Rheumatoid arthritis is a serious disease that a person has to fight against from the moment of diagnosis for the rest of his life.
The treatment is complex, and includes a number of drugs and techniques:
- Basic therapy ;
- Anti-inflammatory therapy of several types ;
- Physical, mechanical, physiotherapeutic and local effects ;
- Special diet.
We begin our conversation with basic therapy, since it, as the name implies, acts as the basis for the treatment of rheumatoid arthritis, and every patient with this serious disease has to deal with it.
The basic treatment of rheumatoid arthritis
Why does the word “basic” appear in the title? Mainly, not because this is the main method of treatment, but because drugs from this group affect the very essence of rheumatoid arthritis, that is, its “basis”. They do not cause relief in a few days or even weeks after the start of administration. These drugs give a pronounced effect no sooner than after a few months and take them in the hope of slowing down the course of the disease, and it is better to drive RA into deep remission.
Long waiting for the result is not the only minus of the basic therapy. Each of its preparations is effective in its own way. But the reaction in different patients is different, therefore, when making a treatment plan, a rheumatologist has to rely not only on medical statistics. You need to include your medical intuition and evaluate each patient as an individual.
Modern basic therapy includes drugs of five groups:
- Anti-malarial ;
- Sulfonamides ;
- D-penicillamine ;
Consider in detail the pros and cons of each of the five components of basic therapy and try to understand how to achieve the best effectiveness and good tolerance to the treatment of rheumatoid arthritis.
Cytostatics: immune suppressants
The shorter word “cytostatics” is usually called drugs from the group of immunosuppressants (remicade, arava, methotrexate, cyclosporine, azathioprine, cyclophosphamide and many others). All of these drugs inhibit cellular activity, including the activity of immune cells. As you know, rheumatoid arthritis has an autoimmune nature, so it is not surprising that it is treated with cytostatics. And the technique itself was adopted by rheumatologists from oncologists who fight with the help of cytostatics with another terrible threat – cancer.
It is cytostatics, and primarily methotrexate, that pushed gold from a leading position in the treatment of RA. Not only rheumatoid but also psoriatic arthritis is successfully treated with immunosuppressants. The drugs of this group currently form the basis of the basic therapy of RA. This fact itself often scares patients, because it is scary to lose immunity almost completely. But keep in mind that rheumatology uses much lower doses of cytostatics than oncology, so you should not be afraid of the terrible side effects that are observed in cancer patients.
Advantages and Disadvantages of Immunosuppressants
The first advantage of cytostatics is their high efficiency at a relatively low dosage. Patients with rheumatoid arthritis are prescribed a 5-20 times lower dose of immunosuppressants than patients with oncology, but in almost 80% of cases this is enough to achieve an excellent therapeutic effect. Cytostatics have proven themselves best in the treatment of severe rheumatoid arthritis with a high rate of disease progression.
The second undoubted advantage in favor of taking cytostatics is the low frequency and low severity of side effects. Only a fifth of patients complain of unpleasant symptoms:
- Skin rash;
- Loose stools or constipation ;
- Difficulty urinating;
- Sensation as if goosebumps were running across the skin.
As soon as the drugs cancel or adjust the dosage, these side effects disappear by themselves. For prophylaxis, once a month, blood and urine tests are taken from the patient in order to notice the problem in time. Malfunctions in the work of the kidneys, liver and inhibition of blood formation. But usually, cytostatics are well tolerated, and a month after the start of therapy, improvements in the patient’s condition with rheumatoid arthritis are visible.
To treat rheumatoid arthritis, modern rheumatologists use three immunosuppressants: methotrexate, Arava, and Remicade. Let’s look at the advantages and disadvantages of each of the drugs.
We have already mentioned methotrexate several times, and this is no accident because this cytostatic is the recognized leader in the basic treatment of RA. It is very convenient to take it: once a week the patient needs to drink one capsule with a dosage of 10 mg. Usually the doctor and the patient agree on what day of the week they will now be “methotrexate” for long months. For example, on Mondays or Thursdays, the patient will now have to take these pills, so confusing or forgetting is difficult.
