Combination Therapy for Rheumatoid Arthritis

Combination Therapy for Rheumatoid Arthritis

         Combination Therapy for Rheumatoid Arthritis

There is no drug that can cure rheumatoid arthritis (RA), but there are many drugs to treat it. Doctors are discovering that the best way to ease swelling, improve movement, and reduce damage caused by RA is to treat it early and aggressively. This could mean taking more than one RA drug at the same time. This is called combination therapy.
Recent studies show that using combination therapy for newly diagnosed and active RA may be better than using one drug alone. In one study, doctors found that for people with early, active, and moderate to severe RA, using two drugs was more likely to control RA symptoms and prevent joint damage than using only one drug.
If you have early and active RA, combination therapy may be the best way to get your RA under control and stop your symptoms. This is called putting your disease into remission.

Drugs Used in Combination Therapy

There are four basic types of drugs used to treat RA:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to relieve pain and swelling quickly.
  
• Corticosteroids are quick-acting and powerful drugs that block and decrease swelling (inflammation) in RA.
  
• Disease-modifying anti-rheumatic drugs (DMARDs) are stronger than NSAIDs and are used to slow down the progression of RA. They take a few weeks to start working.
  
• Biologic response modifiers (biologic DMARDs) are drugs that may be used when regular DMARDs are not working. Some of these drugs are also called anti-TNF drugs because they block tumor necrosis factor (TNF), a substance in your blood that causes inflammation and joint damage.
  

NSAIDs and steroids may be combined with any type of RA treatment to get a quick response. When doctors talk about combination therapy, they are talking about the best combination of DMARDs or biologic DMARDs for your long-term treatment of RA.

Finding the Right Level of Combination Therapy

Your RA will respond differently than other people’s RA. No combination therapy is right for everyone. If your RA is mild, you may start out with only one drug. If your doctor decides to use combination therapy, one of the drugs will probably be the DMARD methotrexate.
Methotrexate is used as the first drug in combination treatment because it works well in many people. It also causes fewer side effects than many other RA drugs. Methotrexate is the DMARD that most people with RA stay on the longest.
The American College of Rheumatology has these guidelines for combination therapy (Source: ACR):

• Two-drug DMARD therapy may be used if you have moderate to severe RA. The recommended combination is methotrexate and hydroxychloroquine. Hydroxychloroquine is a drug that also works for malaria. Doctors are not sure how it works in RA.
  
• Three-drug DMARD therapy may be used if your RA is moderate to severe and your doctor is worried about long-term damage from RA. A common combination is methotrexate, hydroxychloroquine, and sulfasalazine. Sulfasalazine is not as strong as methotrexate but seems to work well when combined with methotrexate.
  
• Methotrexate and an anti-TNF drug may be used if you have severe RA and have never been on a DMARD before. Anti-TNF drugs include etanercept, infliximab, certolizumab, golimumab and adalimumab. Anti-TNF drugs need to be given by injection or infusion (through an IV).
  

Side Effects and Long-Term Use

All RA drugs have side effects. Side effects from DMARDs may include liver damage, lung damage, and decreased resistance to infection. These drugs may not be safe during pregnancy.
Using more than one drug in combination therapy does not seem to cause more side effects, but doctors are still studying the long-term effects. If your doctor prescribes a combination therapy for you, see him or her for frequent follow-up visits. You may need to have blood tests to make sure you are not having a reaction to the drugs. Talk with your doctor about all the risks and benefits of combination therapy for RA.

6 Tips to Ease Your RA Pain

6 Tips to Ease Your RA Pain

6 Tips to Ease Your RA Pain

 Many people with rheumatoid arthritis believe there's nothing they can do to ease their pain and stiffness, but they're wrong.

Give the following self-care steps a try :

• Lose weight. Every extra pound you carry translates to added stress and pain to your knees and hips. Too much weight also increases your risk for gout.
  
• Get moving. Exercise helps lessen pain, helps with weight loss, increases range of movement, reduces fatigue, and helps you feel better overall, according to the Arthritis Foundation. Your doctor, a physical therapist, or other health care professional can teach you beneficial range-of-motion and strengthening exercises.
  
