Treatment for rheumatoid arthritis
Rheumatoid arthritis is a serious disease that a person has to deal with from the moment of diagnosis for the rest of their life.
The treatment is complex and includes a number of drugs and techniques:
- Basic therapy;
-
Anti-inflammatory therapy of several types;
- Selective anti-inflammatory drugs
- Treatment with corticosteroids (hormones)
- Physical, mechanical, physiotherapeutic effects;
- Local treatment (injections, laser, cryotherapy);
- A special diet.
Let's start our conversation with basic therapy, since it, as the name implies, is the basis for the treatment of rheumatoid arthritis, and every patient with this serious disease has to deal with it.
Basic therapy for rheumatoid arthritis
Why does the title include the word "basic"? 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 give you any relief until a few days or even weeks after you start taking them. These drugs give a pronounced effect not earlier than after a few months, and they are taken in the hope of slowing down the course of the disease, or, better, driving RA into deep remission.
A long wait for the result is not the only disadvantage of basic therapy. Each of the drugs included in it is effective in its own way. But the reaction in different patients is different, therefore, when drawing up 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:
- Immunosuppressants
- Antimalarial;
- Sulfonamides;
- D-penicillamine;
Let's 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 efficacy and good tolerability of the treatment of rheumatoid arthritis.
Cytostatics: drugs that suppress the immune system
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 suppress cellular activity, including the activity of immune cells. As you know, rheumatoid arthritis is of 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 are fighting with the help of cytostatics against another terrible threat - cancer.
It was cytostatics, and primarily methotrexate, that moved gold from the leading positions in the treatment of RA. Immunosuppressants are successfully treated not only for rheumatoid, but also for psoriatic arthritis. The drugs of this group currently form the basis of the basic therapy for RA. This very fact often frightens patients, because it is scary to lose immunity almost completely. But keep in mind that much smaller doses of cytostatics are used in rheumatology than in oncology, so you should not be afraid of such terrible side effects as 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 sufficient to achieve an excellent therapeutic effect. Best of all, cytostatics have proven themselves in the treatment of severe forms of rheumatoid arthritis with a high rate of disease progression.
The second undoubted plus 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;
- Feeling as if goosebumps are running down the skin.
As soon as the drugs are canceled or the dosage is adjusted, 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. Disruptions in the work of the kidneys, liver and inhibition of hematopoiesis are possible. But usually cytostatics are well tolerated, and within a month after the start of therapy, improvements in the patient's condition with rheumatoid arthritis are visible.
For the treatment of rheumatoid arthritis, modern rheumatologists use three immunosuppressants: methotrexate, arava, and remicade. Let's take a look at the pros and cons of each drug.
Methotrexate
Earlier, we have already mentioned methotrexate several times, and this is not accidental, because it is this cytostatic that is the recognized leader in the basic therapy 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 which day of the week they will now have "methotrexate" for many months. For example, on Mondays or Thursdays, the patient will now have to take these pills, so it is difficult to confuse or forget.
An improvement in well-being can usually be said after 4-6 weeks from the start of taking the drug, and about a persistent and pronounced progress in treatment - after 6-12 months. There is one important note: on the “methotrexate” day, you should not take NSAIDs, which are also included in the basic therapy of RA in most cases. On any other day of the week, you can safely continue treatment with non-steroidal anti-inflammatory drugs.
Arava (leflunomide)
Arava is considered a very promising immunosuppressant, and many rheumatologists are switching their patients to this new drug. But there are also doctors who consider arava to be a heavier medicine with worse tolerance than 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 already in the first year of the disease there are serious problems with joints, up to loss of mobility. About a month after the start of the intake, the first positive changes are usually visible, and after six months - a persistent improvement in the condition of the bones.
Remicade (infliximab)
Another novelty in the arsenal of rheumatologists is the remicade drug.
It differs from methotrexate, arava and other immunosuppressants in two ways:
- Amazing speed;
- Very high cost.
Given the latter feature, remicade usually acts as a lifeline for patients with severe rapidly progressive rheumatoid arthritis, who are absolutely not helped by methotrexate and other affordable cytostatics. Another two 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 therapy for RA. As you can see, there are enough reasons for prescribing remicade, but sometimes all of them are outweighed by the high cost of the drug.
