Information on Rheumatoid Arthritis

Rheumatoid Arthritis is a type of arthritis that can affect many of the joints in your body. It is more common in women than in men, and it is often found in patients less than 50 years of age. Rheumatoid Arthritis affects the joints on both sides of the body. This means that if a joint is swollen on one side of the body, the same joint should be swollen on the other side of the body.

What are the Symptoms of RA?
The symptoms of RA include:

• Stiffness in the morning
• Swelling and/or tenderness of joints such as the wrists, joints of the fingers, elbows, knees, ankles, and/or joints of the toes
• Feeling tired
• Nodules or lumps that form along bones or over joints

Can RA be Treated?
There is no cure for Rheumatoid Arthritis, but there are many treatments. Some of these, such as methotrexate, leflunomide (Arava), and sulfasalazine (Azulfidine), have been used for many years. Others, such as adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), rituximab (Rituxan), kineret (Anakinra), and abatacept (Orencia), are relatively new. There are other new medicines being used and tested for Rheumatoid Arthritis.

Does Rheumatoid Arthritis Affect Only the Joints?
Rheumatoid Arthritis can affect other parts of the body. For example, patients with RA may develop nodules or lumps. These nodules are not usually tender or painful. Nodules may improve on their own over a period of time, or may grow even if the joint swelling improves.

Rheumatoid Arthritis can also affect the eyes by causing pain, redness, dryness, or decreased vision. Patients who have any of these symptoms should call their doctor immediately.

Patients with RA may develop fluid around their heart or lungs or inflammation of some of the heart or lung tissue. If a patient experiences shortness of breath or chest pain, he/she should inform his/her doctor immediately, or go to the emergency room.

Will I be Able to Function Well With Rheumatoid Arthritis?
The goal of treatment is to manage all of the joint swelling so that patients will be able to do everything they want to do. Rheumatologists are arthritis experts. Most patients with Rheumatoid Arthritis who see their Rheumatologist regularly, do well.

There are many medicines that are used to treat Rheumatoid Arthritis.

NSAIDS
NSAIDS (non-steroidal anti-inflammatory drugs) are medicines which include ibuprofen (motrin, advil), naproxen (Aleve, naprosyn) , meloxicam (Mobic), celecoxib (Celebrex), etc. These medicines are often used to treat the pain of Rheumatoid Arthritis (and other types of arthritis).
NSAIDS should be taken with food because they can irritate the stomach. Patients should tell their doctors if they experience an upset stomach, vomiting blood, blood in their bowel movements, or black bowel movements.
Patients who take NSAIDS should also have their blood counts and their kidney function checked periodically.

Methotrexate
Methotrexate has been used for many years to treat Rheumatoid Arthritis (and other types of arthritis). It is used in much higher doses to treat cancer. Methotrexate should be taken once a week, with a vitamin called folic acid (which is taken every day). Folic acid helps to prevent some of the side effects of methotrexate.
Methotrexate may have side effects which include: hair loss, problems with blood counts, mouth sores, liver and/or lung problems. Patients taking methotrexate should have their blood drawn every four to eight weeks to monitor for side effects. Patients should not drink alcohol and should not become pregnant while taking methotrexate.

Biologics
These are new medicines that change the immune system and help stop Rheumatoid Arthritis (and other types of arthritis). These medicines are: adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), rituximab (Rituxan), kineret (Anakinra), and abatacept (Orencia). They are administered by injection under the skin, or by IV infusion. These medicines may cause patients to become infected more easily, so patients taking these medicines should tell their doctors if they have fever, and/or signs of infection such as cough, diarrhea, or pain when urinating.

Sulfasalazine
Sulfasalazine (Azulfidine) is used to treat Rheumatoid Arthritis (and other types of arthritis). Patients usually take this medicine twice a day or three times a day. Patients taking sulfasalazine may experience nausea, diarrhea, rash, and problems with blood counts. Men taking this medicine may have low sperm counts. Patients taking this medicine should have their blood drawn every 2 to 4 weeks for the first three months in order to monitor for side effects. After the first three months, blood work should be drawn every 3 months.

Hydroxychloroquine
Hydroxychloroquine (Plaquenil) is used to treat Rheumatoid Arthritis and other types of arthritis. Patients take this medicine either once a day or twice a day. The main side effect, which is very rare, is changes in eyesight. Patients are required to see their eye doctor every six to twelve months while taking hydroxychloroquine. Other side effects include nausea, headache, and abdominal pain.

Leflunomide
Leflunomide (Arava) is also used to treat Rheumatoid Arthritis (and other types of arthritis). Patients usually take this medicine every day. It has side effects which include: diarrhea, nausea, vomiting, abdominal pain, rash, and liver abnormalities. Patients taking leflunomide should have their blood drawn every 4 to 8 weeks to monitor for side effects. Patients should not drink alcohol and should not become pregnant while taking this medicine.