You can usually talk about improving well-being after 4-6 weeks from the start of taking the drug, and about persistent and marked progress in treatment – after 6-12 months. There is one important note: on the “methotrexate” day, you should not take NSAIDs, which also in most cases are included in the basic treatment of RA. On any other day of the week, you can safely continue treatment with non-steroidal anti-inflammatory drugs.
Arava is considered a very promising immunosuppressant, and many rheumatologists are transferring their patients to this new drug. But there are also doctors who consider Arava to be a heavier medicine with worse tolerance compared to methotrexate. In general, we can say that Arava is prescribed as an alternative to methotrexate if the latter caused side effects in the patient.
Arava is recommended for patients with a very rapid course and rapid development of rheumatoid arthritis, when in the first year of the disease serious joint problems appear, including loss of mobility. About a month after the start of the administration, the first positive changes are usually visible, and after six months -a steady improvement in the condition of the bones.
Another novelty in the arsenal of rheumatologists is the Remicade drug.
It differs from methotrexate, Arabs, and other immunosuppressants in two ways:
- Amazing speed;
- Very high cost.
Considering the latter feature, remicade usually acts as a kind of life buoy for patients with severe form of rapidly progressing rheumatoid arthritis, who are absolutely not helped by methotrexate and other affordable cytostatics. Two other reasons for replacing methotrexate with remicade are poor tolerance and the need for an urgent reduction in the dose of corticosteroids, which are also part of the basic treatment of RA. As you can see, there are enough reasons for prescribing a remicade, but sometimes the high cost of the drug outweighs all of them.
The high efficiency and speed of action of remicade has a flip side: this medicine has many side effects and contraindications. Before you start taking the drug, you need to carefully examine the patient and heal absolutely all the inflammatory processes found in him, even hidden and sluggish. Otherwise, after the start of therapy in conditions of depressed immunity, all these infections will “raise their heads” and lead to serious problems, up to sepsis.
Possible side effects, including an itchy rash, are recommended to be preventively controlled with antihistamines. It is very important for women to carefully protect themselves while taking remicade, since pregnancy and lactation are absolutely impossible during this period. Moreover, you can think about motherhood at least six months after the end of treatment with a remicade.
Of course, there are other immunosuppressants, including more affordable ones:
But all these drugs during clinical trials did not show their best side – the frequency of side effects is very high, and the complications are usually more serious than when taking the same methotrexate. Therefore, the rejection of the three most demanded in basic therapy of RA cytostatics is advisable only if they do not give any effect or are poorly tolerated.
Treatment of rheumatoid arthritis with antimalarial drugs
The drugs delagil (rezoquin, chloroquine, hingamine) and plaquenil (hydrochlorin, hydroxychlorin) have been used in medicine for a long time as an agent against a tropical disease – malaria . But what does rheumatoid arthritis have to do with it, you ask. The fact is that in the middle of the last century, scientists who were looking for at least some new and effective medicine for treating RA tried almost all types of anti-inflammatory drugs because rheumatoid arthritis has long been considered just a special kind of infection. One of these studies brought good news – delagil and Plaquenil slow down the course of RA and reduce the severity of its manifestations.
Nevertheless, anti-malarial drugs in the modern basic therapy of RA occupy, perhaps, the most modest place, since they have only one advantage – good tolerance. And they have one drawback, moreover, a very serious one – they act very slowly (improvement occurs only after six months or a year) and even if successful they give a weak therapeutic effect.
Why have doctors not given up on antimalarial therapy?