The high efficiency and speed of action of remicade has a downside: this drug 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 ones. Otherwise, after the start of therapy in conditions of suppressed immunity, all these infections "raise their heads" and lead to serious problems, up to sepsis.
Possible side effects, including an itchy rash, are recommended to be prevented with antihistamines. It is very important for women to carefully protect themselves while taking remicade, since pregnancy and breastfeeding are absolutely impossible during this period. Moreover, you can think about motherhood at least six months after the end of treatment with remicade.
Other cytostatics
Of course, there are other immunosuppressants, including more affordable ones:
- Cyclosporine;
- Chlorbutin;
- Azathioprine;
- Cyclophosphamide.
But all these drugs during clinical trials showed themselves not on the best side - the frequency of side effects is very high, and the complications, as a rule, are more serious than while taking the same methotrexate. Therefore, the rejection of the three most popular cytostatics in the basic therapy of RA is advisable only if they do not give any effect or are poorly tolerated.
Treatment of rheumatoid arthritis with antimalarial drugs
The drugs delagil (rezoquine, chloroquine, hingamin) and plaquenil (hydrochlorin, hydroxychlorine) have long been used in medicine as a remedy 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 drug for the treatment of RA tried almost all types of anti-inflammatory drugs, because rheumatoid arthritis has long been considered just a special type of infection. One such study brought good news - Delagil and Plaquenil slow down the course of RA and reduce the severity of its manifestations.
Nevertheless, antimalarial drugs in modern basic therapy for 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 haven't doctors given up on anti-malarial 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 RA therapy was based on the following principle: first delagil and plaquenil, then gold, if it does not help - D-penicillamine or immunosuppressants, and if all else fails - 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 building basic therapy is criminal in relation to the patient.
Suppose a person has acute, rapidly developing rheumatoid arthritis with severe pain syndrome and rapidly degrading joints. Is it reasonable to wait six months for the antimalarial drugs to work (the question is - will they work?), If stronger and more effective drugs can be prescribed? Even if side effects arise, it is better than just watching how a person is suffering, and how the condition of his joints deteriorates catastrophically every day.
But there are, nevertheless, cases when antimalarial drugs are still relevant:
- The patient tolerates very poorly all other drugs from the basic therapy of RA;
- The drugs considered to be more effective had no 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 drugs of the sulfonamide group
Salazopyridazine and sulfasalazine are two drugs from the sulfonamide group that are successfully used in the treatment of rheumatoid arthritis.
If you try to create a certain hit parade according to the degree of effectiveness among the drugs of basic therapy for RA, then it will look something like this:
- In the first place is methotrexate;
- On the second - gold salts;
- On the third - sulfonamides and D-penicillamine;
- On the fourth - antimalarial drugs.
Thus, sulfonamides cannot be classified 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.
There is only one drawback of sulfonamides, but significant - they act slowly. The first improvements are visible only three months after the start of treatment, and stable progress is usually observed after a year.
Treatment of rheumatoid arthritis with D-penicillamine
D-penicillamine (distamine, cuprenil, artamine, trolovol, metalcaptase) is almost never included in the basic therapy for RA if the patient tolerates methotrexate well. It is somewhat inferior to the listed drugs in terms of effectiveness, but 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 prescribing D-penicillamine is the lack of progress in 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 a third of cases of treatment of seronegative RA. Why is it, nevertheless, still used by doctors?
Because sometimes there is simply no other way out. We tried cytostatics, but no result. Or had to be canceled due to poor portability. And the disease progresses rapidly. Then the rheumatologist has only one, though dangerous, but, in fact, the only strong drug in the arsenal - D-penicillamine. This is exactly the situation when the end justifies the means. If there is a negative reaction of the body, the medicine can always be canceled. Therefore, it is better to appoint him after all than to do nothing at all.
D-penicillamine has a trump card in its sleeve - this drug is good for those patients who have RA complications in the heart, kidneys or lungs - for example, amyloidosis has developed. With satisfactory tolerance, D-penicillamine is taken for 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, as, for example, gold salts, which are better not to be canceled for a long period. Unfortunately, in a small part of patients (about 10%), after a temporary improvement in health, a sharp deterioration occurs.
Basic therapy: main findings
We have reviewed the pros and cons of all five groups of drugs included in the list of the so-called basic therapy for rheumatoid arthritis. In this story, phrases about complications, side effects and dangers flashed so often that one involuntarily wants to ask - what kind of compulsory treatment for rheumatoid arthritis is, if it heals on the one hand (and even then not always), and on the other hand cripples (almost always)?