• Protect your joints. Avoid excess stress on joints by learning how to do chores and activities in less stressful ways. An occupational therapist can show you how to manage everyday tasks with less strain and pain.
  
• Learn to pace yourself. Spread out difficult activities over a week's time instead of trying to do them all in one day and then suffering for several days afterward.
  
• Stretch. Stretching is a simple way to keep joints and muscles flexible. It relieves stress and can help you maintain your daily activities with less stiffness.
  
• Adjust your attitude. Try to maintain a positive state of mind about your condition and how it affects your life.
  

Facts About Biologics for Rheumatoid Arthritis (RA)

Facts About Biologics for Rheumatoid Arthritis (RA)

Facts About Biologics for Rheumatoid Arthritis (RA)

Over the last decade, significant progress in the treatment of RA has been made because of drugs known as biologics. Biologic drugs are made from human genes inside non-human cells. Your doctor may suggest biologics if you respond poorly to other treatments. Here's what you should know about these exciting advancements and how they may be able to improve your RA and your quality of life.

How Biologics Work

How Biologics Work

RA is an autoimmune disease. This means your body mistakes some of its own tissues as foreign substances and attacks itself. In RA, when your immune system attacks your joint tissue, it causes inflammation that damages your joints and makes them painful. Biologics are designed to inhibit the cells that cause your immune system to go into this mistaken overdrive.

How Biologics Are Given

How Biologics Are Given

Biologics are not yet available in pill form. Because the biologics are made of such large protein molecules, your body cannot absorb them if you swallow them in a pill or liquid form. Biologics need to be introduced into the body slowly. The only biologics that have been approved for RA by the U.S. Food and Drug Administration must be injected or given intravenously. In the future, you may be able to take biologics by mouth: Oral biologics for RA made from small protein molecules are in development.

Who Can Benefit Most from Biologics

Who Can Benefit Most from Biologics

Your doctor may suggest biologics if your RA is moderate to severe and has not responded to traditional treatments. You may be given biologics alone or with other medications to increase their effectiveness and decrease their side effects. Biologics have been shown to be effective in two out of three people who use them.

When You'll Feel the Results

When You'll Feel the Results

Studies show that RA patients who are given biologics generally show improvement in about 4 to 6 weeks. However, many patients report less joint swelling and discomfort soon after their first or second injection. How often your injections are scheduled depends on which biologic you're given. Some are given daily; others, every few weeks.

Common Side Effects

Common Side Effects

Most biologics are well-tolerated. About a third of people given biologics experience a skin reaction at the site of the injection. This could be a burning or itching sensation or a rash that will go away on its own in a week or two. A more serious side effect is your increased risk of infection, including tuberculosis, when taking biologics. You can work with your doctor to recognize the signs and symptoms of infection.

The Cost of Biologics

The Cost of Biologics

Biologics are expensive, between $12,000 and $30,000 a year. Because they are produced from live organisms, the materials needed to make them are expensive. The manufacturing process is more complicated than that for traditional drugs made from chemicals. Their cost also reflects the cost of research and development. Generic versions, which could cost less, are not yet available.

Biologics and Cancer Risk

Biologics and Cancer Risk

There is some concern about long-term, serious risks from taking biologics, including some forms of cancer, but the research is inconclusive. Because of the relative newness of biologics, any long-term risks are not yet known. It's difficult to draw hard and fast conclusions from the small amount of existing research. Always weigh the benefits and the risks of all treatment options through a careful discussion with your rheumatologist.

Causes of Hand Pain

Causes of Hand Pain

Causes of Hand Pain

What causes hand pain?

Hand pain can be caused by irritation and inflammation due to a variety of mild to serious diseases, disorders and conditions, such as trauma, infection, autoimmune diseases, and nerve compression. For example, tingling pain in the fingers can be due to compression of the nerves that carry sensation messages from the hand and fingers to the spinal cord.
Hand joints, such as the knuckles, are particularly vulnerable to injury and other conditions, such as arthritis. Joints are complicated structures and consist of cartilage, ligaments that hold bones together, bursas (fluid-filled sacs that help cushion the joint), and synovial membranes and fluid, which lubricate the joints.
In some cases, hand pain is a symptom of a serious condition that should be immediately evaluated in an emergency setting, such as a broken bone or invasive bacterial infection.

