance, %A may affect both wrists, both hands, both !nees, and both an!les and feet.
A +isua! ,uide to -nderstanding Rheumatoid Arthritis .RA/
What are the symptoms of hand and finger ,A?

The wrist joints and the finger joints closest to the hand are common targets of hand %A. -ith hand and finger %A, you may feel the following&

<and pain# finger pain# swelling# and stiffness <and joints and finger joints that are warm and tender to the touch The same joints affected symmetrically &both wrists# fingers on both hands*
/inger joints that >creak> when movedI this is called crepitus )eformities in finger joints ,arpal tunnel symptoms such as numbness and tingling of the hands 3ore inflammation# pain# and stiffness that affect other symmetrical joints such as both sides of the jaw# both sides of the neck# shoulders# elbows# hips# knees# ankles# and feet /lu%like feeling /atigue that is not easily resolved Pain and stiffness that last for more than an hour upon arising
What causes hand and finger ,A?

/cientists are unsure about the causes of hand and finger %A. They do !now that %A affects about 9.= million Americans and occurs in all racial and ethnic groups. About two to three times as many women suffer from rheumatoid arthritis as men. /ome rheumatoid arthritis research points to the following factors as possibly influencing rheumatoid arthritis&

Jenetic factors. nvironmental factors such as a viral or bacterial infection. <ormones. 5A tends to improve with pregnancy# while breastfeeding and the postpartum period &the time after delivery* may aggravate rheumatoid symptoms.
What is a swan1nec# deformity?

%heumatoid arthritis is a common cause of a swan)nec! deformity. ItDs estimated that about #:N of those with %A have this deformity. -ith a swan)nec! deformity, the base of the finger and the outermost joint bend, while the middle joint straightens. Over time, this imbalance of the finger joints can result in the croo!ed swan)nec! position. (True swan)nec! deformity does not occur in the thumb.) A swan)nec! deformity can ma!e it almost impossible to bend the affected finger normallyJ it can ma!e it difficult to button shirts, grip a glass, or pinch with the fingers. +y e(amining the hand and fingers, a rheumatologist can diagnose a swan)nec! deformity and determine appropriate treatment, which may include&

/inger splints or ring splints (urgery to realign the joints or fuse the joints for better function
Rheumatoid Arthritis o# the -nee

%heumatoid arthritis (%A) is a serious type of inflammatory arthritis that affects 9.= million Americans. In 5#N of cases, %A affects women. %A can affect people of any age, even very young children. <nli!e osteoarthritis (OA), the Gwear)and)tearG arthritis, %A is a chronic autoimmune disease in which the immune system attac!s the joints. %A usually occurs in a symmetrical pattern, affecting both hands, !nees, an!les, feet, hips, elbows, and shoulders.
Re"ommended Re!ated to Rheumatoid Arthritis

Auvenile Arthritis at /chool& #:" 8lans, I28s, and 8ain Issues
(am ;illiams and his parents knew something was wrong when it hurt for the K%year%old to grip a baseball bat# but they never considered juvenile arthritis. "t hurt to write# giving (am a sound excuse for not wanting to do his homework %% or even his work at school. After several weeks# (am9s pain grew worse %% and moved into his knees. <e also had pain in his jaw and had trouble walking. ><is brother had to carry him piggyback up the stairs#> says 5ose ;illiams# (am9s mother. After several months#...
%ead the Auvenile Arthritis at /chool& #:" 8lans, I28s, and 8ain Issues article Q Q %A causes severe joint swelling, joint pain, stiffness, and deformity. It also affects other tissues and organs such as the heart, s!in, and lungs. %A can also cause fever, fatigue, weight loss, and flu)li!e symptoms. Hetting dressed, tying shoelaces, or wal!ing to the car may be painful with !nee arthritis. +ut with early and aggressive medical treatment, most cases of !nee %A can be managed.
What Is 6nee ,A?

%heumatoid arthritis of the !nee causes the joints to become tender, warm, and swollen. Although !nee osteoarthritis causes pain and stiffness, joint pain with !nee %A is more severe. 0ormally, a small pouch covered with a thin tissue called synovium lies between the two pieces of joint cartilage. artilage is a material that covers the ends of joint bones. artilage helps to !eep bones from rubbing against each other during movement. The synovium secretes a li'uid. This li'uid helps !eep joints lubricated. -hen joints are well lubricated, they move smoothly and painlessly. Inflammation of the synovium leads to damage and permanent destruction of the joint.
What Are the Signs and Symptoms of 6nee ,A?

-ith !nee %A, you may feel the following&

Pain (welling# inflammation (tiffness ;armth around the knee joints /ever /lu%like symptoms /atigue
What %auses 6nee ,A?

The actual causes of %A are not understood. -e !now that %A occurs when the bodyDs own immune system doesnDt function properly. %A may be lin!ed to genetics. 2nvironmental factors also may be involved. +ut, e(perts are unsure of the e(act cause.
How Is 6nee ,A &iagnosed?

$our doctor can diagnose !nee %A. *e or she will do a physical e(am, tal! with you about your personal and family medical history, and perform blood tests.

2lood tests for 5A may be positive for the following$ Anemia &low red blood cell count* 5heumatoid factor &5/*# found in about LB@ to KB@ of those with 5A <igh erythrocyte sedimentation rate &sed rate*# which indicates inflammation Antibodies to cyclic citrullinated peptides &,,P* <igh levels of ,%reactive protein &,5P*
$our doctor may order an 7)ray of the joints. An @%I may also be used to detect evidence of joint damage or destruction. $our doctor may withdraw a sample of joint fluid (synovial fluid) to analyEe. 8eople with %A usually have joint fluid thatDs filled with inflammatory material.
Rheumatoid Arthritis o# the -nee

&continued*
What4s the 'reatment for 6nee ,A?

The best treatment for !nee %A is early and aggressive medical care. @edical treatments include the use of disease)modifying anti)rheumatic drugs (1@A%1s), which are used with 0/AI1s (non steroidal anti)inflammatory drugs) andFor steroids in low doses. 1@A%1s include&

methotrexate &5heumatrex# /olex* leflunomide &Arava* hydroxychloro4uine &Pla4uenil* sulfasala0ine &A0ulfidine* gold &3yochrisine injected into musclesI Auranofin %% given orally* minocycline &3inocin# Fectrin# )ynacin* a0athiaprine &"muran* cyclosporine &'eoral# (andimmune* tofacitinib &=eljan0*
Another category of 1@A%1s are biologic modifiers )) usually used with methotre(ate. +iologic agents include&

adalimumab &<umira* anakinra &:ineret* etanercept & nbrel* infliximab &5emicade* abatacept &Orencia* rituximab &5ituxan*
Other treatments are&

'onsteroidal anti%inflammatory drugs &'(A")s* %% over%the%counter and prescription strength (teroids
Along with early and aggressive medical therapy, regular e(ercise is important. 2(ercise helps strengthen the muscles around the !nee and helps support the joint. /ometimes physical therapy and occupational therapy are recommended.
Is Surgery 9ecessary for 6nee ,A?

At some point, total joint replacement may be performed. This surgery is usually a Glast resortG instead of the first treatment option for !nee %A. TodayDs advances in total joint replacement give a successful outcome in most cases.
Synovectomy is another procedure that4s per#ormed in rheumatoid arthritis3 )ith synovectomy2 the surgeon removes the in#lamed synovium or 0oint lining3 Synovectomy can be done as an open procedure or by arthroscopy3 "n general2 arthroscopic procedures are associated with #ewer complications and #aster recovery than a more invasive surgery3 The relie# in $nee pain with syno!ip Rheumatoid Arthritis
About 9.= million Americans suffer from rheumatoid arthritis (%A). This chronic inflammatory arthritis affects two to three times as many women as men. Although %A is most commonly associated with joints of the hands and wrists, it can also affect larger joints, such as the hips, !nees, and shoulders. /ymptoms of hip arthritis may occur later than those from %A affecting smaller joints.
What Are the Symptoms of Hip ,A?

*ip %A can cause symptoms such as severe pain, stiffness, and swelling. -ith %ADs hip pain, you may have discomfort and stiffness in the thigh, lower bac!, and groin. Other symptoms of %A include fatigue, loss of appetite, fever and pain, swelling, and stiffness in other joints. %A symptoms can come on gradually or suddenly.
What %auses ,A?

%A is an autoimmune disease )) the immune system attac!s the patientDs own body. Although the cause of %A is not !nown, e(perts believe the following may play a role&

Jenetics nvironmental factors <ormones
How Is ,A &iagnosed?
To ma!e a diagnosis of %A, your doctor will do a physical e(am, ta!e a patient history, and order tests such as blood tests and 7)rays. Other tests that may be helpful in diagnosing %A include&
35"
Cltrasound 2one scan
What4s the 'reatment for ,A?

Treatments for %A include disease)modifying anti)rheumatic drugs (1@A%1s). These drugs are used with non)steroidal anti)inflammatory drugs (0/AI1s) andFor corticosteroids in low doses. 1@A%1s include&

methotrexate &5heumatrex# /olex* leflunomide &Arava* hydroxychloro4uine &Pla4uenil* sulfasala0ine &A0ulfidine* gold &3yochrisine injected into musclesI Auranofin % given orally* minocycline &3inocin# Fectrin# )ynacin* a0athiaprine &"muran* cyclosporine &'eoral# (andimmune* tofacitinib &=eljan0*
1@A%1s also include drugs !nown as biologic modifiersJ these are usually used with methotre(ate. +iologic agents include&

adalimumab &<umira* anakinra &:ineret* etanercept & nbrel* infliximab &5emicade* abatacept &Orencia* rituximab &5ituxan* golimumab &(imponi*
0/AI1s may also be used to treat hip %A. 0/AI1s may be over)the)counter or prescription strength.
Is ()ercise Important for ,A?
%egular e(ercise is important for %A. 2(ercise strengthens muscles that support joints. 2(ercise also helps you stay fle(ible. This is important to prevent painful falls. 8hysical therapy can help you learn ways to move without pain or injury. Occupational therapy is helpful to learn easier ways to perform activities of daily living, such as dressing, coo!ing, eating, or cleaning.
What A!out Surgery for Hip ,A?

*ip surgery is an option when severe pain or joint destruction causes immobility. ,or patients with earlier stage %A of the hip, hip arthroscopy may help to ease pain. Arthroscopy is done with a thin tube connected to a light source through a small surgical incision. ,or more severe disease, total joint replacement may be recommended. ItDs estimated that about K:N of patients will have good results for 94)9# years after hip replacement. @ost patients have little pain after this surgery. vectomy in %A may last up to five years.
Rheumatoid Arthritis 5RA6 Complications

Thin! of rheumatoid arthritis (%A) and you probably thin! of the stiff, painful, and inflamed joints that characteriEe the disease. +ut what you might not !now is that %A complications can occur in many parts of the body. The autoimmune process that wrea!s havoc on the joints can also affect the eyes, lungs, s!in, heart and blood vessels, and other organs. The medications you ta!e for %A can have unwanted side effects as well. And, dealing with a chronic disease li!e %A day in and day out may cause emotional distress. @any people with %A suffer from depression. To manage the complications of rheumatoid arthritis, itDs important to recogniEe problems early and get appropriate treatment. *ere are some potential problems you should be aware of&
(ffects on the S#in

One)fifth of people with rheumatoid arthritis develop lumps of tissue called rheumatoid nodules, usually under the s!in, particularly on the elbows, forearms, heels, or fingers. The nodules, which may develop gradually or appear suddenly, can be an indication of more severe disease activity. %heumatoid nodules can also occur in other areas of the body, such as the lungs and heart. %A)related inflammation of the blood vessels, or vasculitis, can cause changes to the s!in and surrounding tissue that can appear as ulcers.
Other types of rashes or s!in changes related to %A or medications may be seen in patients. ItDs important to alert your doctor regarding any s!in rash or sores.
(ye %omplications
%heumatoid arthritis can affect the eyes in several ways. Inflammation of the episclera, a thin membrane that covers the sclera, or white of the eye, is a common complication of %A. It is usually mild, but the eye can become red and painful. /cleritis, inflammation of the white of the eye, is more serious and can lead to vision loss. *aving rheumatoid arthritis also puts you at ris! of /jogrenDs syndrome, a condition in which the immune system attac!s the lacrimal glands, which produce tears. This can cause your eyes to feel gritty and dry. If not treated, dryness can lead to infection and scarring of the conjunctiva (the membrane that covers the eye) and cornea. If you have rheumatoid arthritis, as! your doctor about the need for regular eye e(ams.
Heart and "lood <essel &isease

@any people with rheumatoid arthritis have a collection of fluid between the pericardium and the heart itself (called a pericardial effusion), but not all will have clinical symptoms from it. 2pisodes of pericarditis (inflammation of the membrane that surrounds the heart) usually develop during flares, or periods of heightened disease activity. 8ersistent pericarditis can lead to thic!ening and tightening of the membrane, which can interfere with the heartDs ability to wor! properly. 3esions similar to rheumatoid nodules can also develop on the heart and affect heart function. Inflammation of the heart muscle itself (myocarditis) is a rare complication.