This question, of course, visits the heads of all patients with rheumatoid arthritis immediately after a disappointing diagnosis. Many people sit on medical forums and listen to angry rebukes, 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 the part about ignorance. Because only the Lord God can know exactly how to cure a person from a serious illness of an inexplicable nature.
The selection of basic therapy drugs for each individual patient with rheumatoid arthritis takes on average about six months. Finding the most suitable medicine in a shorter time is almost impossible, no matter how professional a rheumatologist is, and no matter how brutal he has a sense of. And no one can predict how the drugs will be tolerated.
So maybe not start this basic therapy? Why torture a person? Well, yes, even if the disease develops as quickly as possible, so that the person dies early, then he will certainly stop suffering. Practice shows that if basic therapy is started immediately, immediately after the diagnosis, then there is a more than decent chance to slow down the course of the disease or even achieve a stable remission. But there are no 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 think about side effects? The disease itself will arrange for you such side effects that drugs never dreamed of, and very soon.
Treatment of rheumatoid arthritis with non-steroidal anti-inflammatory drugs
Further in the story, we will call non-steroidal anti-inflammatory drugs by the abbreviation NSAIDs, so it is more convenient. This group includes:
- Ibuprofen (Nurofen);
- Diclofenac;
- Ketoprofen (ketorolac, ketanov);
- Indomethacin;
- Butadion;
- Piroxicam.
In the treatment of rheumatoid arthritis, these drugs act as an ambulance for joint pain. They reduce not only pain, but also inflammation in the articular and periarticular tissues, so their use is advisable in any case. Why didn't we include diclofenac or ibuprofen in the group of drugs for basic therapy for RA? Because they do not cure the disease itself and do not slow down its development in any way. They act symptomatically, but at the same time qualitatively improve the life of a patient with rheumatoid arthritis.
Of course, NSAIDs have to be taken constantly, and with long-term use, rarely any medicine does not give side effects. That is why it is important to choose the right NSAID for a specific patient and to use the drug wisely without exceeding the dosage. We will talk about how to do this further.
Selection criteria for NSAIDs
The first criterion is toxicity, therefore, first of all, patients with RA are prescribed the least toxic NSAIDs, which are rapidly absorbed and quickly excreted from the body. First of all, these are 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 from the body for a longer time, in addition, the latter can cause mental disorders in elderly patients. That is why these three drugs are usually prescribed for young patients with no liver, kidney, stomach or heart problems. Then the likelihood of side effects and complications is low.
The second criterion is the effectiveness of NSAIDs, and everything is very subjective. A patient with rheumatoid arthritis usually takes each of the medications recommended by the doctor for a week in order to assess the result according to his feelings. If a person says that everything hurts me from diclofenac, but ibuprofen helps well, the doctor usually agrees with this.
Speaking of subjectivity, one cannot fail to note the power of suggestion, which is possessed by the usual instructions for the drug. So, many patients, having read the annotation to diclofenac, where all its possible side effects are honestly and frankly described, clutch their heads in horror and say that they will never drink such pills. In fact, diclofenac is no more dangerous than aspirin, which people drink for any reason, almost by handfuls. It's just that aspirin doesn't have a box with detailed instructions embedded inside.
Summing up, let's say that when assessing the effectiveness of NSAIDs, you need to take into account not only your feelings (helps / does not help), but also data from regular examinations, demonstrating 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 more and more inflamed, it makes sense to switch to another NSAID on the advice of a doctor.
Treatment of rheumatoid arthritis with selective anti-inflammatory drugs
This group of drugs includes Movalis, a relatively new drug that was created specifically for long-term continuous use in order to minimize possible side effects. Returning to the subjectivity of assessments, let us say that the majority of patients with RA find Movalis no less and sometimes more effective pain reliever. At the same time, movalis is very well tolerated and rarely causes negative reactions of the body, which cannot be said about NSAIDs, the reception of which is often accompanied by digestive disorders.
Under the supervision of a physician, 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 tablet is enough to relieve pain, which is drunk either in the morning or before bedtime. Movalis is also available in the form of rectal suppositories. If the pain syndrome is very intense, you can resort to Movalis injections. During an exacerbation of rheumatoid arthritis, the patient often has to give injections for a whole week, and only then switch to pills. But I am glad that Movalis, firstly, helps almost all patients, and secondly, it has almost no contraindications.
