Rheumatoid Arthrtis

10 Serious RA Symptoms to Never Ignore

Painful, swollen joints are a hallmark of rheumatoid arthritis. But for people with RA, it's not the only thing to watch out for.

A result of the body’s immune system attacking its own tissues, rheumatoid arthritis requires more than just managing the pain. Other symptoms that might even seem unrelated to the condition may pose a threat.

People with more severe rheumatoid arthritis are more likely to have other complications. But it can also happen in milder cases.

Here are the top 10 symptoms rheumatoid arthritis patients should never ignore.

1. Shortness of breath or chest pain

Because rheumatoid arthritis can affect the blood vessels and muscle of the heart, people with the condition are at a greater risk for heart attacks and heart failure.

If you’re getting winded easily, you could also have a lung infection. Or you could have some form of interstitial lung disease, which causes lungs to become inflamed and scarred, Mandell says. Fluid might also be surrounding the lungs, which would require drugs and drainage to treat.

Seek medical attention immediately if you’re having these problems, even if you've never had heart or lung issues before.

2. Numbness or tingling

Rheumatoid arthritis can cause connective tissues in the hand or foot to become inflamed and push up against a nerve causing numbness and tingling. As a result, you might experience weakness or clumsiness, or even nerve damage.

This type of swelling can happen in tissues throughout the body. But it most commonly occurs around the wrist area, causing carpal tunnel syndrome, Mandell says.

If you experience numbness or tingling, you need to be evaluated by your rheumatologist or another health care provider as soon as possible to determine the cause.

3. Inability to move or raise your hand or foot

Compared to numbness or tingling, suddenly not being able to raise or move a hand or foot is a much more severe complication to result from rheumatoid arthritis. 

It’s also a much more rare occurrence, involving damage to nerves that are connected to muscles.

Seek emergency treatment for this symptom. Bathon says not doing so could lead to permanent paralysis.

4. Spots on or around your fingertips

Little red or black spots on or around the fingernails may mean that the tissue in those areas has died from small inflamed blood vessels.

Although very uncommon, the spots can signal an advanced form of systemic inflammation, says Bathon, who suggests promptly seeing a rheumatologist. 

If the symptom goes untreated, it may ultimately lead to losing fingers or toes.

5. Red, inflamed eyes

Blood vessels in the eyes are another common target of rheumatoid arthritis, especially among people with more serious forms of the disease. 

If the outer layer of your eye feels dry or irritated, eye drops can usually treat the problem, Mandell says.

However, sudden severe pain and redness of the eyes could mean deeper parts of the eye are affected. That’s a very serious complication, so see a doctor immediately if that happens, Mandell says.

6. Tummy troubles

If you take a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen or naproxen to treat your rheumatoid arthritis, you are at risk for stomach problems.

These drugs can cause stomach ulcers, which could in turn make the stomach bleed or form a hole in its wall.

When taking an NSAID, report any tummy pain, black or bloody bowel movements, or nausea to your doctor.

7. High fever and other signs of infection

Another problem from rheumatoid arthritis treatment is infection related to TNF inhibitor drugs such as Cimzia, Enbrel, Humira, Remicade, and Simponi.

The most telling sign of an infection is high fever (greater than 101 or 102 degrees Fahrenheit), Bathon says. Others are an unexplained cough, or an area of the skin that is extremely hot, red, swollen, or more painful than usual.

This type of infection can spread very quickly and is usually tough to control since rheumatoid arthritis patients have compromised immune systems to begin with. That gives them a lower tolerance for fever, Bathon says.

If you suspect an infection, see a doctor immediately, even if it means a trip to the ER, she says.

8. Feeling blah

Symptoms that just make you feel not well could also signify infection. So don’t ignore your body when it’s telling you something isn’t right, Mandell says.

Specifically, things like loss of energy, night sweats, sudden weight loss, unexplained fatigue, or a low-grade fever might mean it’s time to re-evaluate your treatment regimen. 

Be sure to discuss any of these symptoms with your doctor.