A logical question, because there are drugs that act faster and work better. But medicine is one of those branches of science where prejudices and the elementary force of inertia are very strong. Thirty years ago, the basic therapy of RA was based on the following principle: first, delagil and plaquenil, then gold, if it does not help, D-penicillamine or immunosuppressants, and if nothing helps, corticosteroids. That is, the direction was chosen from the most harmless to the most potentially dangerous. But if you think about it, this principle of constructing basic therapy is criminal in relation to the patient.
Suppose a person has acute, rapidly developing rheumatoid arthritis with severe pain and rapidly degrading joints. Is it reasonable to wait half a year for antimalarial drugs to work (the question is whether they will work?), If stronger and more effective drugs can be prescribed? Even if side effects occur, it’s better than just watching how a person suffers, and how the condition of his joints catastrophically worsens every day.
But there are, however, cases where antimalarial drugs are still relevant:
- The patient does not tolerate all other drugs from the basic treatment of RA;
- Considered more effective drugs did not give any effect;
- Rheumatoid arthritis is very mild and develops slowly, so there is no need to resort to the most powerful, but dangerous means.
Treatment of rheumatoid arthritis with sulfanilamide preparations
Salazopyridazine and sulfasalazine are two drugs from the group of sulfonamides that are successfully used in the treatment of rheumatoid arthritis.
If you try to create a hit chart on the degree of effectiveness among the drugs of basic therapy of RA, then it will look something like this:
- In the first place – methotrexate;
- On the second – gold salts;
- In the third – sulfonamides and D-penicillamine;
- On the fourth – anti-malarial drugs.
Thus, sulfonamides can not be ranked among the leaders in terms of effectiveness, but they have huge advantages:
- Good tolerance (incidence of side effects – 10-15%);
- Low severity of complications, if any;
- Affordable price.
The disadvantage of sulfonamides is only one, but significant – they act slowly. The first improvements are visible only three months after the start of treatment, and steady progress is usually observed after a year.
Treatment of rheumatoid arthritis with D-penicillamine
D-penicillamine (distamine, cuprenyl, artamine, trolovol, metalcaptase) is almost never included in the basic treatment of RA if the patient tolerates methotrexate well. It is somewhat inferior to the listed drugs ineffectiveness, but it significantly exceeds them in the number of possible side effects, the frequency of their occurrence and the severity of complications. Therefore, the only reason for the appointment of D-penicillamine is the lack of progress in the treatment with gold and methotrexate or their poor tolerance.
D-penicillamine is a highly toxic substance that causes negative side reactions in almost half of cases of treatment of seropositive rheumatoid arthritis, and in one-third of cases of treatment of seronegative RA. Why is it, however, still used by doctors?
Because sometimes there simply is no other choice. We tried cytostatics, there is no result. Or had to be canceled due to poor tolerance. And the disease progresses rapidly. Then the rheumatologist in the arsenal has only one, albeit dangerous, but, in fact, the only strong drug – D-penicillamine. This is exactly the situation when the end justifies the means. If a negative reaction of the body occurs, the medicine can always be canceled. Therefore, it is better to appoint it all the same as not to do anything at all.
D-penicillamine also has a trump card in the sleeve – this drug helps those patients who have had complications of the heart, kidneys or lungs, for example, amyloidosis. With satisfactory tolerance, D-penicillamine is taken 3-5 years in a row, then they take a break for a couple of years and repeat the course. In this case, the medicine does not lose its effectiveness, such as, for example, gold salts, which are better not to cancel for a long period. Unfortunately, in a small part of patients (approximately 10%), after a temporary improvement in well-being, a sharp deterioration occurs.
Basic Therapy: Key Findings
We have examined the pros and cons of all five groups of drugs included in the list of so-called basic therapy for rheumatoid arthritis. In this story, phrases about complications, side effects and dangers have so often flashed that one involuntarily wants to ask – what is this obligatory treatment of rheumatoid arthritis if it treats (and not always) on the one hand, and cripples on the other (almost always) )?
