Rheumatoid Arthritis (RA) is an autoimmune inflammatory disorder that affects the joints. It can cause painful swelling and deterioration of the joints. It is often symmetrical, starting in the smaller joints and moving to larger joints as the disease progresses. RA impacts the synovium, the lining of the joints and eventually the cartilage, causing thickening and destroying the joint structure and alignment. The damage is caused by inflammation, which is triggered by the body fighting and destroying the joint tissues.
Inflammation & Pain
RA is an inflammatory process. Inflammation itself is painful. Whenever a person has an injury, inflammation occurs. In injury cases, this is a limited process, as the damaged tissue heals, the inflammation disappears, and the pain resolves. In rheumatoid arthritis, the joint inflammation is an ongoing process. Therefore, as long as joints become inflamed, pain can be a problem.
The diagnosis of rheumatoid arthritis is made based on exam and the findings of inflammatory markers in the blood being elevated as well as the finding of specific blood markers for rheumatoid factors. The disease can be followed by the extent of inflammation, and whether the markers in the blood for inflammation are controlled.
Controlling Pain from Rheumatoid Arthritis
In the past, controlling rheumatoid arthritis was very difficult. Originally the main medications were steroids that had many side effects, especially when used long term. Pain medications could control symptoms, but had no effect on the disease. About 30 years ago, some cancer drugs were being used to control the immune system and these decreased the activity and severity of the disease. In the last ten years, a number of drugs have been developed that specifically suppress the immune system. These drugs, when they are effective, do a remarkable job at stopping inflammation, and markedly slow or eliminate the joint destruction. When inflammation is stopped, minimal pain is present and there is no need for additional pain medications.
Controlling the disease process with the appropriate medications is the key to management of rheumatoid arthritis. If you have RA, the disease should be managed by a Rheumatologist, a doctor specializing in the management of these types of conditions. Pain is a characteristic of inflammation. If pain is present, this usually means that medications need to be adjusted to better control the disease. Rarely, when RA is well managed, will a patient need any additional pain medication.
Thomas Cohn, MD
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