9. Bone fracture

A bone fracture in a rheumatoid arthritis patient may reveal underlying osteoporosis, especially among women.

Because of its inflammatory nature, rheumatoid arthritis can cause bone loss. On top of that, the risks of fracture can skyrocket if you’re taking prednisone, a common treatment for rheumatoid arthritis.

In addition to exercising and following a diet rich in calcium and Vitamin D, people with rheumatoid arthritis should consider having a bone density test to detect osteoporosis soon after their RA diagnosis.

10. Suddenly bruising easily

If you find you’re suddenly bruising very easily, you could be experiencing a complication from rheumatoid arthritis that lowers your blood platelet count, Mandell says.

That could either be because of your treatment therapy, or due to the disease itself.

Be sure to see your doctor soon so you can get a blood platelet count. When blood platelet counts are very low, you are at increased risk of bruising and may experience serious bleeding.

Heat and Cold Therapy for Arthritis

Is there anything you can do about the pain and stiffness of arthritis? Perhaps you've heard that heat or cold therapy can help relieve your pain and are wondering if it's worth giving them a try. Well, it is.

Many arthritis doctors recommend both heat and cold treatments to help reduce inflammation and ease the pain and stiffness that comes with arthritis. It may take a little "trial and error" to learn which therapy works best for your pain. But by staying with it, you'll find the right combination of hot packs and ice packs to get the most relief from pain and make it easier to manage your arthritis.

How does heat and cold therapy ease arthritis pain?

Heat or cold therapy works by stimulating your body's own healing force. For instance, heat dilates the blood vessels, stimulates blood circulation, and reduces muscle spasms. In addition, heat alters the sensation of pain. You can use either dry heat -- such as heating pads or heat lamps -- or moist heat -- such as warm baths or heated wash cloths.

Conversely, cold compresses reduce swelling by constricting blood vessels. While cold packs may be uncomfortable at first, they can numb deep pain.

What temperature is best when using heat therapy?

When using moist heat therapy, make sure the temperature is not so hot that you burn your skin. Find a temperature that you can comfortably tolerate, whether you are using a bath, hot water bottle, or spa therapy.

You also need to give it time to work. Use the moist heat application for at least 15 minutes before exercise. Then use it again immediately following exercise. You can also use moist heat anytime you want additional relief from arthritis pain.

Which types of heat therapy are effective for arthritis pain?

You can choose from the following popular types of heat therapy:

• disposable heat patches or belts available at most drugstores
• heated swimming pool
• hot packs (you can buy some -- such as Bed Buddy -- that can be warmed in a microwave)
• moist heating pad
• therapeutic mixture of paraffin and mineral oil
• warm bath
• warm shower
• warm whirlpool or hot tub
• warm, moist towel or cloth

You may also sit on a stool that has rubber tips for safety while letting the warm shower hit the affected area. The constant heat flowing on the arthritic joint or pain site helps to keep pain minimal and allows for easier movement.

Can hot baths or spas help alleviate arthritis pain?

Many people with arthritis find good relief from pain and stiffness with hot baths or spas. The moist heat increases muscle relaxation, boosts blood supply to the site of pain, and relieves rigidity and spasms in the muscles. But avoid hot tubs or spas if you have diabetes, high blood pressure, or cardiovascular disease, or if you are pregnant.

Does cold therapy work for arthritis pain?

Yes. Cold packs numb the sore area and reduce inflammation and swelling. Ice packs are especially good for joint pain caused by an arthritis flare. You might also try using a local spray such as fluoromethane (nonflammable) on your back or painful area before and after exercise. This superficial cooling decreases muscle spasms and increases the threshold of pain. Or you can make instant cold packs from frozen bags of vegetables.

Some patients prefer cold therapy to moist heat for arthritis pain, while others tell of having the best relief when they alternate the sessions with moist heat and ice. You can experiment with moist heat and ice therapy and then select the method that gives the best relief with the least trouble or expense.

How often should I use moist heat or ice for arthritis pain?

Try to use moist heat or ice packs at least twice a day for the best relief from pain and stiffness.