Such a question, of course, visits the heads of all patients with rheumatoid arthritis immediately after a disappointing diagnosis. Many sit on medical forums and listen to angry rebuffs, the essence of which can be formulated in one sentence: “I became a victim of a medical error, and in general, doctors themselves do not know how to treat rheumatoid arthritis.” This statement is not far from the truth in that part of which it refers to ignorance. Because it is only the Lord God who knows exactly how to cure a person of a serious illness of an inexplicable nature.
The selection of basic therapy for each individual patient with rheumatoid arthritis takes an average of about six months. It is almost impossible to find the most suitable medicine in a shorter period of time, no matter how professional a rheumatologist is, and no matter how brutal instinct he possesses. And to predict how drugs will be transferred, not at all given to anyone.
So maybe not starting this basic therapy? Why torture a person? Well, yes, let the disease develop as quickly as possible so that a person dies early, then certainly he will cease to suffer. Practice shows that if basic therapy is started immediately, immediately after diagnosis, there is more than a decent chance to slow down the course of the disease or even achieve a stable remission. But the cases when a patient with rheumatoid arthritis did not receive any treatment and suddenly recovered, medicine does not know.
Think for yourself, if there is even a small chance to extend your life or the life of a loved one, will you begin to think about side effects? The disease itself will suit you with such side effects that the drugs never dreamed of, and very soon.
Treatment of rheumatoid arthritis with non-steroidal anti-inflammatory drugs
Non-steroidal anti-inflammatory drugs, we will continue to call the abbreviation NSAIDs, as it is more convenient. This group includes:
- Ibuprofen (Nurofen);
- Ketoprofen (ketorolac,);
In the treatment of rheumatoid arthritis, these drugs act as ambulances for joint pain. They reduce not only pain, but also inflammation in the articular and periarticular tissues, so their administration is advisable in any case. Why didn’t we include diclofenac or ibuprofen in the group of drugs for the basic treatment of RA? Because they do not cure the disease itself and in no way slow its development. They act symptomatically, but at the same time they qualitatively improve the life of the patient with rheumatoid arthritis.
Of course, you have to take NSAIDs constantly, and with prolonged use, rarely what medicine does not give side effects. That is why it is important to choose the right NSAIDs for a particular patient and use the drug wisely without exceeding the dosage. We will talk further about how to do this.
NSAID selection criteria
The first criterion is toxicity, therefore, the least toxic NSAIDs, which are rapidly absorbed and quickly excreted from the body, are prescribed primarily to patients with RA. First of all, it is ibuprofen, ketoprofen, and diclofenac, as well as the selective anti-inflammatory drug Movalis, which we will discuss in detail below. Ketorolac, piroxicam and indomethacin are excreted longer, in addition, the latter can cause mental disorders in elderly patients. That is why these three drugs are usually prescribed to young patients who do not have problems with the liver, kidneys, stomach and heart. Then the probability of side effects and complications is small.
The second criterion is the effectiveness of NSAIDs, and here everything is very subjective. A patient with rheumatoid arthritis, as a rule, takes each of the drugs recommended by the doctor for a week, in order to feel the result according to his feelings. If a person says that everything hurts from diclofenac, but ibuprofen helps, the doctor usually agrees.
Speaking of subjectivity, one cannot but note the power of suggestion, which has the usual instructions for the drug. So, many patients, after reading the annotation to diclofenac, where all its possible side effects are honestly and openly described, clutch their heads in horror and say that they will never drink such pills. In fact, diclofenac is not more dangerous than aspirin, which people drink for any reason almost handfuls. It’s just that aspirin does not have a box with detailed instructions embedded inside.
Summarizing, we say that when evaluating the effectiveness of NSAIDs, you need to take into account not only your feelings (helps/does not help), but also data from regular examinations that demonstrate the general condition of your body and diseased joints in particular. If there are side effects (the work of internal organs has worsened), and the joints become inflamed more and more, it makes sense to switch to another NSAID on the advice of a doctor.
