Rheumatoid Arthritis Pain Management

Article by Rosley Bin Muhamad

What is rheumatoid arthritis?

The term arthritis is used to refer to a variety of conditions secaracterizan by pain, loss of mobility and joint inflammation. Although most cases occur in adults as well children are suffering from some form of arthritis. The causes are varied and include genetic defects, illness and infection and immune disorders.

There are two main types of arthritis: rheumatoid arthritis and osteoarthritis. This article will discuss the issue of rheumatoid arthritis. In another article we discussed the issue of osteoarthritis.

Rheumatoid arthritis is an inflammatory type of arthritis that usually affects people over 40, although it can occur at any age. The incidence of rheumatoid arthritis is about thirty cases per hundred thousand. A greater proportion of women than men have. In some American Indian groups the incidence is much higher and among some black people in the Caribbean region the incidence is lower.

Symptoms

The main symptoms of rheumatoid arthritis are pain and swelling in joints lasmanos, arms, or legs. A feature of rheumatoid arthritis is that usually occurs symmetrically, ie the same joints on both sides of the body are affected. It also produces insomnia and a general feeling of tiredness. You can also develop a fever is not very high, pallor, anemia, morning stiffness, Nodules under the skin (the latter is usually a sign that the disease is more severe than usual) and loss of appetite, among other symptoms. The joint pain usually begins later.

Damage caused by rheumatoid arthritisRheumatoid arthritis, in addition to affecting the joints, can cause damage to other parts of the body like the heart, muscles, lungs, eyes and nerves. In some cases it may occur suddenly but more commonly it develops gradually affecting more and more joints. In most cases it begins to manifest itself in the small joints of the fingers or toes, wrists, hands, elbows and ankles. In some people with rheumatoid arthritis has only mild symptoms that last a short time. However, in most cases the disease follows a progressive course and lasts a lifetime. Rheumatoid arthritis is considered the most serious and disabling the various forms of arthritis.

In the elderly rheumatoid arthritis can cause deformities of the hands and feet. This occurs when arthritis causes weakening of muscles, tendons and shrinking an abnormal enlargement of the anterior part of the bones. There are cases where the bone is eroded and the joint is dislocated being immobilized in a position.

CausesRheumatoid arthritis is, in many cases, an autoimmune disease, ie it is a condition in which our immune system, which is responsible for defending attacking viruses and bacteria that invade us, begins to attack and destroy parts of our body . It is believed that one or several genetic factors may play a role in the development of this disease. However, it is considered that genetic factors are the only ones involved. It is thought that some external factor such as a virus or bacteria can serve as a trigger trigger that initiates the development of rheumatoid arthritis. They have identified several genes that predispose to certain types of rheumatoid arthritis. Other cases of rheumatoid arthritis are caused by crystal deposits in joints and some infections.

DiagnosisThe diagnosis of rheumatoid arthritis can be difficult because other diseases such as gout, acute rheumatic fever, Reiter’s syndrome, pseudogout, Lyme disease, ankylosing spondylitis, psoriatic arthritis, gonococcal arthritis, and arthritis psoriatic may have some similar symptoms. In many cases, require laboratory tests such as a test used to detect one type of antibody known as rheumatoid factor present in about 70 percent of people with rheumatoid arthritis. This test is not specific as the rheumatoid factor is found in people with other diseases such as Sjrogren syndrome (an inflammatory disorder characterized by excessive dryness of the eyes, mouth and other mucous membranes) chronic liver disease and some infections. About 90 percent of people with rheumatoid arthritis test that measures the sedimentation rate of erythrocytes (red blood cells are red blood cells) is high. This test measures how quickly red blood cells come together and go to the bottom of a test tube. You can also carry out an examination of synovial fluid (fluid that fills the joint cavity and serves as a lubricant). Another test has been developed recently which detects the presence of a type of antibody known as ACP. This test is more specific than rheumatoid factor, and that contrary to what happens with the latter rarely is positive in people without rheumatoid arthritis.

Medical treatment of rheumatoid arthritisIn the medical treatment of rheumatoid arthritis can be used from simple measures such as rest and adequate nutrition to various types of drugs and surgery. The drugs used are the disease-modifying antirheumatic drugs (DMARDs for short in English) that generally work by reducing or suppressing immune responses. These drugs, among which are azathioprine (Imuran), methotrexate (Rheumatrex) and cyclophosphamide (Cytoxan) are effective in reducing the inflammation of rheumatoid arthritis but have a number of side effects can be severe and even fatal including liver toxicity and bone marrow, lung inflammation and increased susceptibility to infections. Cyclophosphamide may also cause bleeding from the bladder.

Also used an injectable drug called Kineret (anakinra). This is an artificial protein that blocks interleukin-1 which is a protein that has inflammatory effects.

In late 2005, was approved in the United States a new drug that also acts on the immune system, through a novel mechanism called Orencia (abatacept). This is a drug used to reduce symptoms of rheumatoid arthritis and retarding structural damage it causes in patients who have not responded to other medications. Side effects of this medicine include: respiratory problems including chronic obstructive pulmonary disease and increased susceptibility to infection. Other common side effects but not serious are headache, nasopharyngitis and nausea.

Another type of medication are called inhibitors of tumor necrosis factor (TNF by its acronym in English), a protein produced by the immune system that causes inflammation. These include medications such as infliximab (Remicade) administered intravenously and etanercept (Embrel) and adalimumab (Humira) is given as injections.

They are also used corticosteroids such as prednisone. These are extremely effective in reducing inflammation in the early stages of use. However, they lose effectiveness over time. Moreover, although they may alleviate inflammatory symptoms these drugs do not slow the progression of rheumatoid arthritis. Other serious side effects such as osteoporosis, diabetes, hypertension, cataracts, increased levels of glucose, bruising, psychosis, skin becomes more thin and delicate and others that can affect almost every organ in the body. For this reason they are usually used for short periods and at lower doses showing effectiveness.

Other drugs used are nonsteroidal anti-inflammatory agents including aspirin and ibuprofen (Motrin, Advil). The doses used are usually quite high and can have effects such as upset stomach and damage the protective lining of the stomach. May also occur headaches, hypertension, confusion, edema and in some cases even kidney damage. In the United States has requested that manufacturers of non-steroidal anti-inflammatory agents on the label include a warning that they may increase the risk of heart attacks and strokes and gastrointestinal bleeding.

The gold-based compounds are another type of medication that can help reduce bone deformities caused by rheumatoid arthritis. In the short term can cause a remission. It is usually used as injections but there is a drug of this type called auranofin (Ridaura) used orally. These drugs may make some people more sensitive to sunlight. These people may suffer from a rash in the sun or a rash already present can agrav