The tenth of series of Autoimmune Disorders. My reasons for this series is twofold. First, to make people aware of the many Autoimmune Disorders and to give some history of the well known or more prevalent ones. It is noted that 1 in 5 Americans have been diagnosed with at least one Autoimmune Disorder, of which 75% are women. Second, allowing people to be aware, especially those who are affected by Autoimmune Disorders, that they don’t need to live with the residual aches and pains, inflammation, stress, depression, and anxiety. There are alternative options that work alongside conventional therapies. My focus, as a Reiki Practitioner and Wellness Advocate, is to educate and better help those who are suffering needlessly. I teach a class on the benefits of Reiki Energy Healing for those who have been diagnosed with Autoimmune Disorders. For more information and to register, please contact me at 860-357-5263.
Rheumatoid arthritis (RA) happens when your body’s defenses – your immune system – targets your joint linings. RA affects joints on both sides of the body, such as both hands, both wrists, or both knees. This symmetry helps to set it apart from other types of arthritis. It can also affect the skin, eyes, lungs, heart, blood, or nerves.
What Are the Symptoms of Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is long-term disease. Its symptoms can come and go, and it’s different for each person.
Some people have long periods when their disease isn’t active. They have few or no symptoms during this time. Others feel it for months at a time.
Most people have persistent problems with episodes of worsening disease. Treatment is changing the overall picture with more people experiencing low disease activity or even remission.
When It’s in Your Joints
RA always affects the joints. It makes them inflamed. The classic signs are:
- Stiffness– The joint is harder to use and doesn’t move as well as it should. It’s especially common in the morning. While 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.
- Swelling– Fluid enters the joint and makes it puffy.
- Pain– Inflammation inside a joint makes it sensitive and tender. Over time, it causes damage and pain.
- Redness and warmth– The joints may be warmer and show color changes related to the inflammation.
RA most often affects the hands, but it can strike any joint, including the knees, wrists, neck, shoulders, elbows, feet, hips, even the jaw. There is usually a symmetrical pattern, affecting the same joints on both sides of the body, like both wrists or both hips.
Rheumatoid Arthritis Symptoms That Affect the Entire Body
Rheumatoid arthritis can go beyond your joints. You may feel:
- Muscle aches
- Poor appetite
Some people with RA also get rheumatoid nodules, which are bumps under the skin that most often appear on the elbows. Infrequently they are painful.
RA can affect your lungs. The inflammation can damage the lungs or the lining around the lungs. This may not cause symptoms. If you get shortness of breath, your doctor can treat it with drugs that reduce inflammation in the lungs.
Likewise, it can inflame the lining around your heart. You probably wouldn’t notice symptoms from that. There’s a chance you could feel shortness of breath or chest pain, which you should call your doctor about.
RA can affect a joint in your voice box, causing hoarseness.
RA can also affect your eyes. Scleritis, cataracts, and Dry Eye Syndrome are common in people with the disease.
How Do Doctors Diagnose Rheumatoid Arthritis?
If your joints feel sore and swollen for weeks, and you’re especially stiff in the morning, it’s a good idea to see a doctor. He may suspect you have rheumatoid arthritis (RA).
Unlike osteoarthritis, which usually develops from age or from injury to a joint, RA is a problem with your immune system. If you don’t diagnose and treat it in time, it could harm your joints. In fact, most people with RA do have some sort of joint damage. Most of it happens in the first 2 years.
Your primary care doctor may order blood tests and X-rays to help confirm a diagnosis or you may be sent to someone who specializes in diagnosing and treating RA. This type of doctor is called a rheumatologist.
A Difficult Diagnosis
Sometimes, RA can be tough to figure out. Symptoms may come and go, and they aren’t the same in all people who have it. But these tend to be common:
- Joint pain/swelling/stiffness, especially in small joints (wrists, hands, feet)
- Discomfort for at least 6 weeks
- Morning stiffness that lasts at least 30 minutes
- Loss of appetite
- Low-grade fever
There isn’t a single test that gives doctors a clear answer, and in the early stages, RA can resemble other diseases like:
That’s why your doctor will rely on many factors to help pinpoint the cause of your pain and other symptoms.