Treatment of rheumatoid arthritis with selective anti-inflammatory drugs
Movalis belongs to this group of drugs – a relatively new medicine that was created specifically for long-term continuous use in order to minimize possible side effects. Returning to the subjectivity of the estimates, let us say that most patients with RA find no less, and sometimes more, effective painkillers. At the same time, Movalis is very well tolerated and rarely causes negative reactions of the body, which can not be said about NSAIDs, the intake of which is often accompanied by digestive disorders.
Under the supervision of a doctor, Movalis can be taken for several months or even years in a row, if there is such a need. It is also very convenient that one pill is enough to relieve pain, which is drunk either in the morning or at bedtime. There is also moval in the form of rectal suppositories. If pain syndrome is very intense, you can resort to injections of Movalis. During an exacerbation of rheumatoid arthritis, the patient often has to take injections for a whole week, and only then switch to tablets. But the fact that movalis, firstly, helps almost all patients, and secondly, has almost no contraindications, is encouraging.
Treatment of rheumatoid arthritis with corticosteroids
Another “firefighter” and symptomatic method of alleviating the condition of patients with rheumatoid arthritis is taking corticosteroid hormonal drugs (hereinafter – corticosteroids).
- Prednisoloneum (medical representative);
- Methylprednisolone (medrol, depot-medrol, metipred);
- Triamcinolol (triamsinolol, polcortolone, Kenalog, Kenacort);
- Betamethasone (celestone, phlosterone, diprospan);
Corticosteroids are very popular in the West, where they are prescribed for almost all RA patients. But in our country, doctors are divided into two warring camps: some advocate taking hormones, while others violently reject this technique, calling it extremely dangerous. Accordingly, patients who want to keep abreast of all the news from the world of medicine read interviews from American and Russian rheumatologists and are confused: who should be trusted? We’ll try to figure it out.
Corticosteroid intake causes a rapid improvement in well-being in patients with RA: pain disappears, stiffness of movements and chills in the morning disappear. Of course, this cannot but please the person, and he automatically assigns the status of a “professional” to the attending physician. The pills helped – the doctor is good, they did not help – the doctor is bad, everything is clear here. And in the West, it is customary to express gratitude to the doctor in monetary terms. That is why there are many more “good” doctors than “bad” ones.
In our country, in conditions of free insurance medicine, a doctor will think for three times before prescribing hormones to his patient. Because time will pass, and the same doctor, most likely, will have to disentangle the consequences of such therapy.
The danger of hormone replacement therapy
Why is taking corticosteroids so dangerous? These are stress hormones that have a powerfully negative effect on all organs. While a person accepts them, he feels great, but as soon as he stops, and the disease becomes more active with tripled strength. If before the joints hurt so that it could be tolerated, now they hurt unbearably, and nothing helps.
So maybe keeping the patient on hormones all the time? This is absolutely impossible, because, firstly, over time, they will bring less and less effect, and secondly, the negative impact on internal organs will accumulate and accumulate until it leads to a serious malfunction.
Here are just a few of the likely consequences:
- Itsenko-Cushing’s syndrome – terrible swelling and hypertension as a result of too slow withdrawal of sodium and fluid from the body;
- Increased blood sugar, and as a result – diabetes ;
- obesity ;
- Decreased protective properties of the body, frequent colds;
- The development of peptic ulcer of the stomach and / or duodenum ;
- Thrombosis of veins and arteries;
- Amenorrhea and dysmenorrhea;
- Hemorrhagic pancreatitis ;
- Acne ;
- Convulsive seizures and psychoses ;
- Insomnia and uncontrolled agitation of the nervous system.
A creepy list, isn’t it? Usually, when at least one serious side effect occurs, corticosteroids are immediately canceled, but here the worst thing starts – the body protests against the cancellation. This is expressed in a wave-like increase in the inflammatory process in articular and periarticular tissues and severe pains that cannot be relieved by anything. Hormones try to cancel gradually to avoid such shock consequences.