According to the American College of Rheumatology, 5-minute to 10-minute ice massages applied to a painful area within the first 48 hours of pain onset can help relieve pain. So can heat, which relaxes the muscles. Heat should be used for pains that last longer than 48 hours.

Should I use heat or ice for acute injuries?

If the new injury is red, swollen, or inflamed, then cooling the injury may help prevent inflammation. For example, if your pain stems from a muscle injury, treat it immediately with RICE -- rest, ice, compression and elevation. Rest the injured body part and then apply ice. You can use an ice pack or a pack of frozen vegetables or fruit for 20 minutes. Then take it off for 20 minutes. Add compression with a firm elastic bandage. Elevate the injured part to keep swelling to a minimum.

Before using moist heat or ice therapy, be sure your skin is dry and free from cuts and sores. If you have visible skin damage, don't use cold or heat. And always protect your skin with a towel. After using heat or cold, gently move the arthritic joint to reduce stiffness.

Osteoarthritis and Your Diet

For centuries, we humans have considered that our health is influenced by what we eat. Let's face it - if you eat a taco with hot sauce and have diarrhea followed by anal burning the next morning, the food affected your body!

The concept that diet can, in any way, affect osteoarthritis (degenerative arthritis) is being evaluated by researchers. Keep in mind that this field is just developing and few hard conclusions can be reached. Here is the latest:

• Obesity increases the risk for developing osteoarthritis. Overweight persons might reduce their chances for developing or aggravating their osteoarthritis by losing weight. Furthermore, if a person already has substantial osteoarthritis in a weight-bearing joint, such as a knee or hip, weight reduction can significantly improve their ability to rehabilitate after joint surgery as well as decrease their risk of surgical complications.
• Vitamin C is important in the development of normal cartilage. A deficiency of Vitamin C might lead to the development of weak cartilage. Vitamin C is commonly available in citrus fruits. Supplementation with a Vitamin C tablet may be advised if dietary fruits are unavailable.
• Persons with low bone mineral density, such as in osteoporosis, may be at increased risk for osteoarthritis. Exercise and adequate calcium intake, as recommended for age and gender, can help to maintain bone density.
• Vitamin D deficiency has been shown to increase the risk of joint space narrowing and progression of disease in osteoarthritis. Many doctors are recommending Vitamin D supplementation of 400IU daily. This can also help to prevent osteoporosis.
• In recent years, there have been studies originally conducted in Europe and more recently in the United States that have verified that the food supplementsglucosamine and chondroitin can help to relieve osteoarthritis symptoms, including pain and stiffness. Each of these supplements can be taken alone or in combination formulations. Keep in mind that glucosamine has been marketed as a "cartilage rebuilder." This is in part under the assumption that, because glucosamine is a component of normal cartilage, consuming it will assist in the rebuilding of damaged cartilage. There is no strong evidence that glucosamine alone, or in combination with chondroitin, is of value in rebuilding cartilage that has been damaged by osteoarthritis.

Arthritis: Knee Replacement Surgery

Who Needs Knee Replacement Surgery?

A person may want to consider knee replacement surgery if they have a stiff, painful knee that prevents them from performing even the simplest of activities and other treatments are no longer working.

What Happens During Knee Joint Replacement Surgery?

Once you are under general anesthesia (meaning you are temporarily put to sleep), spinal, or epidural (numb below the waist) anesthesia, an eight- to twelve-inch cut is made in the front of the knee. The damaged part of the joint is removed from the surface of the bones, and the surfaces are then shaped to hold a metal or plastic artificial joint. The artificial joint is attached to the thigh bone, shin and knee cap either with cement or a special material. When fit together, the attached artificial parts form the joint, relying on the surrounding muscles and ligaments for support and function.

What Are Recent Advances in Knee Joint Replacement Surgery?

Minimally invasive surgery (MIS) has revolutionized knee replacement surgery as well as many fields of medicine. Its key characteristic is that it uses specialized techniques and instrumentation to enable the surgeon to perform major surgery without a large incision.