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 referred to as corticosteroids).
These include:
- Prednisolone (medopred);
- Methylprednisolone (medrol, depot-medrol, metipred);
- Triamcinolol (triamsinolol, polcortolone, kenalog, kenacort);
- Betamethasone (celestone, phlosterone, diprospan);
- Dexamethasone
Corticosteroids are very popular in the West, where they are prescribed to almost all RA patients. But in our country, doctors are divided into two opposing camps: some advocate taking hormones, while others vehemently 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 of American and Russian rheumatologists and are confused: who to believe? Let's try to figure it out.
Taking corticosteroids causes a rapid improvement in well-being in patients with RA: pain goes away, stiffness of movements and chills in the morning disappear. Of course, this cannot but rejoice the person, and he automatically assigns the attending physician the status of “professional”. The pills helped - the doctor is good, they did not help - the doctor is bad, everything is clear here. And in the West, the feeling of gratitude to the doctor is usually expressed in monetary terms. That is why there are many more "good" doctors than "bad" ones.
In our country, in the conditions of free insurance medicine, a doctor will think three times before prescribing hormones to his patient. Because time will pass, and the same doctor will most likely have to disentangle the consequences of such therapy.
Dangers of hormone therapy
Why is taking corticosteroids so dangerous? These are stress hormones that have powerful negative effects on all organs. As long as a person accepts them, he feels great, but one has only to stop, and the disease is activated with tripled strength. If earlier the joints hurt so much that it was quite possible to endure, now they hurt unbearably, and nothing helps.
So maybe keep the patient on hormones constantly? 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 failure.
Here are just a few of the likely consequences:
- Itsenko-Cushing's syndrome - terrible edema and hypertension as a result of too slow removal of sodium and fluid from the body;
- An increase in blood sugar levels, and, as a result, diabetes mellitus;
- Obesity;
- Decreased protective properties of the body, frequent colds;
- Development of gastric ulcer and / or duodenal ulcer;
- Thrombosis of veins and arteries;
- Amenorrhea and dysmenorrhea;
- Hemorrhagic pancreatitis;
- Acne;
- Lunar oval of the face;
- Seizures and psychosis;
- Insomnia and uncontrolled excitement of the nervous system.
Spooky list, isn't it? Usually, when at least one serious side effect appears, corticosteroids are immediately canceled, but then the worst thing begins - the body protests against cancellation. This is expressed in a wave-like increase in the inflammatory process in the articular and periarticular tissues and severe pain that cannot be relieved by anything. Hormones are tried to be canceled gradually in order to avoid such shock effects.
To drink or not to drink hormones?
But how can you drink them, if it threatens with such dire consequences, you ask. Indeed, at some stage, corticosteroids will necessarily cease to provide relief and begin to harm the patient. But there are situations when you have to choose the lesser of several evils. Sometimes the patient has nowhere worse, and moreover, only hormones can alleviate his condition. We are talking about patients with Still's syndrome, Felty's syndrome, polymyalgia rheumatica and other serious complications.
A reasonable and far-sighted specialist will prescribe hormones only to such a patient whose rheumatoid arthritis is at a very high stage of activity, ESR is off scale, the level of C-reactive protein in the blood is prohibitive, and the inflammatory process is not stopped by NSAIDs.
The conclusion is that corticosteroids should be prescribed to a patient with rheumatoid arthritis if the expected benefit of treatment outweighs the likely harm.
Physical and mechanical methods of treating rheumatoid arthritis
Such techniques include thoracic lymphatic duct drainage, lymphocytophoresis, plasmaphoresis, and irradiation of lymphoid tissue. Each of the listed procedures is quite effective, but has several disadvantages. Let's consider them in detail.
Drainage of the thoracic lymphatic duct
This procedure requires sophisticated medical equipment. The doctor, with the help of a drainage apparatus, enters the patient's thoracic lymphatic duct, pumps out all the lymph from there, places it in a special centrifuge that rotates and separates the contents into pure lymph and cellular debris, microbial waste and other "garbage". The 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 purified lymph is again filled with harmful impurities, because the disease has not disappeared anywhere. This is why thoracic lymphatic duct drainage is almost never used in modern rheumatoid arthritis practice. The procedure is complicated and expensive, but its effect lasts for too short a period of time.