To drink or not to drink hormones?
But how to drink them, if it threatens with such terrible consequences, you ask. Indeed, at some stage corticosteroids will surely cease to bring relief and begin to harm the patient. But there are situations when one has to choose the lesser of several evils. Sometimes a patient has nowhere worse, and besides, only hormones can ease his condition. We are talking about patients with Still’s syndrome, Felty’s syndrome, polymyalgia rheumatism and other serious complications.
A sensible and far-sighted specialist will prescribe hormones only to such a patient in whom rheumatoid arthritis is at a very high stage of activity, ESR goes through the roof, the level of C-reactive protein in the blood is prohibitive, and the inflammatory process cannot be stopped with NSAIDs.
The conclusion is as follows: corticosteroids should be prescribed to a patient with rheumatoid arthritis in the event that the expected benefit of the treatment exceeds the likely harm.
Physico-mechanical treatments for rheumatoid arthritis
Such techniques include drainage of the thoracic lymphatic duct, lymphocytes phoresis, plasmapheresis, and irradiation of lymphoid tissue. Each of these procedures is quite effective but has a number of disadvantages. Let’s consider them in detail.
Thoracic lymphatic duct drainage
This procedure requires sophisticated medical equipment. Using a drainage device, the doctor enters the patient’s chest lymphatic duct, pumps out all the lymph from there, puts it in a special centrifuge, which rotates and separates the contents into pure lymph and cell decay products, microbial waste and other “garbage”. Completely purified lymph is pumped back into the thoracic duct.
A couple of weeks after this procedure, the patient begins to feel much better, but this effect lasts only for a month. Then the cleaned lymph is again filled with harmful impurities, because the disease has not disappeared. That is why drainage of the thoracic lymphatic duct is almost not used in the modern practice of treating rheumatoid arthritis. The procedure is complicated, expensive, but the effect of it persists for a too modest period of time.
This procedure is also very expensive and is carried out on high-tech medical equipment in large medical centers. The doctor, as it were, “crashes” into the patient’s circulating bloodstream so that the blood passes through a special centrifuge, and monocytes and lymphocytes are removed from it. In the four hours during which lymphocytes phoresis is performed, approximately 12120 lymphocytes can be removed from the patient’s bloodstream.
Why is this needed, and what does it give? Lymphocytes, or cells of the immune system, are satellites of the inflammatory process. That’s why a rheumatologist is never happy to see an increased level of lymphocytes in the results of your blood test. If at least part of these cells is removed from the bloodstream, the well-being of a patient with RA will immediately improve. True, this effect, as in the previous case, will last only about a month. That is why lymphocytes phoresis is used extremely rarely.
The procedure of plasmapheresis lasts about six hours, during which plasma containing harmful components: inflammatory mediators, aggressive immune cells, rheumatoid factor, bacterial waste products is removed from a large volume of the patient’s blood. The “bad” plasma is replaced by donor or albumin. In just one procedure, 40 ml of plasma can be removed from the body for each kg of patient weight. Plasmapheresis is carried out in courses of 15-20 procedures, the treatment takes about a month and a half.
What is such suffering for? Plasmapheresis greatly reduces ESR and ROE, reduces the amount of immunoglobulins in the blood, and the patient begins to feel much better. True, negative consequences are also possible: edema, a decrease in hemoglobin, and potassium deficiency. Side effects can be easily dealt with; the benefits of the procedure outweigh the risk.
The main disadvantages of plasmapheresis are its high cost and short duration of the therapeutic effect. A positive result persists for several months, and then the course has to be repeated. Nevertheless, plasmapheresis is often resorted to, especially with the sudden acute development of rheumatoid arthritis and when the choice of drugs for basic therapy is delayed. It is plasmapheresis that enables the attending physician to gain time and prevent a fatal deterioration of the patient’s condition.