MIS knee joint replacement requires a much smaller incision, three to five inches, versus the standard approach and incision, which is typically eight to twelve inches. The smaller, less invasive approaches result in less tissue trauma by allowing the surgeon to work between the fibers of the quadriceps muscles instead of requiring an incision through the tendon. It may lead to less pain, decreased recovery time and better motion due to less scar tissue formation.

Currently this less invasive procedure is performed by only a small percentage of orthopaedic surgeons in North America. Because this type of surgery is still relatively new, research has been initiated to determine how the immediate and long-term results will compare to traditional surgery.

What Happens After the Surgery?

The average hospital stay after knee joint replacement is usually three to five days. The vast majority of people who undergo knee joint replacement surgery have dramatic improvement. This improvement is most notable one month or more after surgery. The pain caused by the damaged joint is relieved when the new gliding surface is constructed during surgery.

After knee joint replacement, people are standing and moving the joint the day after surgery. At first, you may walk with the help of parallel bars, and then a walking device -- such as crutches, walker, or cane -- will be used until your knee is able to support your full body weight. After about 6 weeks, most people are walking comfortably with minimal assistance. Once muscle strength is restored with physical therapy, people who have had knee joint replacement surgery can enjoy most activities (except running and jumping).

How Long Will I Need Physical Therapy After Knee Joint Replacement?

After you are discharged from the hospital, you are usually sent home or to a rehabilitation facility, depending on your condition at that time. If you are sent to a facility, the average rehabilitation stay is approximately seven to ten days. If you are sent directly home from the hospital, your doctor will usually have a physical therapist come to treat you at home. Your doctor also may have you go to an outpatient physical therapy facility as the final stage of the rehabilitation process. Outpatient therapy may last from one to two months, depending on your progress.

Remember, every person is different and the course of rehabilitation will be determined on an individual basis with the assistance of your doctor and physical therapist.

Will I Have to Avoid Certain Movements and/or Activities Following Surgery?

After knee joint replacement surgery, you should not pivot or twist on the involved leg for at least six weeks. Also during this time, when lying in bed, you should keep the involved knee as straight as possible. Kneeling and squatting also should be avoided soon after knee joint replacement surgery.

Your physical therapist will provide you with techniques and adaptive equipment that will help you follow guidelines and precautions while performing daily activities. Remember, not following the given precautions could result in the dislocation of your newly replaced joint.

How Can I Manage at Home During Recovery?

The following tips should make your recovery at home easier.

• Stair climbing should be kept to a minimum. Make the necessary arrangements so that you will only have to go up and down the steps once or twice a day. 
• A firm, straight-back chair is extremely helpful in adhering to these joint precautions. Recliners should not be used. 
• To help avoid falls, all throw rugs should be removed from the floor and rooms should be kept free of unnecessary debris. 
• Enthusiastic pets should be kept far away until you have healed. 

You should ask your doctor before returning to such activities as driving, sexual activity, and exercise.

Is Knee Joint Replacement Surgery Safe?

Knee joint replacements have been performed for years and surgical techniques are being improved all the time. As with all surgeries, however, there are risks. Since you will not be able to move around much at first, blood clots are a particular concern. Your doctor will give you blood thinners to help prevent this.

Infection and bleeding also are possible, as are the risks associated with using general anesthesia. Other less common concerns that you and your doctor must watch out for include the following:

• Pieces of fat in the bone marrow may become loose, enter the bloodstream and get into the lungs, which can cause very serious breathing problems. 
• Nerves in the knee area may be injured from swelling or pressure and can cause some numbness. 
• Other bones may be broken during the surgery, which may require a longer hospital stay. 
• The replacement parts may become loose or break. 

How Long Will My New Joint Last?

When joint replacement procedures were first performed in the early 1970s, it was thought that the average artificial joint would last approximately 10 years. We now know that about 85 percent of the joint implants will last 20 years. Improvements in surgical technique and artificial joint materials should make these artificial joints last even longer.

Exercises to Treat Arthritis And Rheumatic Diseases.