&continued*
Heart and "lood <essel &isease continued...

1rugs used for %A treatment may also wea!en the heart and other muscles. /ystemic inflammation puts people with %A at increased ris! of cardiovascular disease. %ecent research shows that people with %A have an increased ris! of heart attac! that is about the same as for people with type 4 diabetes. *aving %A also increases ris! of stro!e. Inflammation of blood vessels, called vasculitis, is an uncommon but serious complication of rheumatoid arthritis. Pasculitis associated with %A, called rheumatoid vasculitis, more commonly affects the small blood vessels supplying the s!in, but it can affect many of the bodyDs organs, including the eyes, heart, and nerves.
&iseases of the "lood and "lood1;orming %ells
@ost people with active %A e(perience a reduction in red blood cells called anemia. Anemia may cause symptoms such as fatigue, rapid heart beat, shortness of breath, diEEiness, leg cramps, and insomnia. Active inflammation may also lead to high levels of blood platelets, while treatment to suppress the immune system may lead to low levels of blood platelets, a condition called thrombocytopenia. Another possible, but uncommon complication of %A is ,eltyDs syndrome, a condition in which the spleen is enlarged and the white blood cell count is low in people with rheumatoid arthritis. *aving ,eltyDs syndrome may increase the ris! of lymphoma, a cancer of the lymph glands.
ung .ro!lems
The inflammatory process that affects the lining of the heart can similarly affect the membrane lining the lungs, leading to pleuritis and fluid collection. %heumatoid nodules also can form in the lungs. In most cases, the nodules are harmless, but can possibly lead to problems such as a collapsed lung, coughing up blood, infection, or pleural effusion )) the accumulation of fluid between the lining of the lung and the chest cavity. Interstitial lung diseases and pulmonary hypertension can also develop as complications of %A. %A treatments can affect the lungs, as well. ,or e(ample, one of the most commonly used %A treatments, methotre(ate, can potentially cause lung problems, characteriEed by shortness of breath, cough, and fever. /ymptoms tend to improve when methotre(ate is stopped.
Suscepti!ility to Infection
8eople with %A are more prone to infections, which may be related to the underlying disease itself or the immune)suppressing medications used to treat it. /tudies show that treatment with biologic agents, a relatively new and effective class of %A treatment, may greatly increase the ris! of serious infections in people with %A.
(motional (ffects
3iving day to day with the pain and limitations of a chronic disease can ta!e a toll on your emotional as well as physical health. One recent study showed that almost 99N of people with %A had moderately severe to severe symptoms of depression. Those who were rated as being more restricted in their normal activities were significantly more li!ely to have depression. The study also showed that only one in five patients who showed symptoms of depression discussed it with their arthritis doctor.

&continued*
.rotect 7ourself ;rom ,A %omplications
Although you may not thin! to mention problems li!e depression, chest pain, or dry eyes to the doctor treating your rheumatoid arthritis, itDs important that you do so. All of these problems can be related to your arthritis. Although different problems may re'uire different doctors andFor different treatments, often a change in arthritis treatment )) either to better control the disease or to eliminate the side effects of a certain treatment )) can be an important step in managing or resolving all of these problems.
'iagnosing Rheumatoid Arthritis

1iagnosing rheumatoid arthritis (%A) in the early stages can be difficult. There is no single test that can clearly identify rheumatoid arthritis. Instead, doctors diagnose rheumatoid arthritis based on factors that are strongly associated with the disease. The American ollege of %heumatology uses this list of criteria&
A. 3orning stiffness in and around the joints for at least one hour. E. (welling or fluid around three or more joints simultaneously. 3. At least one swollen area in the wrist# hand# or finger joints. M. Arthritis involving the same joint on both sides of the body &symmetric arthritis*. ?. 5heumatoid nodules# which are firm lumps in the skin of people with rheumatoid arthritis. These nodules are usually in pressure points of the body# most commonly the elbows. N. Abnormal amounts of rheumatoid factor in the blood. L. =%ray changes in the hands and wrists typical of rheumatoid arthritis# with destruction of bone around the involved joints. <owever# these changes are typical of later%stage disease.
%heumatoid arthritis is officially diagnosed if four or more of these seven factors are present. The first four factors must have been present for at least si( wee!s. @ore recently, guidelines have changed somewhat in an attempt to diagnose %A in its earlier stages.
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/ymptoms of rheumatoid arthritis can come and go but are usually persistent. To diagnose %A, your doctor may need to see your joints when the disease is active for several reasons&

Patients may find it hard to describe symptoms to doctors in a way that allows them to make the diagnosis. 5heumatoid arthritis can appear similar to other common causes of joint pain# leading to the wrong diagnosis. Patients often think they are feeling >normal> aches and pains and ignore or just live with their symptoms for a long time before seeking treatment.
/everal diseases can mas'uerade as rheumatoid arthritis, which contributes to the difficulty in diagnosis. These other diseases include&

Osteoarthritis Jout /ibromyalgia Other autoimmune diseases such as systemic lupus erythematosus &lupus* 1oint inflammation caused by infections
+ecause of these difficulties, a proper diagnosis is often missed early on. In fact, the average time between the onset of symptoms and the official diagnosis of rheumatoid arthritis is almost nine months. Though diagnosing rheumatoid arthritis isnDt easy, it is e(tremely important to correctly identify those with the disease. 1elaying the diagnosis can be harmful because joint damage can occur early in the disease. /ome e(perts thin! that bloc!ing early joint damage can have huge long) term benefits. The problem arises when it loo!s li!e someone has rheumatoid arthritis but they donDt yet meet the criteria for diagnosis. If someone doesnDt actually have it, it would be wrong to treat them because the drugs used to treat %A are powerful and can have serious side effects.
'iagnosing Rheumatoid Arthritis

continued...
If you or your doctor suspects rheumatoid arthritis, your doctor will follow a series of steps to either diagnose or rule out the disease. It will ta!e time, but eventually you will have a definite answer. There is some information and a few tools that are valuable to doctors in diagnosing rheumatoid arthritis. They include&

A careful history. Take note of the fre4uency# severity# and time of day of your symptoms. Pass this information on to your doctor. A physical exam. !our doctor will look closely at your joints to detect signs of inflammation or damage. -ab tests. These can include tests for inflammation in your blood or joint fluid and more specific tests for rheumatoid arthritis. =%rays. They can be useful to identify any joint damage that has already occurred.
In early rheumatoid arthritis, there may be no instant answers, either for you or your doctors. The best strategy is close follow)up by a physician. If you thin! you have rheumatoid arthritis, see a rheumatologist or consult with your primary care doctor, and visit regularly.
(lood Tests to 'iagnose Arthritis

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If your doctor suspects you have arthritis, he or she may have your blood drawn to determine which type of arthritis you have. In people with osteoarthritis, blood tests are not usually abnormal, but with other types of arthritis, including rheumatoid arthritis, certain tests will help with a proper diagnosis. *ere is a review of the different types of blood tests and mar!ers used to diagnose arthritis and other inflammatory conditions.
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What "lood *ar#ers Are +sed to &iagnose ,heumatoid Arthritis?
%heumatoid factors are a variety of antibodies that are present in 5:N to L:N of people with rheumatoid arthritis (%A). %heumatoid factor (%,), however, can be found in people without %A or with other autoimmune disorders. In general, when no rheumatoid factor is present in someone with %A, the course of the disease is less severe. A new test for rheumatoid arthritis that measures levels of antibodies that bind citrulline modified proteins (anti) 8) is more specific and tends to be elevated in patients with rheumatoid arthritis or in those about to develop rheumatoid arthritis. The presence of anti) antibodies can be used to predict which patients will get more severe rheumatoid arthritis.
Are 'here 'ests to &etermine Inflammation?

$es. The erythrocyte sedimentation rate (2/%) reflects the degree of inflammation in the body. In healthy people, the 2/% is low and it climbs with inflammation. It doesnDt point to any particular disease, but is a general indication of the amount of inflammation in the body. In lupus and polymyalgia rheumatica, the 2/% often correlates with disease activity. )reactive protein ( %8) levels are an even better indication than 2/% of the amount of inflammation present. In people with rheumatoid arthritis, if the %8 is high, it suggests that there is significant inflammation or injury in the body. +oth %8 and 2/% levels are used to monitor disease activity and to monitor how well someone is responding to treatment.
What 'ests Indicate &isorders i#e upus?

The A0A profile is a series of tests that measure the presence of abnormal antibodies. The profile helps your doctor loo! for diseases such as /jRgrenDs syndrome, lupus, drug)induced lupus, polymyostitis, and scleroderma. -hen the A0A is positive, it indicates that you may have an autoimmune disorder, but the test alone canDt ma!e a reliable diagnosis. If the A0A is negative, it is li!ely that you donDt have lupus.
What &oes the .resence of H A1"=> Indicate?

*3A)+45 is a genetic mar!er. In people with inflammatory arthritis of the spine and joints (not osteoarthritis), a positive *3A)+45 test is associated with the presence of one of a group of diseases called seronegative spondyloarthropathies. This includes diseases such as an!ylosing spondylitis (A/), psoriatic arthritis, and %eiterDs syndrome (also called reactive arthritis). *3A) +45 is present in about L:N of people with A/, but the gene can also be seen in people with no sign of arthritis or inflammation.
(lood Tests to 'iagnose Arthritis

What &oes It *ean if *uscle (n0ymes Are High?

-hen muscle enEymes )) creatine phospho!inase ( 8?) and aldolase )) are high, it indicates a possible inflammatory muscle disease. *igher levels of 8? can also be seen after trauma, injections into a muscle, muscle disease due to an underactive thyroid, and while ta!ing certain medications such as cholesterol)lowering statin drugs.
What Are Antineutrophil %ytoplasmic Anti!odies (A9%A)?

A0 A are abnormal antibodies found in the blood in most people with -egenerDs granulomatosis, a disease that affects the upper respiratory tract, lungs, and !idneys. They are uncommon in other diseases, which ma!es them useful in diagnosing this particular disease. A0 A levels are sometimes used to follow the course of -egenerDs granulomatosis.
What Is the %omplement System?

The complement system is made up of a networ! of proteins that involve the immune system and inflammation. 1ecreased levels of various components of complement )) =, ", or *#: )) can be seen in lupus. Other diseases that involve inflammation of the blood vessels )) called vasculitis )) also often have decreased levels of complement in the blood. In lupus, complement levels are used to follow the illness, because they rise and fall according to the activity of the disease.
What Are %ryoglo!ulins?

ryoglobulins are antibodies that may be high in a variety of different diseases, including rheumatoid arthritis, lupus, /jRgrenDs syndrome, -aldenstromDs macroglobulinemia, multiple myeloma, lymphoproliferative disorders, hepatitis + and , and other infections.
Rheumatoid %actor Test

The rheumatoid factor test is a commonly ordered test to help diagnose rheumatoid arthritis. This test measures rheumatoid factor, which is an antibody in the blood thatDs present in many people with %A. In fact, the rheumatoid factor blood test is eventually positive in 5:N to K:N of people with %A, although in early arthritis the percentage may be much smaller. %heumatoid factor may also be elevated in other autoimmune diseases besides %A.
#e!f%Assessment& Are 'ou oing A!! 'ou (an to Manage 'our Rheumatoid Arthritis)
How is the rheumatoid factor test done?