Lymphoid tissue irradiation
The technique of irradiating lymphoid tissue was first applied in 1980 and has been actively used since then. Its essence is to expose the lymph nodes, spleen and thymus of a patient to point irradiation. In one session, the patient receives from 150 to 220 rad, in total for the course of treatment – 4000 rad. In almost all cases, treatment is effective and can reduce the dose of corticosteroids and NSAIDs, or even abandon them altogether. The effect lasts for a long time – 1-2 years.
Like any treatment associated with radiation, exposure to lymphoid tissue has side effects. Some patients have a general weakness, nausea, and a decrease in white blood cell count. Nevertheless, this procedure has been successfully used to treat rheumatoid arthritis, both in our country and in the west.
Topical treatment of rheumatoid arthritis in the active stage
To alleviate the condition of a patient with rheumatoid arthritis in the active stage, you can use hormonal injections in the joint bag, laser therapy, cryotherapy, special ointments and creams. Consider the advantages and disadvantages of each of the methods.
Intra-articular corticosteroid administration
The essence of the technique is the injection of hormonal drugs from the group of corticosteroids into the joint cavity (we spoke about them above). It can be prednisone, Celestone, hydrocortisone, depot-Medrol, diprospan, Kenalog. After the procedure, a quick and pronounced positive effect is observed: the inflammation subsides, the pain decreases or even disappears completely.
Corticosteroid injections are an ambulance for painful joints. The introduction of hormones directly into the joint is done when the patient’s state of health is absolutely deplorable, and no other measures, including taking NSAIDs and Movalis, can help relieve pain and reduce inflammation. Usually, after an injection, the patient feels well for a month, but in severe cases, the procedure has to be repeated every 10 days. More often than not, otherwise corticosteroids will begin to adversely affect the body as a whole.
In addition, doctors do not recommend making hormonal injections into the same joint more than eight times. This can cause destructive changes in the cartilage, ligaments and muscles around the joint. It turns out that for temporary improvement in well-being, the patient will have to pay an exorbitant price.
Laser rays have a beneficial effect on the body of a person suffering from rheumatoid arthritis at any stage of activity. If an exacerbation of the disease is currently observed, the elbow folds of the patient are irradiated with a laser. In this way, they improve the quality of blood, and also provide a more complete blood supply to organs and tissues. It is believed that laser beams also normalize the immune status of patients with RA. This technique is successfully used both independently and in combination with the basic therapy, which we wrote about above.
When the period of exacerbation of the disease has passed, the patient does not have an acute inflammatory process, the body temperature is not elevated, you can directly irradiate the area of the joints with a laser. In the first weeks after the procedure, temporary deterioration in well-being and an increase in pain syndrome may be noted. However, then in 80% of patients there is an improvement that lasts for several months.
The course of treatment usually consists of 15-20 procedures, and they are carried out with an interval of one day. Laser irradiation does little to help patients in the last stages of rheumatoid arthritis – paralyzed, with twisted joints. However, in the initial stages and in periods of remission, such an effect is very effective and simply useful.
There are several important contraindications to laser irradiation:
- The presence in the body of any tumors, including benign;
- Blood diseases, for example, poor coagulability;
- Infectious diseases ( tuberculosis, syphilis );
- Hypertensive crisis;
- Myocardial infarction ;
- Cirrhosis of the liver ;
Cryotherapy, or cold treatment, has been successfully used not only in the treatment of arthritis (rheumatoid, reactive, psoriatic) but also in the treatment of ankylosing spondylitis. This method is good both at the stage of exacerbation and during periods of attenuation of the disease. Almost 80% of RA patients who underwent cryotherapy treatment noted a significant improvement in their well-being. The main thing is to be consistent and undergo procedures regularly for a long time.
Cryotherapy can be dry, this is when the body is exposed to very low-temperature dry air, for example, in a special cryosauna. And maybe liquid cryotherapy – in this case, the patient is exposed to liquid nitrogen. Let’s start with the second option.