People with arthritis who exercise have less pain, more energy, improved sleep, and better day-to-day function, according to the American College of Rheumatology.

One form of arthritis, osteoarthritis, is the most common form of joint disease in humans and is a leading cause of disability among the elderly. Osteoarthritis is a slowly progressive joint disease typically seen in middle-age to elderly people. It occurs when the joint cartilage breaks down, causing the underlying bone to fail. OA symptoms include joint pain, stiffness, knobby swelling, cracking noises with joint movements and decreased function. It typically affects the joints of the hands and spine and weight-bearing joints such as the hips and knees.

People who are physically active are healthier, happier and live longer than those who are inactive and unfit, and this is especially true for people with arthritis. Yet, arthritis is one of the most common reasons people give for limiting physical activity and recreational pursuits.

"People with arthritis avoid exercise for a number of reasons," explains Donna Everix, MPA, BS, physical therapist and Association of Rheumatology Health Professionals member. "Some avoid it due to fear of pain or injury, and others avoid if for the same reason many people without arthritis do not wanting to make a lifestyle change."

Inactivity, in addition to arthritis-related problems, can result in a variety of health risks, including Type II diabetes and cardiovascular disease. In addition, decreased pain tolerance, weak muscles, stiff joints and poor balance common to many forms of arthritis can be made worse by inactivity.

September is Healthy Aging Month, and the American College of Rheumatology encourages people with arthritis to increase physical activity by trying one or more of the major types of exercise. Each can have a positive effect on reducing pain related to arthritis and other rheumatic diseases:

1. Flexibility: Flexibility exercises help to maintain or improve the flexibility in affected joints and surrounding muscles. Benefits include better posture, reduced risk of injuries and improved function. When focusing on flexibility exercises, range of motion exercises should be performed five to 10 times on a daily basis while stretching exercises can be performed at least three days a week with each stretch being held for 30 seconds.

2. Strengthening: Strengthening exercises are designed to work muscles. Strong muscles improve function and help to reduce bone loss related to inactivity. For people with arthritis, one set of eight to 10 exercises for the major muscle groups of the body two to three times a week is recommended. However, older individuals may find that 10-15 repetitions with less resistance are more effective. The resistance or weight should challenge the muscles without increasing joint pain.


3. Aerobic: Aerobic exercises include activities that use the large muscles of the body in a repetitive and rhythmic manner. Aerobic exercise improves heart, lung and muscle function. For people with arthritis, this type of exercise has benefits for weight control, mood, sleep and general health. Safe forms of aerobic exercise include walking, aerobic dance, aquatic exercise, bicycling or exercising on equipment such as stationary bikes, treadmills or elliptical trainers. Current recommendations for aerobic activity are 150 minutes of moderate intensity exercise a week, preferably spread out over several days.

4. Body awareness: Body awareness exercises include activities to improve posture, balance, joint position sense, coordination and relaxation. Tai chi and yoga are examples of recreational exercises that incorporate elements of body awareness and can be a very useful part of an arthritis exercise plan.

The ACR is currently partnering with the Arthritis Foundation on its Ad Council campaign to help people age 55 and up who have, or are at risk for developing, osteoarthritis discover the simple steps that can change the course of the disease and improve the quality of their lives. The campaign, "Fight Arthritis Pain" was created to increase the public's awareness that there are simple steps everyone can take to prevent and decrease the pain and disability of OA.

"For people with arthritis, exercising is an important part of a treatment plan as it along with maintaining a healthy weight can help ease arthritis pain," explains ACR President, Stanley B. Cohen, MD. "You don't need to train for a triathlon to experience the benefits of exercise. Starting slowly, with low-intensity, will allow you to ease into a successful exercise plan that will benefit your arthritis and your overall health."

People with arthritis should discuss their exercise programs and any concerns they have with their rheumatologists and/or other rheumatology health professionals on a regular basis. With the support and guidance of a rheumatology health care team, people with arthritis are able to build regular physical activity and exercise into their daily routines and reap the benefits of an active and healthy lifestyle.

Source: American College of Rheumatology (ACR)