This test is 'uic! and virtually painless. +lood is collected from a vein using a needle and the blood sample is sent to a lab for analysis. Along with rheumatoid factor, your doctor may order other lab tests, including&

,omplete blood count &,2,* to assess blood cells in the body and evaluate for anemia. Antinuclear antibody &A'A* %% antibodies that might be present in 3B@ to MB@ of people with 5A. rythrocyte (edimentation rate &( ) rate* and ,%reactive protein &,5P* %% markers of inflammation. Anti%,,P antibody# which is found in most patients with 5A.
Other tests, including 7)rays, @%I, ultrasound, and other scans, may be ordered. These tests will help the doctor ma!e an accurate diagnosis.
Are there special preparations for the rheumatoid factor test?

There are no special preparations for a rheumatoid factor test. /ome people are more sensitive than others about having blood drawn. If you have any fears or 'uestions, tal! to your doctor before the test. If you feel faint or nauseated, be sure to let someone !now.
What do the results of the rheumatoid factor test mean?

The rheumatoid factor test may provide your doctor more information to ma!e an accurate diagnosis in addition to findings of a physical e(am, other tests, and your history of symptoms. The rheumatoid factor test may also help predict the severity of disease. /tudies show that when %A is lin!ed with high levels of rheumatoid factor, it may signify more aggressive disease.
Is rheumatoid factor positive in other ailments?

The rheumatoid factor test may be positive in people who have other autoimmune diseases such as systemic lupus erythematosus (lupus) and /jogrenDs syndrome.
%heumatoid factor can also be positive in people who suffer with infections. These may include hepatitis, mononucleosis, tuberculosis, and syphilis. 8atients with cancer and may also test positive for rheumatoid factor. %emember, positive results from the rheumatoid factor test do not automatically mean you have rheumatoid arthritis. %heumatoid factor may be positive in some healthy individuals and negative in people who actually have %A.
7nderstanding Rheumatoid Arthritis 88 Treatment

The main treatment goals with rheumatoid arthritis are to control inflammation and slow or stop the progression of %A. Treatment is usually a multifaceted program that consists of medications, occupational or physical therapy, and regular e(ercise. /ometimes, surgery is used to correct joint damage. 2arly, aggressive treatment is !ey to good results. And with today6s treatments, joint damage can be slowed or stopped in many cases.
&rugs for ,heumatoid Arthritis

9SAI&s As part of rheumatoid arthritis treatment, your doctor will probably prescribe a nonsteroidal anti) inflammatory drug (0/AI1). These drugs reduce pain and inflammation but do not slow progression of %A. Therefore, people with moderate to severe %A often re'uire additional drugs to prevent further joint damage. Over)the)counter 0/AI1s include ibuprofen (Advil or @otrin) and napro(en sodium (Aleve). @ost people with %A re'uire a prescription 0/AI1 as they offer a higher dose with longer lasting results and re'uire fewer doses throughout the day. There are many prescription 0/AI1s to choose from. All prescription 0/AI1s carry a warning regarding the increased ris! of heart attac! and stro!e. 0/AI1s can also raise blood pressure. In addition, 0/AI1s can cause stomach irritation, ulcers, and bleeding. $ou and your doctor can weigh the benefits of 0/AI1s against the potential ris!s. $ou may have to try a few different ones to find the one that6s right for you. &*A,&s 1isease)modifying antirheumatic drugs (1@A%1s) help slow or stop progression of %A. The most common 1@A%1 used to treat rheumatoid arthritis is methotre(ate. Other 1@A%1s include Arava, AEulfidine, yto(an, Imuran, 0eoral, 8 la'uenil, and 7eljanE.
In rheumatoid arthritis, an overactive immune system targets joints and other areas of the body. 1@A%1s wor! to suppress the immune system. *owever, they arenDt selective in their targets. Thus, they decrease the immune system overall and increase the li!elihood of catching some infections. 1@A%1s, particularly methotre(ate, have produced dramatic improvements in severe rheumatoid arthritis and can help preserve joint function. "iologics The newest and most effective treatments for rheumatoid arthritis are biologics. +iologics are genetically engineered proteins. They are designed to inhibit specific components of the immune system that play a pivotal role in inflammation, a !ey component in rheumatoid arthritis. +iologics are usually used when other drugs have failed to stop the inflammation of rheumatoid arthritis. +iologics may slow or even stop %A progression. T0, bloc!ers help to reduce pain and joint damage by bloc!ing an inflammatory protein called tumor necrosis factor (T0,). ,or some patients, T0, bloc!ers stop the progression of rheumatoid arthritis. %ecent studies have shown benefits when T0, bloc!ers are combined with methotre(ate. T0, bloc!ers include 2nbrel, *umira, %emicade, imEia, and /imponi. Other biologics suppress different areas of the immune system and include Actemra, ?ineret, Orencia, and %itu(an. /ince biologics suppress the immune system, they also increase the ris! of infection. /evere infections have been reported with biologics. Steroids ,or severe %A or when %A symptoms flare, your doctor may recommend steroids to ease the pain and stiffness of affected joints. In most cases, they can be used temporarily to calm a symptom flare. *owever, in certain people, steroids are needed long term to control pain and inflammation. /teroids can be given as injections directly into an inflamed joint or can be ta!en as a pill. 8otential side effects of long)term steroid use include high blood pressure, osteoporosis, and diabetes. +ut when used appropriately, steroids are often effective and 'uic!ly improve pain and inflammation

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Surgery and ,heumatoid Arthritis
If joint pain and inflammation become truly unbearable or joints simply refuse to function, some people choose joint replacement surgery. Today, joint replacement is commonly done on the hips and !nees and sometimes the shoulders. /urgery can dramatically improve pain and mobility and is typically done after age #:, because artificial joints tend to wear down after 9# to 4: years. /ome joints, such as the an!les, donDt respond well to artificial replacement and do better with joint fusion.
.hysical and Occupational 'herapy for ,heumatoid Arthritis

8hysical and occupational therapy are !ey components of any rheumatoid arthritis treatment plan. 8hysical therapists focus on helping you be able to !eep moving around. They can help you design an e(ercise plan, teach you the appropriate use of heat and ice, perform therapeutic massage, and even provide motivation and encouragement. Occupational therapists help you !eep doing things you are used to doing every day. They can evaluate your daily activities, determine what you may be doing to stress your joints, and teach you easier ways to accomplish daily activities. They can also determine which assistive devices can help you throughout the day.
*anaging &aily ,heumatoid Arthritis .ain

+ecause one of the most trying aspects of rheumatoid arthritis is learning to live with pain, many doctors recommend pain management training. ognitive therapy for pain management combines behavior modification with rela(ation techni'ues. These programs focus on improving emotional and psychological well)being by teaching you how to rela( and conduct daily activities at a realistic pace. 3earning to overcome mental stress and an(iety can be the !ey to coping with the physical limitations that may accompany chronic arthritis. ognitive therapy may include various techni'ues for activity scheduling, guided imagery, rela(ation, distraction, and creative problem) solving.
()ercise? :oint .ain? and ,heumatoid Arthritis

0ot only can e(ercise help rheumatoid arthritis, it6s a vital part of rheumatoid arthritis treatment. -hen joints are stiff and painful, e(ercise might be the last thing on your mind. $et with rheumatoid arthritis, e(ercising regularly is one of the best things you can do.

People who exercise live longer# with or without rheumatoid arthritis. 5egular exercise can actually reduce overall pain from rheumatoid arthritis.
xercise can keep bones strong. Thinning of the bones can be a problem with rheumatoid arthritis# especially if you need to take steroids. xercise helps bones keep their strength. xercise maintains muscle strength. 5egular exercise improves functional ability and lets you do more for yourself. People with rheumatoid arthritis who exercise feel better about themselves and are better able to cope with problems.
9atural 'reatments for ,heumatoid Arthritis

There are a variety of alternative therapies for rheumatoid arthritis. 3et your doctor !now if youDre considering them. Heat and cold& The use of heat and cold is one of the best natural treatments to help ease rheumatoid arthritis joint pain. old compresses reduce joint swelling and inflammation. *eat compresses rela( muscles and stimulate blood flow.

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9atural 'reatments for ,heumatoid Arthritis continued...

*agnets& In people with osteoarthritis, the wear)and)tear type of arthritis, some preliminary studies have shown that magnets improved joint pain better than a placebo. *owever, it6s unclear if magnets might help rheumatoid arthritis. Acupuncture& The 0ational Institutes of *ealth considers acupuncture an additional alternative treatment for arthritis. /tudies have shown that acupuncture helps reduce pain, may lower the need for pain!illers, and can help increase fle(ibility in affected joints. *ind@!ody therapy& @indFbody therapies can help with stress management and improve sleep and pain perception. /trategies include deep abdominal breathing, progressive muscle rela(ation, visualiEation, meditation, and tai chi. "iofeed!ac#& -ith biofeedbac!, you wor! with a therapist who helps you recogniEe feelings of increased tension and learn ways to calm yourself. This can help decrease feelings of pain. 9utritional supplements& ?eep in mind that even natural supplements can interact with medicines. +e sure your doctor is aware of all medicines and supplements you are ta!ing. %esearch shows that omega)= fatty acids in fish oil have an anti)inflammatory effect in the body. /everal studies have shown that fish oil supplements may help reduce morning stiffness with %A.
/ome studies show that borage seed oil along with anti)inflammatory pain!illers can reduce %A symptoms. These studies showed reductions of tender and swollen joints of %A after si( wee!s.
,heumatoid Arthritis .revention

Though arthritis is not preventable, many people are able to prevent disability with early treatment and a well)designed e(ercise program. /mo!ing is associated with the development of rheumatoid arthritis, although it isn6t clear that you can prevent rheumatoid arthritis by not smo!ing. ontinuing to smo!e, however, may ma!e treatment less effective.
Preventing Joint 'amage %rom Rheumatoid Arthritis

-hen rheumatoid arthritis flares up, it ma!es joints feel stiff and achy. That discomfort may go away at times, but there may still be permanent damage. 2ventually rheumatoid arthritis can harm joints so they donDt wor! as well even when the disease itself is not active. *ow does joint damage occur, and how can it be prevented. 8eriods of active inflammation are called high disease activity. -hen joints are inflamed, white blood cells enter the joint space. Inside the joint, these white blood cells produce chemicals that they usually use to !ill invading microorganisms )) only no microorganisms are there. Instead, the chemicals damage the healthy joint tissue. 1uring high levels of disease activity, you e(perience a flare )) joints become swollen, stiff, and painful. $ou can also have low levels of disease activity that come and go and have mild symptoms. There are two main ways this process can cause joint damage&

The infection%fighting chemicals cause cartilage# the cushion between bones in the joint# to slowly degrade and thin. The inflammation inside the joint stimulates the joint lining &synovium* to grow and spread where it doesn9t belong. "f it continues long enough# it can harm healthy cartilage or bone.
The simple rule of thumb is, the GlongerG and GstrongerG the disease activity, the more joint damage is probably occurring.

A person with joint swelling and stiffness every day is more likely to have joint damage than a person with these symptoms less often. &Longer disease activity* (omeone with a lot of joint swelling or lots of swollen joints is more likely to have damage than a person with just a little bit. &Stronger disease activity*
*ow can you tell if you are having disease activity. It can sometimes be difficult.