Injury-related causes of hand pain

Hand pain can occur from the following types of injuries:

• Contusion or abrasion
  
• Crush injury
  
• Degloving injury (separation of the skin and top layer of tissue from the finger and possibly the hand)
  
• Dislocated finger
  
• Fractured finger, hand or wrist bone
  
• Hand ligament sprain
  
• Hand muscle strain
  
• Laceration or blunt force trauma such as a dog bite
  
• Repetitive stress injury
  
• Splinter or other foreign body
  

Degenerative, infectious and inflammatory causes of hand pain

Hand pain can be associated with inflammatory or infectious conditions, or problems associated with aging and wear and tear on joints over time including:

• Bursitis (inflammation of a bursa sac that protects and cushions joints)
  
• Cellulitis (invasive skin infection that can spread to the surrounding tissues)
  
• Ganglion cyst (benign growth or swelling on top of a joint or tendon)
  
• Infection, such as cellulitis caused by a Staphylococcus aureus bacterial infection
  
• Osteoarthritis (breakdown of joint cartilage over time causing stiffness and pain) and age-related wear and tear on the joints
  
• Paronychia (infection around the nail)
  
• Rheumatoid arthritis (chronic autoimmune disease characterized by joint inflammation)
  
• Septic arthritis (infectious arthritis or infection of a joint)
  
• Tendonitis (inflammation of a tendon)
  
• Tenosynovitis (inflammation of the sheaths that enclose tendons)
  
  

  

  Arthritis

  
  

Neurological causes of hand pain

Hand pain and tingling or numbness in the fingers may be caused by moderate to serious conditions that compress nerves and can lead to nerve damage. A variety of other conditions can also cause more widespread nerve damage. Neurological causes of hand pain include:

• Carpal tunnel syndrome (compression in the wrist area of the nerve that provides feeling and movement to the palm and thumb side of the hand)
  
• Cervical spondylosis (degenerative disk disease in the neck)
  
• Heavy metal poisoning such as lead poisoning
  
• Hypothyroidism (underactive thyroid)
  
• Multiple sclerosis (disease that affects the brain and spinal cord causing weakness, lack of coordination, balance difficulties, and other problems)
  
• Neuroma (mass or tumor that grows on a nerve)
  
• Peripheral neuropathy (damage to the nerves outside the brain and spinal cord)
  
• Spinal cord injury or tumor
  
• Stroke
  
• Systemic lupus erythematosus (disorder in which the body attacks its own healthy cells and tissues)
  
• Transverse myelitis (neurological disorder causing inflammation of the spinal cord and possibly arm weakness)
  
• Vitamin B₁₂ deficiency
  

Other causes of hand pain

Hand pain can be associated with other conditions including:

• Buerger’s disease (acute inflammation and clotting of arteries and veins of the fingers)
  
• Frostbite or extremely cold temperatures
  
• Raynaud’s phenomenon (spasms of small blood vessels of the fingers and toes, reducing blood circulation). Raynaud’s phenomenon is secondary to many autoimmune disorders such as lupus.
  

Questions for diagnosing the cause of hand pain

To diagnose the underlying cause of hand pain, your doctor or licensed health care practitioner will ask you several questions related to your symptoms. Providing complete answers to these questions will help your provider diagnose the cause of your hand pain:

• What is the exact location of the pain?
  
• Describe the pain. Is it sharp or dull, tingling or burning? When did it start? How long does it last? Does the pain occur during or after certain activities?
  
• Have you had any recent injuries, including exposure to cold or frostbite?
  
• Do you have any other symptoms, such as swelling?
  
• What is your full medical history? What medications do you take? Do you smoke?
  

What are the potential complications of hand pain?