What to Expect at the Doctor
Here are some of the things you can expect to happen at your appointment if the doctor suspects you have RA.
Personal and family medical history: Your doctor will ask about your past and your relatives’. If someone in your family tree has RA, it may be more likely for you to have the disease.
Physical exam: The doctor will check your joints for swelling, tenderness, and range of motion. RA tends to strike several joints.
- Rheumatoid factor (RF)
- Anti-CCP (anti-cyclic citrullinated peptide)
- ANA, or antinuclear antibodies
Not all people with RA have these antibodies, however.
Other blood tests: Besides RF and anti-CCP antibodies, other blood tests could look for:
- Complete blood count. Anemia (low red blood cells) is fairly common in RA.
- Erythrocyte sedimentation rate and c-reactive protein. These measures of inflammation are often higher when you have RA.
Imaging tests: These can help your doctor judge how severe your disease is and track its progress over time. X-rays can show whether (and how much) joint damage you have, though damage may not show up early on. Magnetic resonance imaging (MRI) and ultrasound give a more detailed picture of your joints. These scans aren’t normally used to diagnose RA, but they can help doctors find it early.
What’s Next After an RA Diagnosis?
Don’t panic if you learn you have rheumatoid arthritis. While there is no cure, people are living better now with RA than ever before. Your doctor will talk to you about all the ways you can treat the disease and manage your symptoms.
Surgery: If you have major joint damage over time, you may want to talk to your doctor about surgery. Total joint replacements of the knee, hip, wrist, and elbow can help. Less serious surgeries may also be good options.
Understanding Rheumatoid Arthritis — Treatment
Treatment usually includes medications, occupational or physical therapy, and regular exercise. Some people need surgery to correct joint damage. Early, aggressive treatment is key to good results and with today’s treatments, joint damage can be slowed or stopped in many cases.
Drugs for Rheumatoid Arthritis
As part of rheumatoid arthritis treatment, your doctor will probably prescribe a nonsteroidal anti-inflammatory drug (NSAID). These medications reduce pain and inflammation but do not slow down RA. So, if you have moderate to severe RA, you’ll probably also need to take other drugs to prevent further joint damage.
Over-the-counter NSAIDs include ibuprofen and naproxen. Most people with RA need a prescription NSAID as they offer a higher dose with longer-lasting results and require fewer doses throughout the day.
There are many prescription NSAIDs that your doctor will consider. All of them carry a warning about the increased risk of heart attack and stroke. NSAIDs can also raise blood pressure and can cause stomach irritation, ulcers, and bleeding.
You and your doctor can weigh the benefits of NSAIDs against the potential risks. You may have to try a few different ones to find the one that’s right for you.
“DMARDs” stands for disease-modifying antirheumatic drugs. They help slow or stop RA from getting worse.
Doctors usually first prescribe methotrexate to treat rheumatoid arthritis. If that alone doesn’t calm the inflammation, doctors may try or add a different type of DMARD. Other DMARDs include hydroxychloroquine (Plaquenil), leflunomide (Arava) and sulfasalazine (Azulfidine).
In rheumatoid arthritis, an overactive immune system targets joints and other areas of the body. DMARDs curb the immune system, but they aren’t selective in their targets. They can lead to infection and a wide variety of other side effects.
DMARDs, particularly methotrexate, have made dramatic improvements in severe rheumatoid arthritis and can help save your joints.
Tofacitinib (Xeljanz) is a different type of DMARD. Because it affects a specific part of the immune system involved in RA, it also has a risk of serious infection.
When methotrexate or other DMARDS don’t ease RA symptoms and inflammation, doctors may recommend a biologic. These are genetically engineered proteins. They block specific parts of the immune system that play a key role in inflammation of rheumatoid arthritis. They may slow or stop RA.