!ou can be feeling a lot of pain# but the cause could be from something other than 5A. 1oint damage can also occur without causing much pain.
1oint swelling is a reliable sign# though. /or the most part# having joint swelling is proof of having ongoing disease activity. Tenderness when pressing on a joint is a reliable sign. The length of morning stiffness each day can be useful. Ask yourself# after getting up# ><ow long does it take until "9m feeling as loose as "9ll feel for the day7> The longer you feel stiff# the more likely it is that your rheumatoid arthritis is active. Another sign you can look for is a >boggy> joint. ;hen the joint lining begins to grow abnormally# it may give a joint a mushy texture. This boggy texture may remain even when you are not having a flare. "f you notice this happening# you should see your rheumatologist.
If you are diagnosed with rheumatoid arthritis, your doctor will do a complete joint e(am and get 7)rays and blood tests. At later visits, you will be chec!ed for any changes to your tests, and your doctor will address possible joint damage with you. +ecause treatment for rheumatoid arthritis is improving, many e(perts believe that most people who now have it will develop less joint damage than ever before. $ou can gain control of rheumatoid arthritis and improve your chances by ta!ing the following steps&
Jet treated early. 3uch of the joint damage that eventually becomes serious starts soon after rheumatoid arthritis is discovered. The earlier you are treated# the less the chance of joint damage. (ee your doctor often. People who see their rheumatologist regularly &several times a year* have less joint damage than people who do not. xerciseO !ou can exercise without causing joint damage. "n fact# exercise has the opposite effect %% regular exercise makes joints stronger. !our doctor will help you with an exercise plan that is safe# effective# and personali0ed for your fitness level and condition. 5est when you need to. /inding the balance between rest and exercise is important so you don9t overdo it. Cse a cane in the hand opposite a painful hip or knee. This reduces wear%and%tear on the affected joint.
Rheumatoid Arthritis !ealth Center

Tools 9 Resources

1oint%/riendly xercises 2est 5A xercises 5heumatoid Arthritis Treatments K 5A 3yths Tips for <ealthy 1oints
asier 5A xercises
Rheumatoid Arthritis 'rug :uide

%heumatoid arthritis (%A) is a progressive inflammatory disease that affects the joints. It gets worse over time unless the inflammation is stopped or slowed. Only in very rare cases does rheumatoid arthritis go into remission without treatment. Arthritis medications play an essential role in controlling the progression and symptoms of rheumatoid arthritis. /tarting treatment soon after diagnosis is most effective. And the best medical care combines rheumatoid arthritis medications and other approaches. $ou may ta!e rheumatoid arthritis medications alone, but they are often most effective in combination. These are the main types of %A medications&

)isease%modifying anti%rheumatic drugs &)3A5)s* 2iologic response modifiers &a type of )3A5)* Jlucocorticoids 'onsteroidal anti%inflammatory medications &'(A")s* Analgesics &painkillers*
In the past, doctors too! a conservative, stepwise approach toward treating rheumatoid arthritis. They started first with 0/AI1s such as ibuprofen. Then, they progressed to more potent %A drugs for people who showed signs of joint damage. Today, doctors !now that an aggressive approach is often more effectiveJ it will result in fewer symptoms, better function, less joint damage, and decreased disability. The goal, if possible, is to put the disease into remission.
,heumatoid Arthritis &rugs8 &*A,&s

If youDve been diagnosed with rheumatoid arthritis, your doctor may recommend that you begin treatment with one of several types of 1@A%1s within a few months of diagnosis. One of the most important drugs in the arsenal for treating rheumatoid arthritis, 1@A%1s can often slow or stop the progression of %A by interrupting the immune process that promotes inflammation. *owever, they may ta!e up to si( months to be fully effective. 1@A%1s have greatly improved the 'uality of life for many people with rheumatoid arthritis. These %A drugs are often used along with 0/AI1s or glucocorticoidsJ however, with this type of medication, you may not need other anti)inflammatories or analgesics.
+ecause 1@A%1s target the immune system, they also can wea!en the immune systemDs ability to fight infections. This means you must be watchful for early signs of infection. In some cases, you may also need regular blood tests to ma!e sure the drug is not hurting blood cells or certain organs such as your liver, lungs, or !idneys. ()amples of &*A,&s8
0ame
1rand 0ame.s/ 5idaura
Pre"autions
Potentia! #ide 2ffe"ts
auranofin &oral gold*
a0athiaprine
"muran
-imit exposure to P )iarrhea sunlight and tell P -ow blood your doctor if you counts have had$ P 3etallic taste P Any adverse P 3outh ulcers reactions to gold% P (kin rash or containing itching medications P A history of blood%cell problems P "nflammatory bowel# kidney# or bowel disease Tell your doctor P /ever or chills if$ P -oss of appetite P !ou use P -iver problems allopurinol P -ow blood P !ou have counts kidney or liver P 'ausea or disease vomiting P xtreme fatigue 5are$ A0athiaprine is associated with certain cancers# such as lymphoma.
cyclosporine
(andimmune Tell your doctor if P <eadache # 'eoral you have$ P <igh blood
P -iver or kidney disease P Active infection P <igh blood pressure
pressure P <air growth P :idney problems P -oss of appetite P 'ausea "ncreased risk of infection and certain cancers.
gold sodium thiomalate &injectable gold*
3yochrysine Tell your doctor if P "rritated# sore you have$ tongue P -upus P "rritated# P (kin rash bleeding gums P :idney disease P 3etallic taste P ,olitis P (kin rash or itching P ;hite spots on mouth or throat 1oint pain may occur for a few days after first few injections. Tell your doctor if P 2lurry vision or you have vision increased light problemsI vision sensitivity may be damaged P <eadache with high doses P Abdominal or long%term use. cramps or pain P -oss of appetite# nausea# vomiting# or diarrhea P "tching or rashes Tell your doctor if P )i00iness you have$ P <air loss P Active infection P <eadache P -iver or kidney P <eartburn disease P <igh blood P ,ancer pressure P Jastrointestinal (top taking or liver problems leflunomide P -ow blood cell before trying to count
hydroxychloro4uine Pla4uenil sulfate
leflunomide
Arava
methotrexate
P 'europathy P (kin rash 5heumatrex# Tell your doctor if P Abdominal pain Trexall you have$ P ,hills or fever P Abnormal blood P )i00iness counts P <air loss P -iver or lung P <eadache disease P -ight sensitivity P Alcoholism P "tching P Active infection P -iver problems or hepatitis P -ow blood counts
conceive.
5are# but serious$ )ry cough# fever# or trouble breathing# which may result from a blood disease
tofacitinib
=eljan0
P =eljan0 adds to P Cpper risk of serious respiratory tract infections# infection cancers# P <eadache lymphoma. P )iarrhea P 3ay increase P "nflammation of cholesterol levels the nasal passage and liver and the upper part en0ymes. of the throat P 3ay lower blood count.

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,heumatoid Arthritis &rugs8 "iologic ,esponse *odifiers

+iologic response modifiers are a type of 1@A%1. They target the part of the immune system response that leads to inflammation and joint damage. +y doing this, they can improve your condition and help relieve symptoms. These %A medications canDt cure rheumatoid arthritis. If the drugs are stopped, symptoms may return. +ut just as with other 1@A%1s, biologic response modifiers may slow the progression of the disease or help put it into remission. If your doctor prescribes one of these %A drugs, you will li!ely ta!e it in combination with methotre(ate. +iologic response modifiers are ta!en by injection andFor by IP and are e(pensive. Their long)term effects are un!nown. 0OT2& +efore ta!ing biologics, itDs important to get appropriate vaccinations and to be tested for tuberculosis and hepatitis + and . ()amples of !iologic response modifiers8
0ame
1rand 0ame
Pre"autions
abatacept
Orencia P Tell your doctor if you P ,ough have a serious infection# P )i00iness
such as pneumonia or P <eadache ,OP). P (erious infection P )o not take live P "nfusion reaction vaccines. P Jet tested for T2 before starting treatment. adalimumab <umira P Tell your doctor if you have a serious infection# such as pneumonia. P )o not take live vaccines. Jet tested for T2 before starting treatment. P Tell your doctor if you have a serious infection or a history of it. P )o not take live vaccines. P 5edness# pain# itching# or bruising at injection site P Cpper respiratory infection
anakinra
:ineret
P 5edness# swelling# pain# or bruising at injection site P -ow white blood cell count P Cpper respiratory infection
etanercept
nbrel
)o not take if you have P 5edness# pain# congestive heart failure# itching# swelling# or and tell your doctor if you bruising at injection have$ site P A serious infection P <eadache P 2een exposed to T2 P (inus infection P A serious nervous 5are complications$ system disorder P -upus P )o not take live P 3ultiple sclerosis vaccines. P (ei0ures P ,hest pain P <ives and trouble breathing P ,hanges in blood pressure P 5edness# pain# swelling# or itching at the injection site P (inus infection
infliximab
5emicad Tell your doctor if you e have$ P A serious infection# especially hepatitis 2 P 2een exposed to T2 P A serious nervous system disorder P )o not take live vaccines.
rituximab
5are complications$ P -upus P 3ultiple sclerosis P (ei0ures 5ituxan P Tell your doctor if you P Abdominal pain have a serious infection# P ,hills or fever or heart or lung disease. P <eadache P )o not take live P "nfection vaccines. P "tching
(erious side effects$ P "nfusion reactions P Tumor lysis syndrome P (evere skin reactions golimumab (imponi P Tell your doctor if you P 5edness at the have any infections or injection site health conditions# like P Cpper respiratory heart disease# 3(# or infections diabetesP Jet tested for P 'ausea T2 before starting P Abnormal liver treatment. tests P )o not take live 5are complications$ vaccines. P (erious infections# P (ee your doctor right away if you develop signs like T2# fungal of infection while taking infections# and reactivation of a this drug. previous hepatitis 2 infection P -upus P 3ultiple sclerosis certoli0umab ,im0ia P Tell your doctor if you P <eart failure pegol have an infection or are P 'erve problems being treated for an such as 3( infection# or if you have P Allergic reactions diabetes# <"F# hepatitis P Autoimmune 2# cancer# or T2. problems like lupus P 5eactivation of hepatitis 2 tocili0umab Actemra P Tell your doctor if you P Cpper respiratory have a serious infection# tract infection
history of gastrointestinal perforation# or if you are pregnant or plan on becoming pregnant. P )o not take live vaccines.
P "nflammation of the nose or throat P <igh blood pressure P <eadache P Abnormal liver en0yme level P (erious infections# like T2# and infections from bacteria# viruses# or fungi

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,heumatoid Arthritis &rugs8 $lucocorticoids

Hlucocorticoids are steroids. They are strong anti)inflammatory drugs that can also bloc! other immune responses. These rheumatoid arthritis medications help relieve symptoms and may stop or slow joint damage. $ou receive these %A drugs by pill, or by injection. +ecause of the ris! of side effects, you should only use these %A drugs for brief periods, for e(ample, when disease flares up or until 1@A%1s reach their full effectiveness. If your side effects are severe, donDt stop ta!ing the drug suddenly. Tal! first with your doctor about what to do. ()amples of glucocorticoids8
0ame
1rand 0ame.s/ Pre"autions
betamethasone ,elestone injectable
Tell your doctor P 2ruising if you have$ P ,ataracts P /ungal P "ncreased infection cholesterol P <istory of T2 PAtherosclerosis P Cnderactive P <igh blood thyroid pressure P )iabetes P "ncreased appetite P (tomach ulcer or indigestion P <igh blood P 3ood swings or
pressure nervousness P Osteoporosis P 3uscle weakness P Osteoporosis P "nfections prednisone )eltasone# 3eticorten# Orasone Tell your doctor P 2ruising if you have$ P ,ataracts P /ungal P "ncreased infection cholesterol P <istory of T2 PAtherosclerosis P Cnderactive P <igh blood thyroid pressure P )iabetes P "ncreased appetite P (tomach ulcer or indigestion P <igh blood P 3ood swings or pressure nervousness P Osteoporosis P 3uscle weakness P Osteoporosis P "nfections
,heumatoid Arthritis &rugs8 9SAI&s

0/AI1s wor! by bloc!ing an enEyme that promotes inflammation. +y reducing inflammation, 0/AI1/ help reduce swelling and pain. +ut they are not effective in reducing joint damage. These drugs alone are not effective in treating the disease. They should be ta!en in combination with other rheumatoid arthritis medications. As with glucocorticoids, you should use them for brief periods )) they can cause severe digestive tract problems. -hich type, if any, your doctor prescribes may depend upon your medical history. If you have a history of liver, !idney, heart problems or stomach ulcers, itDs best to not ta!e these drugs. As! your doctor whether any new 0/AI1/ producing fewer side effects are available. ()amples of 9SAI&s8
0ame
1rand Pre"autions 0ame.s/
celecoxib ,elebrexP Tell your doctor if you have P "ndigestion# had a heart attack# stroke# diarrhea# and
angina# blood clot# or high stomach pain blood pressure or if you P (erious skin have sensitivity to '(A")( reactions or sulfa drugs. P )o not take with other '(A")(. P )o not take late in pregnancy. diclofenac Foltaren Tell your doctor if you$ sodium P )rink alcohol P Cse blood thinners P Take A, inhibitors# lithium# warfarin# or furosemide P <ave sensitivity to aspirinI kidney# liver# or heart diseaseI asthmaI high blood pressureI ulcers P )o not take with other '(A")s. P Abdominal cramps# diarrhea P )i00iness or drowsiness P <eartburn# indigestion# nausea# vomiting# ulcer# or bleeding P "ncreased risk of blood clots# heart attacks# and stroke Jreater risk of complications for people with cardiovascular disease P Abdominal cramps# diarrhea P )i00iness or drowsiness P <eartburn# indigestion# nausea# vomiting# ulcer# or bleeding P "ncreased risk of blood clots# heart attacks# and stroke Jreater risk of complications for people with cardiovascular disease
ibuprofen 3otrin# Advil
Tell your doctor if you$ P )rink alcohol P Cse blood thinners P Take A, inhibitors# lithium# warfarin# or furosemide P <ave sensitivity to aspirinI kidney# liver# or heart diseaseI asthmaI high blood pressureI ulcers P )o not take with other '(A")(.