Lymphocytophoresis
This procedure is also very expensive and is carried out using 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 there monocytes and lymphocytes are removed from it. In four hours, during which lymphocytophoresis is performed, approximately 12,120 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 companions of the inflammatory process. This is why a rheumatologist is never happy to see an elevated lymphocyte count in your blood test. If at least some of these cells are removed from the bloodstream, the health of the RA patient will immediately improve. True, this effect, as in the previous case, will last only about a month. This is why lymphocytophoresis is rarely used.
Plasmaphoresis
The plasmapheresis procedure lasts about six hours, during which plasma containing harmful components is removed from a large volume of the patient's blood: inflammatory mediators, aggressive immune cells, rheumatoid factor, and bacterial waste. "Bad" plasma is replaced by donor or albulin. In just one procedure, it is possible to remove from the body 40 ml of plasma for each kg of the patient's weight. Plasmaphoresis is carried out in courses of 15-20 procedures, the treatment takes about one and a half months.
What is such suffering for? Plasmaphoresis 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, decreased hemoglobin, potassium deficiency. Side effects are manageable and the benefits outweigh the risks.
The main disadvantages of plasmaphoresis are its high cost and short duration of the therapeutic effect. The positive result persists for several months, and then the course has to be repeated. Nevertheless, plasmaphoresis is often resorted to, especially with the sudden acute development of rheumatoid arthritis and in the case when the choice of drugs for basic therapy is delayed. It is plasmaphoresis that makes it possible for the attending physician to gain time and prevent a fatal deterioration in the patient's condition.
Irradiation of lymphoid tissue
The technique of irradiation of lymphoid tissue was first applied in 1980, and has been actively used since then. Its essence is to expose the patient's lymph nodes, spleen and thymus gland to point irradiation. In one session, the patient receives from 150 to 220 glad, in total for the course of treatment - 4000 glad. In almost all cases, treatment is effective and allows you to reduce the dose of corticosteroids and NSAIDs, or even eliminate them altogether. The effect lasts for a long time - 1-2 years.
As with any radiation therapy, irradiation of the lymphoid tissue has side effects. Some patients have general weakness, nausea, and a decrease in the level of leukocytes in the blood. Nevertheless, this procedure is successfully used to treat rheumatoid arthritis, both in our country and in the west.
Topical treatment of active rheumatoid arthritis
It is possible to alleviate the condition of a patient with rheumatoid arthritis in the active stage with the help of hormonal injections into the joint capsule, laser therapy, cryotherapy, special ointments and creams. Let's consider the advantages and disadvantages of each method.
Intra-articular administration of corticosteroids
The essence of the technique consists in injecting hormonal preparations from the group of corticosteroids into the joint cavity (we talked about them above). It can be prednisone, celestone, hydrocortisone, depot-medrol, diprospan, phlosterone, or 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 “first aid” for sore joints. The introduction of hormones directly into the joint is done when the patient's well-being is very deplorable, and no other measures, including the use of NSAIDs and Movalis, help to relieve pain and reduce inflammation. Usually, after the injection, the patient feels well for a month, but in severe cases, the procedure must be repeated every 10 days. More often it is impossible, otherwise corticosteroids will begin to adversely affect the body as a whole.
In addition, doctors strongly advise against injecting hormones 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 a temporary improvement in the patient's well-being, the patient will have to pay an exorbitantly high price.
Laser therapy
Laser beams 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 patient's elbows are irradiated with a laser. In this way, the quality of blood is improved, as well as a more complete blood supply to organs and tissues. It is believed that laser beams also normalize the immune status of RA patients. This technique is successfully applied both independently and in combination with the basic therapy, which we wrote about above.
When the period of exacerbation of the disease has passed, an acute inflammatory process is not observed in the patient's body, the body temperature is not increased, you can directly irradiate the area of the joints with a laser. In the first weeks after the procedure, there may be a temporary deterioration in well-being and an increase in pain. However, then 80% of patients experience improvement, which lasts for several months.
The course of treatment usually consists of 15-20 procedures, and they are carried out at intervals of one day. Laser irradiation will do little to help patients in the last stages of rheumatoid arthritis - paralyzed, with twisted joints. However, in the initial stages and during periods of remission, such an effect is very effective and simply useful.