Complications associated with hand pain vary depending on the underlying disease, disorder or condition and can be serious. It is important to contact your health care provider when you experience persistent pain or other symptoms related to your fingers, hands or wrists. Following the treatment plan you and your health care provider develop specifically for you will minimize the risk of complications including:

• Chronic disability
  
• Gangrene (tissue death) and amputation
  
• Inability to perform daily tasks
  
• Permanent finger or hand deformity
  
• Spread of infection to other tissues including the blood (septicemia)
  

Symptoms of Hand Pain

Symptoms of Hand Pain

Symptoms of Hand Pain

What other symptoms might occur with hand pain?

Other symptoms may occur with hand pain. Additional symptoms vary depending on the underlying disease, disorder or condition. For example, hand pain due to a serious infection that has spread to the blood may be accompanied by swelling, fever and chills, as well as redness and warmth around the affected area.
Other symptoms that may occur with hand pain include:

• Arm or wrist pain
  
• Bruising or other discoloration
  
• Decreased grip strength
  
• Difficulty performing fine motor movements, such as writing or keyboarding
  
• Drainage or pus
  
• Fingernail problems, such as bruising under the nail or detachment of the nail
  
• Flu-like symptoms (fatigue, fever, sore throat, headache, cough, aches, and pains)
  
• Lacerations, abrasions, sores or lesions
  
• Lumps or bumps along the finger
  
• Numbness
  
• Reduced range of motion or movement of a joint
  
• Stiffness
  
• Swelling of the hand or joints
  

Symptoms that might indicate a serious or life-threatening condition

In some cases, hand pain may occur with other symptoms that might indicate a serious condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have these other symptoms:

• Change in color or sensation of your hand or fingers after cold exposure
  
• High fever (higher than 101 degrees Fahrenheit)
  
• Inability to move the finger, wrist or arm
  
• Partial or total amputation of a finger(s)
  
• Red, warm and tender skin, especially with a red streak up the arm
  
• Serious burn
  
• Severe hand, wrist or finger pain
  
• Uncontrolled bleeding or deep laceration
  
• Visible deformity of the hand, wrist or a finger
  

Hand Joint Pain

Hand Joint Pain

Hand Joint Pain

What is hand pain?

Hand pain includes any kind of discomfort in the tissues or joints of the hand or fingers. Hand pain may be described as throbbing, aching, increased warmth, tingling, soreness, or stiffness. Burning or prickling sensations in the hand or fingers, often called pins and needles, are paresthesias. Paresthesias are often due to temporary or permanent damage or pressure on the nerves that carry sensation messages from the hand and fingers to the spinal cord.

The hand is made up of nerves, bones, blood vessels, muscles, and skin. Muscles provide motion, and tendons anchor your hand muscles to the bones. Nerves control sensation and movement of the hand and fingers, and blood vessels ensure continuous blood circulation to and from the tips of the fingers through the hand and arm.

Hand joints, such as the knuckles, are the areas where bones meet. Joints are complicated structures and consist of cartilage, ligaments that hold bones together, bursas (fluid-filled sacs that help cushion the joint), and synovial membranes and fluid, which lubricate the joints. Any of these structures in the hand or joints can become injured, irritated, inflamed and painful in response to a variety of mild to serious diseases, disorders and conditions.

Common causes of hand pain include injury or trauma, such as a boxer’s fracture of the hand, or from repetitive use, such as long periods of keyboarding, which can lead to tenosynovitis and carpal tunnel syndrome. Arthritis is another very common cause of hand pain. More serious conditions, such as diabetes and peripheral neuropathy, can also cause pain or a burning sensation in your hand and fingers.

Because hand pain can be a sign of a serious condition, such as infection or fracture, you should contact your medical professional about your symptoms. Seek prompt medical care if you have unexplained, persistent or recurrent hand pain. Seek immediate medical care (call 911) if your hands have been exposed to freezing temperatures and have changed color or lost feeling, or if you have severe hand pain, a serious burn, a deformity, or uncontrolled bleeding. Other serious symptoms include a high fever with swelling, redness, warmth of the hand, or red streaks up the arm.