&continued*
,heumatoid Arthritis &rugs8 Analgesics

Analgesics reduce pain but they do not reduce swelling or joint damage. There are a variety of over)the)counter and prescription analgesics. 0arcotics are the most powerful type of analgesic. <se these carefully and be sure to let your doctor !now if you have any history of alcoholism or drug abuse. ()amples of analgesics8
0ame
1rand 0ame.s/
Pre"autions
Potentia! #ide 2ffe"ts (ide effects uncommon if taken as directed.
acetaminophe Tylenol# n /averall# Tempra
P Tell your doctor if you have 3 or more drinks of alcohol daily. P Avoid taking more than one product with acetaminophen. P Tell your doctor if you use central nervous system depressants# tran4uili0ers# sleeping medications# muscle relaxants# or narcotic pain medications or if you have a history of drug or alcohol abuse. P )o not stop suddenly or increase the dose on your own. P )o not drive or use heavy machinery until you know how your body reacts to the drug.
tramadol
Cltram
P ,onstipation P )iarrhea P )rowsiness P "ncreased sweating P -oss of appetite P 'ausea
oxycodone
Oxy,ontin# Tell your doctor if you use P ,onstipation 5oxicodone central nervous system P )i00iness
depressants# tran4uili0ers# P )rowsiness sleeping medications# P )ry mouth muscle relaxants or P <eadache narcotic pain medications P "ncreased or if you have a history of sweating drug or alcohol abuse. P "tchy skin P 'ever chew or cut tabletsI P 'ausea or a high dose can be fatal if vomiting released rapidly. P (hortness of breath
Treating Rheumatoid Arthritis )ith 'isease8Modi#ying 'rugs 5'MAR's6

%heumatoid arthritis treatment includes medications that slow the progression of joint damage from rheumatoid arthritis. These drugs are called disease)modifying antirheumatic drugs (1@A%1s), and they are an important part of an overall treatment plan. -hat are these drugs, and how do they wor!. 1isease)modifying drugs act on the immune system to slow the progression of rheumatoid arthritis. This is why they are called Gdisease)modifying.G @any different drugs can be used as 1@A%1s in the treatment of %A, but some are used more often than others.
&*A,& Side (ffects and +se

*ethotre)ate is the most commonly used 1@A%1. This is because it has been shown to wor! as well or better than any other single medicine. It is also relatively ine(pensive and generally safe. 3i!e other 1@A%1s, methotre(ate has side effectsJ it can cause rash and stomach upset, can be to(ic to the liver or bone marrow, and can cause birth defects. In rare cases, it can also cause shortness of breath. %egular blood wor! is necessary when ta!ing methotre(ate. Ta!ing folic acid helps reduce some of the side effects. @ethotre(ateDs biggest advantage could be that it has been shown to be safe to ta!e for long periods of time and can even be used in children. 8la'uenil (hydro)ychloro/uine) and AEulfidine (sulfasala0ine) are used for mild rheumatoid arthritis. They are not as powerful as other 1@A%1s, but they usually cause fewer side effects. In rare cases, 8la'uenil can adversely affect the eyes, and patients ta!ing this medicine should be seen by an ophthalmologist at least once a year. *inocin (minocycline) is an antibiotic. +ut it may help %A by stopping inflammation. It can ta!e several months to start wor!ing and up to a year before the full effects are !nown. -hen ta!en for long periods, minocycline can cause discoloration of the s!in. Arava (leflunomide) wor!s about as well as methotre(ate and can wor! even better in combination with it. The side effects are similar to methotre(ate. /ometimes Arava causes
diarrhea and canDt be used. /ince Arava is !nown to cause harm to a fetus, women must ta!e special precautions to not get pregnant while on it. "iologic drugs8 Actemra (tocili0uma!),2nbrel (etanercept),*umira (adalimuma!),?ineret (ana#inra),Orencia (a!atacept),%emicade (infli)ima!),%itu(an (ritu)ima!), imEia (certoli0uma!),and /imponi (golimuma!). These are the newest drugs for %A and are either injected under the s!in or given directly into a vein. They wor! by neutraliEing the immune systemDs signals that lead to joint damage. -hen used with methotre(ate, these medicines help most people with rheumatoid arthritis. These drugs are thought to have fewer side effects than other 1@A%1s. One side effect is the ris! for potentially severe infections. These medicines can also adversely affect your liver or blood counts. Other potential long)term effects wonDt be !nown until the drugs have been used by patients for many years.
reating Rheumatoid Arthritis )ith 'isease8Modi#ying 'rugs 5'MAR's6

&continued*
&*A,& Side (ffects and +se continued...

0eoral (cyclosporine) is a powerful drug that often wor!s well in slowing down joint damage. +ut because it can hurt the !idneys and has other potential side effects, it is usually used for severe %A after other drugs fail. Imuran (a0athioprine) is used for many different inflammatory conditions, including %A. The most common side effects are nausea and vomiting, sometimes with stomach pain and diarrhea. 3ong)term use of aEathioprine is associated with an increased ris! of cancer. Ael5an0 (tofacitini!) is a type of drug called a AA? inhibitor. It is often used in people who no longer respond to methotre(ate. The drug comes as a pill ta!en twice a day. +ut because it inhibits immune responses, 7eljanE adds to a personDs ris! of serious infections, cancers, and lymphoma. The drug will carry a Gblac! bo(G warning about these ris!s. 1@A%1s slow down rheumatoid arthritis and improve 'uality of life for most people. /ome will even achieve a remission while ta!ing them. @ore commonly, the disease activity continues, but at a slower, less intense pace. -hile ta!ing one or more 1@A%1s, you may have longer symptom)free periods, or flare ups that are less painful or stressful. $our joints may ta!e less time to loosen up in the morning. At a chec!)up, your rheumatologist may end up telling you that your most recent 7)rays are free of any new damage. Ta!ing a 1@A%1 regularly ma!es you less li!ely to have long)term damage to your joints, too.
Are &*A,&s Safe?

The ,1A has approved all 1@A%1s. @any people ta!e them without ever having problems.
+ut because they wor! throughout the body to fight %A, their powerful action typically does cause some side effects, commonly&
#toma"h upset. )3A5)s often cause nausea# sometimes with vomiting# or diarrhea. Other medicines can help treat these symptoms# or they often improve as you get used to the drug. "f the symptoms are too uncomfortable to tolerate# your rheumatologist will try a different medication. Liver prob!ems. These are less common than stomach upset. !our doctor will check blood tests on a regular basis to make sure your liver is not being harmed. 1!ood issues. )3A5)s can affect the immune system and raise the risk of infection. "nfection%fighting white blood cells may also be decreased. -ow red blood cells &anemia* can make you tired more easily. A simple blood test by your doctor every so often will make sure your blood counts are high enough.
$ou should learn about possible side effects of any medicine you are ta!ing and discuss them with your doctor until you feel comfortable. To minimiEe side effects, 1@A%1s are sometimes started one at a time and increased gradually. The goal is to minimiEe both rheumatoid arthritis disease activity and medication side effects. /ometimes it ta!es more than one 1@A%1 to get control of active rheumatoid arthritis.
Treating Rheumatoid Arthritis )ith 'isease8Modi#ying 'rugs 5'MAR's6

&continued*
Are &*A,&s Safe? continued...

*ow do you !now youDre on the GrightG regimen. ThereDs no easy way. %heumatologists use all their training and e(perience to determine whatDs right for you. Though 1@A%1s can have side effects, there is a good reason to ta!e them )) theyDre proven to wor! against rheumatoid arthritis. 2ven if you are in a remission, many rheumatologists believe you should !eep ta!ing a 1@A%1, just to !eep your %A at bay.
Steroids to Treat Arthritis

/teroids (short for corticosteroids) are synthetic drugs that closely resemble cortisol, a hormone that your body produces naturally. /teroids wor! by decreasing inflammation and reducing the activity of the immune system. They are used to treat a variety of inflammatory diseases and conditions.
orticosteroids are different from anabolic steroids, which some athletes use to build bigger muscles. 2(amples of corticosteroid medications include triamcinolone, cortisone, prednisone, and methylprednisolone.
How Are Steroids $iven?

/teroids can be given topically (cream or ointment), by mouth (orally), or by injection. -hen injected, they can be given into a vein or muscle, directly into a joint or bursa (lubricating sac between certain tendons and the bones beneath them) or around tendons and other soft tissue areas.
How &o Steroids Wor#?

/teroids decrease inflammation and reduce the activity of the immune system. Inflammation is a process by which the bodyDs white blood cells and chemicals protect the body against infection and foreign organisms such as bacteria and viruses. In certain diseases, however, the bodyDs defense system (immune system) doesnDt function properly and is overactive. This may cause inflammation to wor! against the bodyDs own tissues and cause tissue damage. Inflammation is characteriEed by redness, warmth, swelling and pain. /teroids reduce the production of inflammatory chemicals in order to minimiEe tissue damage. /teroids also reduce the activity of the immune system by affecting the function of white blood cells.
What %onditions Are 'reated With Steroids?

/teroids are used to treat a variety of conditions in which the bodyDs defense system malfunctions and causes tissue damage. /teroids are used as the main treatment for certain inflammatory conditions, such as systemic vasculitis (inflammation of blood vessels) and myositis (inflammation of muscle). They may also be used selectively to treat inflammatory conditions such as rheumatoid arthritis, lupus, /jRgrenDs syndrome, or gout.
What Are the "enefits of Steroids?

-hen inflammation threatens to damage critical body organs, steroids can be organ saving and, in many instances, life)saving. ,or e(ample, they may help prevent the progression of !idney inflammation, which can lead to !idney failure in people who have lupus or vasculitis. ,or these people, steroid therapy may eliminate the need for !idney dialysis or transplant. 3ow doses of steroids may provide significant relief from pain and stiffness for people with conditions including rheumatoid arthritis. Temporary use of higher doses of steroids may help a person recover from a severe flare)up of arthritis.
Why Are Steroids In5ected?
Injecting steroids into one or two areas of inflammation allows doctors to deliver a high dose of the drug directly to the problem area. -hen doctors give steroids by mouth or IP, they cannot be sure an ade'uate amount will eventually reach the problem area. In addition, the ris! of side effects is much higher with oral or IP steroids.

What %onditions Are 'reated With Steroid In5ections?

/teroids often are injected directly into joints to treat conditions such as rheumatoid arthritis, gout, or other inflammatory diseases. They also can be injected into an inflamed bursa or around tendons near most joints in the body. /ome people report relief from osteoarthritis when steroids are injected directly into swollen or painful joints.
What Are the ()pected "enefits of Steroid In5ections?