There are different biologics that target different parts of the immune system. Biologics include:
- Abatacept (Orencia)
- Adalimumab (Humira)
- Adalimumab-atto (Amjevita), a biosimilar to Humira
- Anakinra (Kineret)
- Certolizumab (Cimzia)
- Etanercept (Enbrel)
- Etanercept-szzs (Ereizi), a biosimilar to Enbrel
- Golimumab (Simponi, Simponi Aria)
- Infliximab (Remicade)
- Infliximab-dyyb (Inflectra), a biosimilar to Remicade
- Rituximab (Rituxan)
- Sarilumab (Kevzara)
- Tocilizumab (Actemra)
Since biologics suppress the immune system, they raise the risk of infection. Severe infections have been reported with biologics.
For severe RA or when RA 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. Some people need to take steroids for a longer time to control pain and inflammation.
You can get steroids as a shot directly into an inflamed joint or take them as a pill. These are not the type of steroids that bulk up your muscles.
Surgery for Rheumatoid Arthritis
If joint pain and inflammation become unbearable or joints are severely damaged, some people need joint replacement surgery. The hips and knees, and sometimes the shoulders, are the most common joints that get replaced. Surgery can dramatically improve pain and mobility. Most people wait until after age 50, because artificial joints tend to wear down after 15 to 20 years.
Some joints, such as the ankles, don’t respond well to artificial replacement and do better with joint fusion, which is a different operation.
Physical and Occupational Therapy
Physical therapists can give you an exercise plan, teach you how to use heat and ice, do therapeutic massage, and encourage and motivate you.
Occupational therapists help you handle daily tasks — like cooking or using your computer — and show you easier ways to do those things. They can also check on whether any gadgets would help you.
How Cognitive Therapy Can Help
Because one of the most trying aspects of rheumatoid arthritis is learning to live with pain, many doctors recommend pain management training. They may call it “cognitive therapy.”
The goal is to improve your emotional and psychological well-being as you develop ways to relax, handle stress, and pace yourself. For instance, it may include activity scheduling, guided imagery, relaxation, distraction, and creative problem-solving.
Exercise, Joint Pain, and Rheumatoid Arthritis
When your joints are stiff and painful, exercise might be the last thing on your mind. Yet with RA, exercising regularly is one of the best things you can do.
- People who work out live longer, with or without rheumatoid arthritis.
- Regular exercise can cut down on RA pain.
- Your bones will be stronger. Thinning of the bones can be a problem with rheumatoid arthritis, especially if you need to take steroids.
- Stronger muscles help you move better.
- Your mood and energy level will benefit.
Natural Treatments for Rheumatoid Arthritis
There are some complementary medicine treatments that might help your RA. It’s a good idea to talk it over with your doctor. You’ll still need to take your medicine and keep up with the other parts of your treatment plan.
Heat and cold: Ice packs can reduce joint swelling and inflammation. Heat compresses relax muscles and stimulate blood flow.
Acupuncture: Studies show that acupuncture curbs pain, may lower the need for painkillers, and is good for flexibility in affected joints.
Mind/body therapy: Mind/body therapies can help with stress management, plus improve sleep and how you react to pain. Strategies include deep belly breathing, relaxing your muscles one by one from head to toe, visualization (such as picturing a calming scene), meditation, and tai chi.
Biofeedback: With biofeedback, you work with a therapist who helps you recognize when you feel tense and learn ways to calm yourself. This can help you handle pain.
Nutritional supplements: Keep in mind that even natural supplements can interact with medicines, so tell your doctor of all medicines and supplements you take. He/She can make sure they’re OK for you.
Research shows that omega-3 fatty acids in fish oil have an anti-inflammatory effect in the body. Several studies have shown that fish oil supplements may help reduce morning stiffness with RA.