A jet of liquid nitrogen is released under high pressure onto a sore joint, which immediately evaporates, but at the same time manages to cool the tissues deeply. The inflammation in them subsides, the blood circulation intensifies, the swelling decreases and the pain goes away. Usually, 8-12 such procedures are carried out every day or every other day to achieve a lasting positive effect. Cryotherapy with liquid nitrogen has almost no contraindications, it can be resorted to even in the treatment of elderly patients with RA. There are only a few limitations – Raynaud’s syndrome, severe arrhythmia, recent heart attack or stroke.
Now let’s talk about dry cryotherapy. The patient is completely undressed and placed in a cryosauna – a room filled with super-cold dry air. The principle of therapeutic effect here is the same as when blowing liquid nitrogen, but the cryosauna has a positive effect on the whole body, and not just on individual joints. Such a procedure is carried out in special medical centers, usually private, so it costs a lot. In addition, dry cryotherapy requires rare, expensive equipment, so even if public hospitals were equipped with cryosaunas, it would hardly be free to use them.
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Therapeutic creams and ointments
Advertising promises us miraculous relief from joint pain, but miracles do not happen. With rheumatoid arthritis, ointments and creams based on all the same NSAIDs are recommended:
- Butadiene ointment;
- Indomethacin ointment;
- Fastum gel;
If you smear a diseased joint with such an ointment, about 5-7% of the active substance will penetrate the skin pores. Will it bring much relief? Unlikely. However, if you take NSAIDs orally, like most patients with rheumatoid arthritis, then the ointment can be used as support, that is, simply to enhance the effect. Creams and ointments for pain in joints have only one indisputable advantage – they are almost harmless (I wanted to say, almost useless).
Physiotherapeutic treatment of rheumatoid arthritis
The fact that arthrosis is good is unacceptable for arthritis, so physiotherapeutic procedures and massage are prescribed only in periods of remission when there is no acute inflammatory process. If the patient has a high fever and the joints are literally burning, what kind of massage or heating can be discussed?
But when the inflammation was stopped, some gentle types of massage, as well as physiotherapy can help improve the blood supply to the joints and restore their mobility.
In the treatment of rheumatoid arthritis in remission, the following physiotherapeutic procedures are used:
- Infrared irradiation;
- Applications with paraffin, ozokerite and therapeutic mud;
- Phonophoresis with hydrocortisone;
- X-ray therapy.
The doctor should choose a method of therapeutic effect. It is absolutely unacceptable when a patient with rheumatoid arthritis goes to a private SPA center to enjoy healing mud there. The advice of various kinds of healers and natural healers is also strictly impossible to follow. And massage at home should not be performed by a person who does not have the appropriate qualifications and does not know how to handle joints affected by rheumatoid arthritis.
Nutrition Recommendations for Patients with Rheumatoid Arthritis
Proper nutrition is simply of great importance for a patient with RA. Almost all patients note that the use of certain products that irritate the body leads to a sharp deterioration in well-being, exacerbation of inflammation and increased pain. And as soon as a harmful product is eliminated, the situation immediately returns to normal.
What are these dangerous foods? Here is the list:
- Some cereals (wheat, oats, corn, rye);
- Milk and dairy products.
As you can see, the list contains products that are usually considered useful (with the exception, perhaps, of pork). But do not be upset, patients with rheumatoid arthritis have a good alternative:
- Fish and seafood;
- Vegetables and fruits (excluding citrus fruits);
- Chicken and quail eggs;
- Buckwheat and pearl barley porridge.
You need to cook food in a healthy way: in the oven or a double boiler, you can cook or stew. It is recommended to eat often: 5-6 times a day but in small portions. Do not eat up at night. It is advisable to exclude salt and sugar from the diet. Avoid smoked meats and fried foods. Some patients with rheumatoid arthritis even have to get special advice from a nutritionist and develop an individual diet to avoid complications caused by improper diet.
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