/teroid injections into a specific area are generally well tolerated and are less li!ely than other forms of steroid drugs to produce serious side effects. Also, the injections may help avoid the need for oral steroids or increased doses of oral steroids, which could have greater side effects.
What ,ole &o Steroid In5ections .lay In an Overall 'reatment .rogram?

/teroid injections can be added to a treatment program that may already include anti) inflammatory pain medications (0/AI1s), physical therapy, occupational therapy, or supportive devices such as canes and braces. -hether one or more of these treatment methods are used depends on the nature of the problem. ,or e(ample, in an otherwise healthy person, tendinitis may be ade'uately treated with only a steroid injection into the inflamed area. *owever, in a person with rheumatoid arthritis, injections are generally a small part of a multifaceted treatment approach.
When Should Steroid In5ections 9ot "e +sed?
/teroids should not be injected when there is infection in the area to be targeted or even elsewhere in the body because they could inhibit the natural infection)fighting immune response. Also, if a joint is already severely destroyed, injections are not li!ely to provide any benefit. If someone has a potential bleeding problem or is ta!ing anticoagulants (often referred to as blood thinners), steroid injections may cause bleeding at the site. ,or these people, injections are given with caution. ,re'uent steroid injections, more often than every three or four months, are not recommended because of an increased ris! of wea!ening tissues in the treated area.
What Are the Side (ffects of Steroid In5ections?

/teroid injections are one of the most effective ways to decrease pain and improve function, yet they generally do not cure the illness. In rare instances, the following side effects might occur&

"nfection Allergic reactions 2leeding into the joint 5upture of a tendon (kin discoloration ;eakening of bone# ligaments# and tendons &from fre4uent# repeated injections into the same area*
0ot everyone will develop side effects and side effects vary from person to person. If steroid injections are infre'uent (less than every three to four months), it is possible that none of the listed side effects will occur.
What Are the .ossi!le Side (ffects of Oral Steroids?

/ide effects are more common with a higher dose and longer treatment. /ide effects are much more common with oral drugs. /ome side effects are more serious than others. ommon side effects of oral steroids include&

Acne 2lurred vision ,ataracts or glaucoma asy bruising )ifficulty sleeping
<igh blood pressure "ncreased appetite# weight gain "ncreased growth of body hair "nsomnia -ower resistance to infection 3uscle weakness 'ervousness# restlessness Osteoporosis (tomach irritation or bleeding (udden mood swings (wollen# puffy face ;ater retention# swelling ;orsening of diabetes
.lease note8 The side effects listed are the most common side effects. All possible side effects are not included. Always contact your doctor if you have 'uestions about your personal situation.

&oes (veryone &evelop Side (ffects of Steroids?

0o. *ow often any side effect occurs varies from person to person. If steroid use is brief (from a few days to a few wee!s), it is possible that none of the listed side effects will occur. The side effects listed generally do not occur when occasional steroid injections are given for arthritis, tendinitis, or bursitis. *owever, if steroid use involves high doses and is prolonged (for a few months to several years), an increase in the number of side effects may occur.
How %an Steroid Side (ffects "e *inimi0ed?
To minimiEe the side effects of steroids, doctors follow these guidelines&

Cse steroids only when necessary. 3onitor closely to detect the development of serious side effects. "f possible# use steroid injections for problems in a specific area. Cse the minimal dose re4uired to gain control of the disease. 5educe the dose gradually as long as the disease remains under control. 3onitor blood pressure often and treat if necessary. 5ecommend calcium supplements# vitamin )# and bone%building prescription medications to help maintain bone strength &this is done especially if steroids will be taken for a long period of time*. <ave your bone density checked every one to two years.
Who Should 9ot 'a#e Steroids?

/teroids, as with other drugs, are not recommended for everyone. In general, people with the following conditions should not ta!e steroids&

"nfection Cncontrolled diabetes Cncontrolled high blood pressure or congestive heart failure Peptic ulcer Osteoporosis &bone thinning* Jlaucoma
How &o I 6now If Steroid 'reatment Is ,ight for *e?

The decision to prescribe steroids is always made on an individual basis. $our doctor will consider your age, your overall health, and other drugs you are ta!ing. $our doctor also will ma!e sure you understand the potential benefits and ris!s of steroids before you start ta!ing them.
Physical and Occupational Therapy #or Rheumatoid Arthritis

%heumatoid arthritis treatment often includes physical therapy andFor occupational therapy.
*ealthy joints are the GhingesG that let us move around and allow us to function every day. @any of us ta!e that for granted. +ut if your joints are affected by rheumatoid arthritis, these simple movements arenDt always automatic or easy. ItDs possible for joints affected by rheumatoid arthritis to be too painful and damaged to use fully. $our treatment team will include a rheumatologist and others.

Physical therapists focus on helping you be able to keep moving around. Occupational therapists help you keep doing things you are used to doing every day.
The goals and treatments used by physical therapists and occupational therapists sometimes overlap, but there are some general differences.
.hysical 'herapy for ,heumatoid Arthritis

8hysical therapy has one simple goal& !eeping you moving. It will stimulate muscles, bones, and joints through e(ercise or other methods. The result is more strength, tone, and overall fitness. 8hysical therapists help you with joint function, muscle strength, and fitness level. They understand the mechanics of bones, joints, and muscles wor!ing together, the problems that can occur, and what to do about them. -or!ing with a physical therapist is a good idea at any stage or severity of rheumatoid arthritis.
arly in the course of rheumatoid arthritis# your physical therapist can assess and document where you are in terms of function# strength# and fitness. !our exercise plan will be designed to maximi0e your chances of avoiding joint problems as the disease progresses. "n moderate or advanced rheumatoid arthritis# a physical therapist can help you keep or increase the strength and flexibility you have.
Together, you and your physical therapist will create a road map of improvement for each muscleFjoint group, and for your overall fitness. This will become part of the treatment plan for your rheumatoid arthritis. There are a number of strategies your physical therapist can use to reach your treatment goals.
xercise. This is the cornerstone of any physical therapy plan. Together with you and your doctor# your physical therapist will design an exercise plan that is targeted to your ability and fitness level. A good plan will include stretching+flexibility exercisesI strength exercises# and conditioning &or aerobic* exercise. <eat+"ce. Treating inflamed or painful joints with heat or ice packs helps some people feel better. 3assage. "n some patients with chronic pain# therapeutic massage reduces symptoms. 3otivation and encouragement. ;hile >low%tech#> it9s hard to overestimate the value of having someone in your corner cheering you on%and pushing you to do better.
Occupational 'herapy for ,heumatoid Arthritis

Occupational therapists specialiEe in ma(imiEing your independence. They can assess your ability to perform the activities of daily living. If doing routine things around the house or at wor! has become harder, an occupational therapist can probably help. They have many tools at their disposal.
fficiency analysis. Occupational therapists can see where you9re wasting energy or time in doing your daily activities# including where you9re stressing your joints unnecessarily. Then# they can teach you better or easier ways to accomplish those things. Assistive devices. "f activities like dressing# cooking# or bathing become difficult or painful# occupational therapists can recommend or provide solutions. Assistive devices are products or improvements that make doing what you9re used to doing easier.
-eb@1 @edical %eference

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)hen "s Surgery Right #or Rheumatoid Arthritis

1rugs for rheumatoid arthritis (%A) can slow down the disease. *owever, after joint damage has occurred, surgery may be a reasonable option. Advancements in surgical treatment are giving people with rheumatoid arthritis more chances to maintain function and !eep moving. *aving surgery is never something to enter into lightly, but sometimes it can really help. -hen is the right time for surgery for rheumatoid arthritis, and what can you e(pect.
Re"ommended Re!ated to Rheumatoid Arthritis

%heumatoid Arthritis in -omen
2ess (chear# now age MK# once aspired to be a professional chef# but now she is happy just cooking for her husband# <oward# and their closest friends. 2ut she9s not complaining because there was a time when she didn9t even think this type of informal cooking was possible. )iagnosed with rheumatoid arthritis &5A* as a newlywed at age E3# (chear was forced to give up her dream of becoming a chef because it became increasingly harder to lift stockpots and chop veggies# even with the help of her sous...
%ead the %heumatoid Arthritis in -omen article Q Q
There are a couple of reasons to choose surgery for rheumatoid arthritis&

5elieving pain. Pain relief is the most consistent benefit of orthopedic surgery. "mproving function. 5epair or replacement of a weakened joint may help you regain some of your previous activity level.
When %an Surgery Help ,heumatoid Arthritis?

The first 'uestion to as! your doctor is, can surgery help your rheumatoid arthritis. -hen there is structural damage to a joint or the tissues around it, medicines canDt fi( it, and surgery may help. 1etermining whether surgery will fi( a joint problem is complicated and re'uires consulting with your rheumatologist and an orthopedic surgeon. The timing of surgery is also critical. +ecause any surgery is serious and can have complications, in general itDs best to reserve surgery for when other treatments havenDt helped. If surgery is delayed too long, though, it can be less successful. ,iguring the optimal time to perform surgery re'uires close attention and consideration )) by both your rheumatologist and orthopedic surgeon.
What Is 'otal :oint ,eplacement?

The hip and the !nee are the joints most often replaced in people with rheumatoid arthritis. The damaged structures are ta!en out, and an artificial joint )) or prosthesis )) put in. -ith proper care and depending on factors such as the personDs physical condition, activity level, and body weight, the life of a replaced joint can be over 4: years. After that point, a second surgery is needed (revision surgery), which is more difficult and the outcome is not generally as good. Therefore, the timing of joint replacement surgery is critical.
When Is 6nee ,eplacement Surgery ,ecommended?

If you have a stiff, painful !nee that prevents you from performing even the simplest of activities and other treatments are no longer wor!ing, you may want to as! your doctor about !nee replacement surgery. @inimally invasive surgery for the !nee joint re'uires a much smaller incision, three to five inches long, versus the standard approach, which typically re'uires an incision eight to twelve inches long. The smaller, less invasive approaches result in less tissue damage by allowing the surgeon to wor! between the fibers of the 'uadriceps muscles instead of re'uiring an incision through the tendon. It may lead to less pain, improved recovery time, and better motion due to less scar tissue formation.

&continued* (hare this$
/ont si0e$ AAA
When Is Hip ,eplacement Surgery 9eeded?

*ip replacement surgery is a procedure in which a doctor surgically removes a painful arthritic hip joint and replaces it with an artificial joint. It usually is done when all other treatment options have failed to provide ade'uate relief. The procedure should relieve a painful hip joint, ma!ing wal!ing easier. *ip replacement surgery can be performed traditionally or by using what is considered a minimally)invasive techni'ue. The main difference between the two procedures is the siEe of the incision. The small cuts are thought to lessen blood loss, ease pain following surgery, shorten hospital stays, reduce scar appearance, and speed healing.
What Other Surgeries Are +sed for ,heumatoid Arthritis?

Other procedures for rheumatoid arthritis may include the following&

(arpa! tunne! re!ease. This can relieve the pain of carpal tunnel syndrome &compression of a nerve in the hand*. #ynove"tomy. This is the removal of the abnormal joint lining to prevent it from eroding cartilage and bone. ;hile effective# eventually the joint lining &synovium* may grow back and the surgery may need to be repeated. 1one or joint fusion surgery. ,alled arthrodesis# bone or joint fusion surgery is performed to relieve pain in the ankles# wrists# fingers# thumbs# or spine. "n arthrodesis# two bones on each end of a joint are fused# eliminating the joint itself.
What Should I ()pect ;rom ,A Surgery?

If your doctor recommends surgery for joint damage due to %A, what can you e(pect. There are some things to thin! about and steps you can ta!e to ma!e the surgery and your recovery more successful.

!our doctor may temporarily stop some of your medications# because they may lead to immune system suppression that would make infection more likely. !ou may need to stop aspirin or other blood%thinning drugs a week or so before the operation. 2efore knee or hip surgery# your doctor may have you practice walking on crutches to strengthen your arm muscles.
!ou may need to give blood in advance in case you need it during the surgery.
There are several things you can do to lower your ris! of complications during surgery and improve your recovery.

