Rheumatoid Arthritis- Management

Manage the Signs and Symptoms of Rheumatoid Arthritis-Care for your Joints Designed on Canva Pro Introduction In my last article, I discussed the signs and symptoms of Rheumatoid Arthritis ( RA). In this article, we will discuss how to manage this disease by using these 5 easy methods, namely- fomentation, massage, diet, exercise, and medications. Before we delve into the details of the management of RA, let's see briefly what the worldwide statistics have to tell us about this condition. Global Statistics of Rheumatoid Arthritis in 2021 The picture below shows statistics on RA in 8 countries of the world as of 2018. This value has been increasing in spite of proper management. And these countries are the major markets for anti-RA drugs. Statistics in 8 countries in 2018, Courtesy- Pharmalogical Technology Courtesy-ACR As of 2021, in India, the total no. of adult RA patients is 0.45%, which is roughly 40 to 45 lakhs in a population of 100 million-plus. The picture below on the right shows the percent-wise distribution of RA cases in various cities of India. In the USA it is about 71/10000 adult population. Now that you know the statistics, you can understand the significance of proper treatment of RA, as it is cost-intensive in most cases[discussed below]. Around 10 per cent of arthritis problems are bad, painful, crippling inflammatory arthritis such as RA. Though there is much variation, India has 4-5 million patients of RA which predominantly is a women’s disease. It was shocking to find that around one-third of RA patients in India were young women (20-40 years) and this was much more than any other country. Source-Indian Express After reading the above information, I am reminded of one lady patient of mine who developed RA at a very young age of 25 years when she gave birth to her first child. This lady was bedridden for the rest of her life. At times I was called upon to have a look at her when she had flares of RA symptoms. She later passed away after a prolonged illness at the age of 55 years. What is the Purpose of the Treatment of RA- Rheumatoid arthritis is the disease caused by auto-destruction of the joints by antibodies that attack our joints mistakenly. In my earlier article on Arthritis, had described how a typical human joint looks like. Antibodies attack the synovial membrane of the joints[ have a look at the picture below] causing inflammation and gradually destroying it over a period of time. Anatomy of A Typical Joint in the Human Body Our purpose in treating this condition is to slow down its progress, because, any changes that may have occurred due to RA in the joint are irreversible. Management of RA The optimal or best care for patients with rheumatoid arthritis (RA) consists of an integrated approach that includes both Pharmacologic[ with medicines]- Medication-based therapies comprise several classes of agents, including nonsteroidal anti-inflammatory drugs (NSAIDs), nonbiologic and biologic disease-modifying antirheumatic drugs (DMARDs), immunosuppressants, and corticosteroids. Early therapy with DMARDs has become the standard of care, because it can both retard disease progression more efficiently than later treatment and, potentially, induce more remissions. Non-pharmacologic[ without medicines ]therapies. In this article, we are going to learn the non-pharmalogic[ i.e. treatment without medicine] methods. Non- pharmacologic[medicine] therapy- In this article, we will try to understand the basics of the treatment for RA. To begin with, we will learn how non-pharmacological methods[ i.e., without medicines] can tackle RA. Many nonpharmacologic treatments are available for this disease, that includes- Exercise, Diet, Massage, Counseling Stress reduction, Physical therapy. Active participation of the patient and family is a must in the design and implementation of the therapeutic program. It helps boost morale and ensure compliance, as does explaining the rationale for the therapies used. The 5 easy tips to treat Rheumatoid Arthritis In my introduction, I have mentioned 5 prong management of RA that I follow at my Clinic- Fomentation of affected joints Massaging of affected joint, Diet Exercise and Medications Going ahead, I will dedicate one article each to the above-mentioned tips. In this article, I will discuss how you can use fomentation to relieve pain. The first 4 methods pertain to lifestyle changes. The last one includes the use of different medicines both conventional and traditional. If you think you may be experiencing the signs and symptoms of rheumatoid arthritis, it’s important to see your doctor. Here I will discuss how I go about treating my patients. Let's start with the first one- Fomentation- This is the first and foremost method used by those suffering from- Joint pains; Aching muscles; or If both of the above conditions are together. What is fomentation? Fomentation is a method by which we apply either heat, cold, or both to the affected joint by using packs or pads or simply hot or cold water. This method has been in use for ages. Remember the last time you got a bump on your head? And your mother or grandmother placing ice packed in a kerchief or napkin on the bump? The idea behind this is to restrict the swelling. Cold fomentation constricts the blood vessels which have broken causing blood to flood below the skin while you got the bump. Similarly, when there is inflammation, as in arthritis, the joint is warm or hot due to fluid accumulating around the joint parts- the cold fomenting restricts fluid accumulation. Cold fomenting This is done by using an ice pack is recommended when the joint is swollen and hot[ acute inflammation]. Ice packs of various sizes are available as shown below. A dual-action gel fomenting pack This method uses- Ice packs as shown above Direct application of ice by rubbing ice block[ ice massage] over