---

Скачать книгу

---

13.)

      Applying hot or cold compresses

      Applying hot or cold packs to inflamed joints may ease the pain and help reduce inflammation. Use heat to ease sore muscles and increase circulation, and try cold to dull the pain and reduce inflammation. (See Chapter 10.)

      Taking medication

      Many drugs can be used to combat RA symptoms. The following subsections give you the details on the five types of medication commonly prescribed.

      Non-steroidal anti-inflammatory drugs (NSAIDs)

      NSAIDs (pronounced n-seds) reduce swelling, relieve pain, and are the most commonly used drugs for pain management in RA. While these medicines can help with symptom control, they do not prevent disease progression or stop the immune attack on the joints. Therefore, they should never be the only treatment for your RA.

      Ibuprofen (Advil) and naproxen (Aleve) are two well-known over-the-counter NSAIDs, but prescription NSAIDs such as celecoxib (Celebrex) may be preferred because they come in higher doses (which means you take fewer pills) and have longer-lasting results.

      

As with all drugs, certain side effects can occur when taking NSAIDs, including upset stomach, nausea, diarrhea, stomach ulcers, and stomach bleeding. Take this type of medication with food to prevent these reactions. However, if you have kidney disease, high bleeding risk, or heart disease, NSAIDs many not be a good choice. Discuss them with your provider first.

      Disease-modifying antirheumatic drugs (DMARDs)

      DMARDs are first-line treatments for RA that turn off a part of the immune system that is overactive in RA, addressing the problem at the source. They can alter the course of the disease by reducing inflammation and joint damage, while preserving joint function. DMARDs often used to treat RA include methotrexate, sulfasalazine, hydroxychloroquine, and leflunomide. Some DMARDs are also used to treat autoimmune diseases such as lupus.

      

DMARDs are also known as remittive drugs and slow-acting drugs. They’re called slow acting because you may not see results for 8 to 12 weeks.

      These drugs may influence the immune system — whose errant behavior can lead to RA — to slow the formation of joint deformities, affect cell growth, or otherwise lessen the progress of RA. They can even send the disease into remission, at least temporarily.

      Typically DMARDs are used for life, although the dose may be reduced once the disease has been in remission for a while. Potential side effects of DMARDs include increased infections, gastrointestinal distress (diarrhea, loss of appetite, vomiting, and so on), liver problems, rashes, and blood cell disorders.

      Biologics

      Biologics are proteins that are genetically engineered to target specific parts of the immune system that affect inflammation. Each one zeroes in on a particular cause of inflammation and either tamps it down or turns it off completely, or shores up certain immune system components that fight inflammation. Biologics can slow joint damage significantly or actually bring it to a halt.

      While they can be used alone, all of them work better in combination with DMARDs such as methotrexate. Two biologics should not be used together. Biologics are quite expensive because they must either be injected or infused. Generally speaking, they take about three months to start working, although some people start to feel better sooner.

      Many different types of biologics exist:

       Tumor necrosis factor (TNF) inhibitors (Humira, Enbrel, Simponi, Cimzia, Remicade): All but Remicade are injections given anywhere from once a week to once a month; Remicade is an infusion. Since they have been around the longest, these are typically the first type of biologic used when DMARDs alone fail to provide adequate relief.When TNF inhibitiors fail, there are several other types of biologics that can be tried next. Which drug is chosen will depend on the patient’s health, personal preferences, and insurance coverage.

       B-cell inhibitors (Rituxan): One treatment (two infusions given two weeks apart every four to six months) may provide relief of RA symptoms.

       Interleukin-1 (IL-1) inhibitors (Kineret): A daily injection.

       Selective co-stimulation modulators (Orencia): A once a month injection thought to have the lowest risk of infection.

       Interleukin-6 (IL-6) inhibitors (Actemra, Kevzara): Injection given every one to two weeks. There is also an infusion version of Actemra.

       Janus kinase (JAK) inhibitors (Rinvoq, Xeljanz): Pills taken 1 to 2 times daily.

Suppressing the immune system increases your risk of developing infections. Since each biologic partially disables an “arm” of the immune system, you will become more susceptible to certain infections when taking these drugs. For example, the TNF inhibitor biologics can increase your risk of tuberculosis and fungal infections. B-cell inhibitors can cause chest pain, difficulty breathing and flu-like symptoms, and increase your susceptibility to colds and sinus infections. Interleukin inhibitors can cause bowel perforation in rare instances. And selective co-stimulation modulators can contribute to pneumonia, tuberculosis and flu. Ask your doctor about these risks before taking biologics.

      Steroids

      Steroids, which are technically called corticosteroids or glucocorticoids and include the drugs prednisone, hydrocortisone and dexamethasone, are powerful weapons against inflammation. They work by suppressing the immune system, which brings about the inflammation seen in RA. Although often prescribed in pill form, steriods can also be injected into the RA-affected joints to relieve pain and swelling. While the relief can be dramatic, unfortunately it doesn’t last, and the long term side effects and consequences of chronic steroid use are numerous.

      

Steroids are “souped-up” versions of cortisone, the body’s natural immune suppressor. Because they act quickly to reduce inflammation and suppress flare-ups, they may be prescribed during early RA in addition to DMARDs and/or other medications which can take weeks or months to produce results. However the routine use of steroids to treat RA, even in early stages, is not recommended because of severe side effects. Steroids are typically reserved for severe cases and used for only short periods of time. Once the DMARDs or other drugs take effect, steroid therapy must be tapered off.

      Side effects include high blood pressure, osteoporosis, increased blood glucose, cataracts, accelerated atherosclerosis (clogged arteries), weight gain, bruising and thinning of the skin, and a substantially increased risk of infections.

      

If you suddenly stop taking steroids, you may suffer from pain, swelling, critical illness, or even death due to adrenal crisis. Always taper off your use of these drugs.

      Saving your joints through surgery

      When all else fails and RA becomes severe or disabling, surgery may be an option. Surgeons have different approaches to relieving the symptoms. Some of the approaches are included in the following list:

       Diseased joint linings can be surgically removed.

       Joint

---

Скачать книгу