"f you have any tooth or gum disease# have it treated before the surgery. This helps prevent infection from bacteria in your mouth. 5eport any discomfort with urination to your doctor. "f you have a urinary infection# it should be treated before the surgery. at a healthy# balanced diet. This will give you the energy and nutrition you need to heal faster. xercise. People with a higher fitness level do better after surgery. "f you smoke# 4uitO (topping smoking reduces the risk of complications from surgery. -ose weight. -ess weight means less stress on the artificial hip or knee# making it last longer. (ome surgeons will not perform joint replacement surgery on a hip or knee unless a person is less than 3BB pounds. Prepare your home. !ou will need someone to help you with cooking# cleaning# and shopping while you are recovering. 3ake your home fall%proof by taping down loose carpets or electrical cords.

What Should I ()pect After Surgery for ,heumatoid Arthritis?

After surgery for rheumatoid arthritis&

!ou9ll be in the hospital for a few days. !ou can expect some pain and soreness# but pain medicines will control that. -earn your physical therapy plan and stick with it when you get home. )on9t lie aroundO Practice walking every day.
;ithin three to six weeks# you should be getting back to normal light activity. Around this time# you9ll see your orthopedic surgeon again to make sure you9re healing and progressing well. "t9s also important to be realistic. (urgery can ease pain significantly and allow you to get around much better# but it will rarely be a perfect fix.
%an 'here "e %omplications ;rom ,A Surgery?

There usually arenDt any complications after %A surgery, but itDs important to watch out for them just in case. all your surgeon if you notice any of the following&

The skin around the area of surgery becomes unusually red or hot The wound drains pus or thick# foul%smelling fluid A fever higher than ABA degrees ,hest pain or noticeable shortness of breath Cnusual pain or swelling of one leg
&atural Treatments #or Rheumatoid Arthritis

3oo!ing for some natural treatments for rheumatoid arthritis, or %A. 0atural therapies are popular today as people see! to control their health and healing. ,or those with %A, alternative techni'ues may let you have greater control of your pain and activities.
What Are Some 9atural 'reatments for ,heumatoid Arthritis?

According to the 0ational enter for omplementary and Alternative @edicine (0 A@), natural treatments for rheumatoid arthritis range from moist heat and magnets to acupuncture and natural supplements. Although some of these natural treatments may help %A, none of these therapies is fully grounded in science and many have not been completely tested for side effects. Tal! to your doctor before you use any unprescribed remedy.
How Are Heat and %old +sed for ,heumatoid Arthritis?

@any doctors recommend heat andFor cold treatments to reduce rheumatoid arthritis symptoms.
old compresses reduce joint swelling and inflammation. $ou can apply a cool compress or ice pac! to the affected joint during an %A flare)up to help ease inflammation and pain. $ou donDt want to overdo cold treatments. Apply the cold compress for 9# minutes at a time with at least a =:)minute brea! in between treatments. *eat compresses rela( your muscles and stimulate blood flow. To use heat therapy, you can try a moist heating pad or a warm, damp towel. @any people li!e using microwavable hot pac!s. 1onDt go too hot. $our s!in should not burn. $ou can also use heat therapy by standing in the shower. 3etting the warm water hit the painful area on your body may help ease pain. A hot tub is a good way to rela( stiff muscles )) and itDs enjoyable. ( aution& Avoid hot tubs or spas if you have high blood pressure, heart disease, or are pregnant.)
%an *agnets Improve ,heumatoid Arthritis Symptoms?

@agnets are commonly said to be a helpful alternative therapy for rheumatoid arthritis pain control. ,ound at most natural food stores, magnet therapies come in a variety of forms, such as bracelets, nec!laces, inserts, pads, or dis!s. @ost research on magnets has been done in people with osteoarthritis, the wear)and)tear type of arthritis associated with aging. In people with !nee and hip osteoarthritis, some preliminary studies have shown that magnets improved joint pain better than a placebo. 1octors do not understand e(actly how magnets might relieve pain. ItDs also unclear if magnets might also help those with rheumatoid arthritis.
What A!out *ind@"ody 'herapies for ,heumatoid Arthritis?

@any studies have reviewed the use of mindFbody therapies for rheumatoid arthritis pain. @indFbody therapies may be helpful when added to conventional treatments. @indFbody therapies may help with stress management. They can help improve sleep and pain perception. &eep a!dominal !reathing8 Ta!ing deep, slow breaths from the abdomen (not the chest) can help alter your emotional state. 1eep breathing can ma!e a stressful moment lessen in intensity. It can decrease the production of stress hormones and slow the heart beat during stressful times.

&continued*
What A!out *ind@"ody 'herapies for ,heumatoid Arthritis? continued...

.rogressive muscle rela)ation8 oncentrating on different muscle groups, contract, then rela(, all of the major muscle groups in the body. /tart with your head, nec!, and arms. Then contract and rela( your chest, bac!, and stomach. ,inish by doing your pelvis, legs, and feet. Along with muscle rela(ation, use deep breathing. +reathe in while tensing the muscles. +reathe out or e(hale while rela(ing the muscles. <isuali0ation8 PisualiEation can help reduce stress and pain. -ith this e(ercise, you close your eyes, breathe deeply, and imagine that youDre in a 'uiet, peaceful place. <sing visualiEation during stressful times can be soothing and refreshing. *editation8 @editation brings about rela(ation and stress reduction. It can slow the heart rate and breathing, and help with pain perception. Those who practice meditation tell of having decreased an(iety and depression. They also report increased concentration and resilience. 'ai chi8 /tudies are being done on tai chi for pain reduction. The movements of tai chi are gentle and graceful, ma!ing the practice safe for people with arthritis. Tai chi can also help increase range of motion and joint strength. /ome people believe that tai chi has a spiritual component, because it encourages the mind to focus away from pain. Acupuncture: -ith acupuncture, the practitioner uses stainless steel needles to stimulate the major pathways )) called GmeridiansG )) in the body. The goal is to stimulate various points targeted at specific areas of the body. Traditional hinese medicine practitioners believe acupuncture can heal imbalances of energy, or G'i.G The practitioner tries to restore balance to the sic! body and boost the immune system. ItDs believed good health happens when 'i flows unrestricted throughout the body. /ome doctors believe acupuncture needles decrease pain by triggering pain)bloc!ing chemicals called endorphins. 2ndorphins are !nown as the bodyDs natural opioids. Other theories suggest that acupuncture may bloc! pain signals. Although little research has been done on people with rheumatoid arthritis, acupuncture studies do show an improvement in pain, particularly in people with bac! pain. /ome studies have also shown a decrease in pain in people with osteoarthritis. "iofeed!ac#: -ith biofeedbac!, you learn to control automatic responses such as heart rate and blood pressure. +y placing electric sensors on the body, information is sent to a monitor. $ou then have to react to stimuli such as thoughts, pictures, or sounds. -or!ing with a therapist, youDll study your bodyDs reactions to the stimuli. The therapist will help you recogniEe feelings of increased tension and teach you ways to calm yourself.
There is insufficient medical evidence to determine how well biofeedbac! helps pain from arthritis.
Are 'here Safe Supplements for ,heumatoid Arthritis?

There are a few rheumatoid arthritis studies that show some benefit for certain supplements and natural remedies. *owever, the research is preliminary, so the true impact these supplements may have on %A is uncertain.

&continued*
Are 'here Safe Supplements for ,heumatoid Arthritis? continued...

?eep in mind that even natural supplements can interact with other medications. +e sure your doctor is aware of all drugs and supplements you are ta!ing. /upplements for %A that have the best medical research to bac! them up include& "orage. /ome studies show that borage seed oil, along with anti)inflammatory pain!illers, can reduce %A symptoms. These findings show reduced tender and swollen joints of %A after si( wee!s. +orage seed oil appears to be safe, but may cause soft stools, diarrhea, and bloating. +orage seeds and other plant parts, such as the leaf or flower, may contain substances that are potentially harmful to the liver. +orage seed oil does not contain these harmful substances. ;ish oil. /tudies show that omega)= fatty acids in fish oil have an anti)inflammatory effect in the body. /everal studies have shown that fish oil supplements may help reduce morning stiffness with %A. In addition, the omega)= fatty acids in fish oil help protect against heart disease. 8eople with %A are at a higher ris! of developing heart disease. ,ish oil appears to be safe when used appropriately. 1oses greater than = grams per day may increase the chance of bleeding. 'hunder god vine. A few studies have shown a decrease in pain and tender joints in people with %A ta!ing this supplement. A large government)funded study is under way comparing thunder god vine with traditional medicine for rheumatoid arthritis. Thunder god vine appears to be safe. *owever, pregnant women should not ta!e this supplement, as it may cause birth defects.
Can *our 'iet !elp Relieve Rheumatoid Arthritis1

If you have rheumatoid arthritis (%A), you may have heard that a specific diet or certain foods can ease your pain, stiffness, and fatigue.
2ating certain foods or avoiding certain foods may help your rheumatoid arthritis symptoms. +ut the Arthritis ,oundation says there is no specific arthritis diet. If you find certain foods ma!e your rheumatoid arthritis symptoms worse and others ma!e your symptoms better, it ma!es sense to ma!e some changes to your diet. ItDs best to do that with advice from your doctor or a nutritionist, to ma!e sure you get all the nutrients you need.
%an a *editerranean &iet Help ,heumatoid Arthritis?

The traditional @editerranean diet is loaded with fruits, vegetables, nuts, olive oil, legumes, and fish. Those foods are rich in nutrients that are good for you. *owever, many other things also affect your health. A good diet is !ey, but itDs not an %A cure. $our %A treatment plan should include traditional medicine, as well a healthy diet and other good habits.
Will $oing $luten1;ree ,elieve :oint .ain?

Hluten is a protein found in wheat, rye, and barley. ItDs also found in many pac!aged and restaurant foods. -hen people who have celiac disease eat gluten, their bodies react by attac!ing the small intestine and preventing the body from absorbing nutrients. Over time, this can slow growth or lead to anemia, osteoporosis, and intestinal cancer. -hat does celiac disease have to do with rheumatoid arthritis (%A). %esearch shows that having an autoimmune disease (li!e %A) increases your change of getting another (li!e celiac disease or diabetes). 8lus, there6s evidence to suggest that people with %A, but not celiac disease, have improved symptoms when they avoid gluten. Hoing gluten)free doesn6t wor! for everyone. In some cases, it may !eep the body from getting the nutrients it needs or ma!e other illnesses worse. <nli!e wheat products, gluten)free foods are low in fiber and they don6t have to be fortified, so they6re often lac!ing important vitamins and minerals. -hat6s more, many gluten)free products are higher in fat and calories. +efore you decide to go gluten)free, tal! to your doctor or dietitian, and get screened for celiac disease. If you start the diet before being tested, doctors won6t be able to tell if you have it or not.
What <itamins and *inerals Are Important for ,heumatoid Arthritis?