Some studies show that borage seed oil along with anti-inflammatory painkillers can reduce RA symptoms. These studies show that in people with RA, joints were less tender and swollen after 6 weeks.
If you smoke, make it a priority to quit. If you keep smoking, it may make your RA treatment less effective.
When Is Surgery Right for Rheumatoid Arthritis?
When Is the Timing Right?
It may be time to think about surgery when there is damage to your joint, or the tissues around it, and medicines can’t fix it.
You should talk with a rheumatologist, a doctor who treats joint diseases, and an orthopedic surgeon to find out if it would help you, and what results you might get. Surgery can ease pain and allow you to get around much better, but it may not be a perfect fix.
Because any surgery is serious and can have complications, it’s best for you to try other treatments first. If you wait too long, though, surgery can be less successful. Your doctor can let you know when you’re ready for it.
What Is Total Joint Replacement?
Depending on things like your weight, health, and activity level, a replaced joint can last more than 20 years. After that, you may need another surgery, which will likely be more difficult and may not give you results that are as positive. That’s why the timing of joint replacement surgery is important.
“Minimally invasive” surgery for the knee joint isn’t as drastic and uses a much smaller cut. That means your recovery time should be shorter, and, you may move better because you have less scar tissue from the operation.
Hip Replacement Surgery
Hip replacement surgery can be done with a large or small cut. The smaller cut means less blood loss, less pain following surgery, a shorter hospital stay, a smaller scar, and faster healing. Your doctor will tell you which kind of surgery is best for you.
Synovectomy. Doctors remove the lining, or synovium, of a joint so it doesn’t damage your cartilage and bone. You may need to get it done more than once if your joint lining grows back.
Arthroscopy. This is a procedure usually done on large joints. The doctor makes a small cut in your skin and uses a thin lighted tube to look at your joint. If necessary, he can remove bits of floating bone or cartilage to improve the way it functions.
You’ll be in the hospital for a few days. You can expect some pain and soreness, but medicines will help control that.
Learn your physical therapy plan and stick with it when you get home. Don’t lie around. Practice walking every day.
Within 3 to 6 weeks, you should be getting back to normal activity that’s not too hard. Around this time, you’ll see your orthopedic surgeon again to check on how you are healing.
There probably won’t be any complications, but it’s important to watch out for them. Call 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, bad-smelling fluid
- You develop a fever higher than 101 F
- You have chest pain or a noticeable shortness of breath
- You have unusual pain or swelling in one leg
Promise for the Future
Discoveries have made it possible for you to remain active and work much longer than was possible 20 years ago. Scientists are thinking about RA in exciting new ways, and the next generation of treatments shows great promise.
What Are the Holistic and Alternative Modalities for Rheumatoid Arthritis?
Reiki Energy Healing is one of the holistic and alternative modalities to help decrease or release residual inflammation, aches and pains, and mental and emotional stresses due to chronic Autoimmune Disorders.
Reiki supports and enhances the body’s ability to heal itself. It works equally well whether it is used to help accelerate the body’s healing process while recovering from illness or as a form of preventive self-care.
It is one of the most powerful techniques known for alleviating stress, anxiety, and pain. It naturally creates deep states of relaxation and feelings of well-being.
Reiki supports and strengthens the immune system’s ability to fight infection of any kind, including viruses and bacteria.
It is not just for treating physical problems. It works with the body’s natural healing wisdom to restore states of inner peace and balance at all levels… physical, emotional, mental, and spiritual.
Those affected with Autoimmune Disorders quite often deal with stress, anxiety, depression, lack of self-confidence and self-esteem, toxic overload from pharmaceutical medications, lack of mobility, and/or decreased social activities. Reiki can release these symptoms, increase mobility, and facilitate a return to a healthier and happier lifestyle.
Other modalities may include Certified Pure Essential Oils, meditation, sound healing, pranic healing, crystal healing, EFT/Tapping, yoga, qi gong, acupressure/acupressure, and dietary changes.