There are several important contraindications to laser irradiation:
- Any tumors in the body, including benign ones;
- Blood disorders, such as poor clotting
- Infectious diseases (tuberculosis, syphilis);
- Hypertensive crisis;
- Myocardial infarction;
- Cirrhosis of the liver;
- Stroke.
Cryotherapy
Cryotherapy, or cold treatment, is 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 have undergone cryotherapy treatment report a significant improvement in their well-being. The main thing is to be consistent and to undergo procedures regularly for a long time.
Cryotherapy can be dry, this is when the body is exposed to dry air of very low temperature, for example, in a special cryosauna. Or maybe liquid cryotherapy - in this case, the patient is exposed to liquid nitrogen. Let's start with the second option.
A stream of liquid nitrogen is released onto the sore joint under high pressure, which immediately evaporates, but at the same time has time to deeply cool the tissue. The inflammation in them subsides, blood circulation increases, the swelling decreases and the pain goes away. Usually 8-12 such procedures are carried out every day or every other day in order to achieve a lasting positive effect. Cryotherapy with liquid nitrogen has almost no contraindications; it can be used 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 ultra-cold dry air. The principle of the therapeutic effect here is the same as when blowing out liquid nitrogen, but the cryosauna has a positive effect on the whole body, and not only on individual joints. Such a procedure is performed in special medical centers, usually private, so it is not cheap. In addition, dry cryotherapy requires rare, expensive equipment, so even if public hospitals were equipped with cryosaunas, they would hardly be free to use.
Read more about: cryotherapy as a particularly effective treatment method
Healing creams and ointments
Advertising promises us wonderful relief from joint pain, but miracles do not happen. For rheumatoid arthritis, ointments and creams based on the same NSAIDs are recommended:
- Butadion ointment;
- Indomethacin ointment;
- Fastum gel;
- Voltaren emulgel;
- Long.
If you smear a sore joint with such an ointment, about 5-7% of the active substance will penetrate through the pores of the skin. Will this bring great relief? Hardly. However, if you are taking NSAIDs by mouth, like most people with rheumatoid arthritis, then the ointment can be used as a support, that is, simply to enhance the effect. Creams and ointments for joint pain have only one indisputable advantage - they are almost harmless (I would like to say, almost useless).
Physiotherapy treatment for rheumatoid arthritis
What is good for arthrosis is unacceptable for arthritis, therefore, physiotherapy procedures and massage are prescribed only during periods of remission, when there is no acute inflammatory process. If a patient has a high temperature and joints are literally burning, what kind of massage or warming up can we talk about?
But when the inflammation has been stopped, some gentle types of massage, as well as physical therapy, can help improve the blood supply to the joints and restore their mobility.
In the treatment of rheumatoid arthritis at the stage of remission, the following physiotherapeutic procedures are used:
- Diathermy;
- Infrared irradiation;
- Applications with paraffin, ozokerite and therapeutic mud;
- Phonophoresis with hydrocortisone;
- X-ray therapy.
The doctor should choose the method of therapeutic therapeutic effects. It is absolutely unacceptable for a patient with rheumatoid arthritis to go to a private spa center to enjoy the healing mud there. The advice of all kinds of healers and natural healers is also categorically impossible to follow. And massage at home should not be carried out by a person who does not have the appropriate qualifications and does not know how to handle the joints affected by rheumatoid arthritis.
Diet recommendations for people with rheumatoid arthritis
Proper nutrition is of great importance for the RA patient. Almost all patients note that the use of certain foods that irritate the body leads to a sharp deterioration in well-being, exacerbation of inflammation and increased pain. And as soon as the harmful product is excluded, the situation immediately returns to normal.
What are these dangerous products? Here's a list:
- Pork;
- Citrus;
- Some cereals (wheat, oats, corn, rye);
- Milk and dairy products.
As you can see, there are foods on the black list that are generally considered healthy (with the possible exception of pork). But don't be upset, people 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 double boiler, you can boil or stew. It is recommended to eat often: 5-6 times a day, but in small portions. Do not gorge on at night. It is advisable to exclude salt and sugar from the diet. Avoid smoked and fried foods. Some people with rheumatoid arthritis even have to get special advice from a nutritionist and develop an individual diet to avoid complications caused by poor nutrition.
Read more: Diet for rheumatoid arthritis
Author of the article: Kaplan Alexander Sergeevich | Orthopedist
Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.