,olic acid, or folate, is a + vitamin that helps your body ma!e red blood cells. If you ta!e the drug methotre(ate, folic acid may help you to avoid some of the drugDs side effects. /upplementing your diet with bone)boosting calcium and vitamin 1 is important, especially if you ta!e corticosteroids (li!e prednisone) that can cause bone loss. +one loss is more li!ely in people with rheumatoid arthritis. hec! with your doctor to see how much calcium and vitamin 1 you need to get daily through foods, supplements, and sunlight.
Can *our 'iet !elp Relieve Rheumatoid Arthritis1

&continued*
Omega1B ;atty Acids and ,heumatoid Arthritis

Omega)= fatty acids are found in fish such as salmon, tuna, and troutJ walnutsJ tofu and other soybean productsJ fla(seed and fla(seed oilJ and canola oil. They may help curb inflammation. ,ish oil supplements also contain omega)= fatty acids. /ome people with %A report less pain and joint tenderness when ta!ing fish oil, according to the American ollege of %heumatology. $ou may not notice any benefit at first from ta!ing a fish oil supplement. It may ta!e wee!s or months to feel a difference. Tal! to your doctor before ta!ing any supplements. $our doctor can chec! on the dose you need, since the dose used in medical studies was much higher than what youDd get from a normal supplement without a prescription.
Alcohol and ,heumatoid Arthritis

If you ta!e any %A medication, as! your doctor if itDs O? for you to drin! alcohol. Avoid alcohol if you ta!e methotre(ate, because liver damage could be a serious side effect.
Penya3it Remati3 Asam -rat .,O-4/

BK Oct EBAE
Apa itu gout?
$outCpirai adalah bagian dari penya!it reumati! yang dia!ibat!an oleh !ondisi hiperurisemia (pening!atan !adar asam urat a!ibat gangguan pada metabolisme asam urat). ?arena sebagian besar menyerang sendi, ma!a disebut artritis gout I peradangan pada sendi a!ibat gout
Epidemiologi ? 1i Indonesia prevalensi hiperurisemia !ira)!ira 4,>)"5,4N (variasi pada berbagai populasi). /edang!an gout juga bervariasi antara 9)9#,=N & 8ada suatu studi didapat!an insidensi gout &
o o o
B#A@ pada kadar QL mg+dB#?@ pada kadar L%K#H mg+dM#H@ pada kadar asam urat darah RH mg+d- S "nsidensi kumulatif gout mencapai angka EE@ setelah ? tahun# pada kadar asam urat RH mg+d-
8ada umumnya menyerang la!i)la!i (L:N) usia dewasa muda se!itar ": tahun, sedang!an pada wanita penya!it ini lebih banya! menyerang mere!a yang telah mengalami menopause.
Bagaimana terjadinya hiperurisemia dan gout? Asam urat ini merupa!an hasil a!hir peromba!an purin. 8urin merupa!an salah satu Eat yang ada dalam protein tertentu yang berasal dari asupan ma!anan, maupun proses metabolism dalam tubuh sendiri. /e!itar dua pertiga jumlah asam urat yang terbentu! a!an di!eluar!an melalui air seni dan sepertiganya melalui saluran cerna. Hangguan dapat terjadi pada produ!sinya yang berlebihan atau pembuangan yang terganggu, atau !eduanya.
Apa faktor resiko?

A. senang makan makanan yang banyak mengandung purin seperti jeroan# dan makanan dalam kaleng# E. peminum alkohol#
trauma ringan pada sendi terutama sendi ibu jari !a!i, !adar asam urat yang tinggi dalam darah pema!ai obat diureti! (pelancar !encing dan obat penurun te!anan darah golongan * T) dan !urang minum,
fa!tor geneti! F turunan !etida!patuhan pasien terhadap pengobatan dan sebagainya.
Benarkah ada suku atau ras tertentu yang sering terserang penyakit gout? +enar. *asil penelitian epidemiologi menunju!!an ada ras tertentu yang mempunyai !ecenderungan terserang penya!it ini, yaitu bangsa @aori di /elandia +aru, bangsa ,ilipina dan bangsa)bangsa di Asia Tenggara. -alaupun demi!ian penya!it ini dapat dijumpai di setiap negara di dunia. 1i Indonesia terdapat su!u tertentu yang mempunyai !ecenderungan terserang penya!it ini antara lain su!u @inahasa dan Tapanuli.
Apakah keluhan nyeri, pegal, linu di sendi dan otot-otot selalu disebabkan oleh peningkatan asam urat dalam darah? Tida!, itu mitos. Terdapat se!itar 9#: jenis penya!it remati! dengan gejala utama yang hampir sama yaitu nyeri, sehingga harus dibeda!an apa penybabnya dan a!an menentu!an terapinya. Artritis gout mempunyai tanda dan gejala !linis yang !has serta perlu beberapa pemeri!saan yang dapat memasti!annya.
Tanda dan gejala ? Artritis gout muncul sebagai serangan !eradangan sendi yang timbul berulang)ulang. Hejala !has dari serangan artritis gout ialah pembeng)!a!an, !emerahan, nyeri hebat, panas dan gangguan gera! dari sendi yang terserang yang terjadi mendada! (a!ut) yang mencapai punca!nya !urang dari 4" jam. *ampir L: N serangan pertama terjadi pada sendi ibu jari !a!i. 1i antara 4 serangan artritis ma!a pasien merasa sehat dan tanpa gejala.
/erangan artritis gout biasanya dilu!is!an pasien sebagai beri!ut & Saya seorang pria berusia 40 tahun, badan sedikit gemuk karena saya senang makan. Sampai malam sebelum saya terserang artritis gout, saya merasa sehat tanpa gejala apa-apa. Malam itu saya menghadiri sebuah pesta perkawinan dimana resepsi dilakukan dengan cara berdiri (standing party . Saya berdiri selama hampir ! jam dengan menggunakan sepatu yang bagian depannya agak sempit. "ada pesta tersebut saya makan banyak antara lain udang bakar, sup kepiting, cumi, lidah, otak, sate hati, kambing guling, sejumlah emping dan minum ! gelas coke serta sedikit alkohol. "ulang dari pesta saya langsung tidur di kamar tidur saya yang menggunakan #$ tanpa merasa
apa-apa. Menjelang pagi hari maka ibu jari kaki kanan tiba-tiba terasa sangat linu seperti ditarik-tarik sehingga saya tersentak dari tidur. Saya tidak menduga terjadi sesuatu pada diri saya, sehingga saya mencoba melanjutkan tidur akan tetapi gagal karena rasa nyeri makin bertambah bahkan ibu jari kaki saya bila tersentuh selimut terasa sangat sakit. "ada pukul %.00 pagi saya turun dari tempat tidur, ternyata saya merasa sakit sehingga saya berjalan pincang ke kamar mandi. &aktu saya perhatikan ibu jari kaki mulai agak bengkak, agak merah dan agak panas. Saya mencoba mengurangi rasa sakit saya dengan obat warung tetapi tak berkurang. Sekitar pukul 0'.00 badan saya meriang, pembengkakan dan kemerahan ibu jari kaki bertambah, saya memutuskan untuk tidak bekerja. Sepanjang hari saya menahan rasa nyeri sehingga na(su makan saya berkurang. Sore hari pembengkakan, panas dan kemerahan di ibu jari kaki saya mencapai puncaknya, sehingga saya tidak mampu lagi berjalan kaki sendiri dan harus dibantu oleh orang rumah untuk berjalan. Saya memutuskan untuk mencari pertolongan dokter sore itu juga.)
Apa saja syarat seseorang dikatakan menderita penyakit gout? <ntu! dapat di!ata!an seseorang menderita penya!it gout ma!a orang tersebut harus memenuhi syarat)syarat sebagai beri!ut &
A. 3empunyai gejala yang khas penyakit gout. E. 3empunyai perjalanan yang khas penyakit gout. 3. )itemukan asam urat dalam kadar tertentu &tinggi* di dalam darah. M. <asil pemeriksaan secara mikroskopik dari cairan sendi atau tofus &benjolan asam urat* ditemukan kristal asam urat yang berbentuk seperti jarum.
%ontgen tida! terlalu membantu
Bagaimana perjalanan penyakit gout yang khas? Terdapat = tahap &

<iperurisemia asimptomatik Tahap A $ artritis gout akut# dengan gejala serangan artritis yang khas. Tahap E $ gout interkritikal# ditandai kondisi bebas serangan Tahap 3 $ artritis gout kronik bertofus# serangan nyeri yang berlangsung terus menerus disertai adanya tofus
Komplikasi ? Hinjal & nefropati urat, nefrolitiasis (pada 9:)4#N dengan gout primer), gagal ginjal !roni!
Tata laksana ? 8engobatan penya!it gout dapat dibagi dalam 4 tahap &
A. Tahap penekanan serangan radang sendi akut # biasanya dengan menggunakan obat% obatan seperti Obat Anti "nflamasi 'on (teroid &OA"'(* dan kortikosteroid oral atau injeksi sendi# kolkisin# kompres dingin E. Tahap pencegahan serangan radang sendi akut yang terdiri dari $
3engubah gaya hidup antara lain mengubah pola makan &pantang makanan tinggi purin dan alkohol* # mengurangi kegemukan# mencegah trauma pada sendi yang sering terserang dan banyak minum 3enggunakan obat penurun asam urat darah# seperti alopurinol dan probenesid.
*dukasi diet+ /eperti telah disebut!an diatas salah satu fa!tor yang menyebab!an pening!atan asam urat ialah ma!anan yang mengandung purin. @a!anan apa!ah yang mengandung banya! purin &
A. 3akanan yang berkadar purin tinggi yaitu A?B%AKB mg+ABB g bahan makanan# seperti hati# ginjal# jantung# limpa# paru# otak# sarden# ekstrak daging# sehingga makanan dan minuman tersebut harus dipantang. E. 3akanan yang mengandung purin ?B . A?B mg+ ABB g bahan makanan# seperti daging # ikan# kerang# kacang%kacangan# kacang buncis#kembang kol# bayam# asparagus dan jamur# sehingga makanan ini harus dibatasi
/elain itu di!etahui pula bahwa al!ohol dapat menyebab!an pembuangan asam urat dalam urin terganggu, sehingga semua ma!anan dan minuman yang mengandung al!ohol harus dipantang.
dr. ,udy Hidayat? Sp.&16, /pesialis 8enya!it 1alam (%ematologi) %/ 8antai Indah ?apu!

GERE

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This page has been written for people affected by osteoarthritis.

What is osteoarthritis (OA)?

What are the symptoms?

What causes it?

What will happen to me?

Is there a cure for OA?

Living with Osteoarthritis

-hat treatments are there for OA.

"n general terms# treatment usually includes$

-hat can I do.

What causes it?

Ongoing Medical Care

Signs and Symptoms

Arthritis !ow "t !urts

"n#lammation and Sti##ness The !allmar$s o# Arthritis

Arthritis %lares Are &ormal but Still 'i##icult

%atigue O#ten Comes Along with Arthritis Pain

!ow to (eat %atigue

Coping )ith %atigue

)hen to See a 'octor About %atigue

(oost *our +nergy )ith +asy Steps

Who $ets Osteoarthritis?

What Are the Symptoms of Osteoarthritis?

What %auses Osteoarthritis?

The (asics o# Osteoarthritis

How Is Osteoarthritis &iagnosed?

How Is Osteoarthritis 'reated?

How &oes Weight and ()ercise Impact Osteoarthritis?

The (asics o# Osteoarthritis

What *edications Are +sed to 'reat Osteoarthritis?

Are 'here Alternative 'reatments for Osteoarthritis?

What Supportive &evices Are Availa!le to Help With Osteoarthritis?

Is 'here a Surgery for Osteoarthritis?

The (asics o# Osteoarthritis

Is 'here a Surgery for Osteoarthritis? continued...

+,ercises #or OA o# the -nee

Seated Hip *arch

8revious page 0e(t page

How *uch ()ercise?

.. -nee Pain 'os and 'on/ts

"n0ectable Medications #or -nee Osteoarthritis

How 6nee In5ections Wor#

,educe Inflammation With Steroids

"n0ectable Medications #or -nee Osteoarthritis

Hyaluronic Acid continued...

.latelet1,ich .lasma8 %an It Help OA?

-nee Osteoarthritis )hen to Consider Surgery

6nee ,eplacement Surgery

Corticosteroid "n0ections #or Osteoarthritis

What Are the ,is#s?

!yaluronic Acid "n0ections #or Osteoarthritis

Should 7ou 'ry Hyaluronic Acid In5ections?

How (ffective Are Hyaluronic Acid In5ections for Osteoarthritis?

$etting a Hyaluronic Acid In5ection8 What to ()pect

uflexxa <yalgan Orthovisc (upart0 (ynvisc# (ynvisc%One

)hat "s Rheumatoid Arthritis1

What Are the Symptoms of ,heumatoid Arthritis?

Who $ets ,heumatoid Arthritis?

What %auses ,heumatoid Arthritis?

How &oes ,heumatoid Arthritis Affect the "ody?

How Is ,heumatoid Arthritis &iagnosed?

)hat "s Rheumatoid Arthritis1