the skin on the affected joint When to use this method- Whenever there is a flare-up of a rheumatic joint, cold therapy will dull the sensation of pain. It has a numbing effect and relieves the muscle spasm surrounding the joint. How to use this method- After you purchase this ice-pack jelly, keep it in the freezer section of your refrigerator. This will harden the pack. Now, follow these steps- Steps for using ice packs- First, apply a thin layer of mineral oil or petroleum jelly over the skin of the affected joint Secondly, place a moist towel or cloth over this mineral oil Finally, place the ice pack on the wet cloth Cover this pack with dry towels to insulate it Alternately, where there are multiple joints affected by RA, you can use it as shown below- Use of ice-pack on different joints and areas. Source- Amazon.com Ice Massage If you do not have an ice pack, then you can use an ice block directly removed from your freezer. Place this block in a wet towel and gently massage over the spot surrounding a joint for about 10 to 20 minutes or till the area becomes a bit numb. You can apply an ice pack 2 to 3 times a day. Alternately, you can prepare an ice block by using a paper cup like this- Fill the paper cup with water Freeze it in the freezer of your refrigerator After the ice has formed, remove it, cut the bottom of the cup Next, hold this cup in your hand and gently massage it over the affected joint/muscle. What you should not do while using cold packs- Firstly, if you have impaired circulation around your joint, say for eg., in your foot toes[ like in diabetes], you should not use the ice pack/ice massage. Cold fomentation has the ability to constrict blood vessels and can reduce the much-needed blood circulation to the joint or the whole foot. Secondly, do not keep the ice pack for too long on the affected part. This can also impair the blood circulation of that joint. Always check the skin below the pack after a few minutes- if it is getting numb or gets red, it can be a sign of impending frostbite. Hot fomentations/packs Hot fomentation is another way of giving relief to the affected joints that have been practiced for ages. In fact, if you remember, whenever you had muscular or joint pains, the first thing that you will think before taking medicines is hot fomentation. What does a hot fomentation do? Here's what- It increases regional blood circulation thereby- helping remove inflammation-causing chemicals like prostaglandins reduce inflammation and improve joint mobility Ease pain Relax tense, painful muscles Types of hot fomentation- There are 2 types- wet and dry. In the wet type, you can use hot water and a towel. Dip the towel in hot water, squeeze it to remove water, and apply it to the affected part. Another way to do it is by using a hairdryer. A handheld hair dryer Dip a towel in normal water and start the hairdryer. Keep it on dry heat mode, hold it a few inches above the wet towel and move it back and forth till you get the desired heat or warmth. Alternately, you can use the gel pack shown above by immersing it in hot water and then applying it to the affected part. Warmth causes the blood vessels of the muscles to dilate, which increases the flow of oxygen and nutrients to the muscles.Source-https://www.arthritis-health.com/treatment/alternative-treatments/when-and-why-apply-heat-arthritic-joint Precautions while giving hot fomentation- Do not encourage or do hot fomentation if - The joint is hot There is an infection surrounding the affected joint Numbness in the joint area. This is basically to avoid overheating and causing burns. How do we do this? This is done by using warm water or hot water bags or a heating pad. Warm water fomenting with exercise[ as shown below] is recommended for chronic pain and stiffness of joints in RA. [metaslider id="1851"] Usually, when the patients visit me with pain in joints, after clinical examination to rule out any infection, I carry out some investigations to confirm RA. Once confirmed, depending on the present signs and symptoms, treatment is initiated. If the person has only pain and no swelling and it is bearable, my first step is to advise fomentation in warm water as shown above. Alternately, you can use a heating pad to relieve pain in a painful joint[shown below]. Where you can get these tools for Fomentation- Heating pad for dry fomentation Heating pad for dry fomentation There are good electric heating pads available online all over the world. The same item can be purchased on Amazon.com in different countries. I am sharing the Amazon links for these gadgets[kindly read the disclosure]- In India, use this link. Contrast Fomenting In this type of fomenting, you do both hot and cold fomenting alternately. As shown above, you use one bowl containing warm water and another containing normal tap water. Dip your hands in warm water first all the time closing and opening your hands. Repeat the same in cold water. If you are having persistent pain, you will feel relief from it within a few minutes. Repat this contrast fomenting 2 to 3 times a day for at least 10 to 15 minutes at a time. Conclusion I hope that you have understood the importance of getting pain relief by fomentation. In my next article, we will learn how massage helps in relieving the pain and discomfort of RA. Disclosure- The links for products shown above and links for respective countries are affiliate links, meaning that if you purchase any product using this link, the author gets a small commission without extra cost to the purchaser[along with the displayed discount] that helps in maintaining this website and getting fresh contents to you that comes absolutely free with it as and when it is published. Thank you for reading this article. If you have any queries or suggestions on this topic, do reach out to me via the comments section. I will be glad to respond to it promptly. Adios.