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WHAT IS IT?
Arthritis is a name for many joint problems that cause swelling, pain, and stiffness. Two common types are osteoarthritis and rheumatoid arthritis. Osteoarthritis, from wear and tear in a joint, affects about 21 million people in the United States. Rheumatoid arthritis, which affects more than 2 million, is more serious; it often involves the whole body, causing swelling in the joints and sometimes inflaming organs such as the eyes and lungs.Rheumatoid arthritis is chronic, meaning symptoms come and go and may last a lifetime. You may have periods called “flares,” when your joints hurt and swell, as well as times with no symptoms at all. Some people, though, have swollen, painful joints all the time and arthritis that gets steadily worse.

Early medical treatment can help slow the disease and prevent crippling joint damage. You can do a lot for yourself, too. Stay active to keep your joints supple. Join a support group to deal with your feelings about arthritis. By meeting with others who have the illness, you may get good ideas about how best to lead a normal, healthy life.
WHAT IS HAPPENING?
Between the ends of the bones that meet in a joint lies a thin membrane, the synovium. It makes a fluid that lubricates the joint to ease movement. When the synovium thickens and becomes inflamed, you begin to feel the joint pain, stiffness, and aching of rheumatoid arthritis.

Scientists don’t know what triggers rheumatoid arthritis, though some suspect a virus. But there’s no proof that the illness can spread from person to person.

Rheumatoid arthritis can come on slowly or quickly. It is an autoimmune illness, which means the body’s defense system against disease turns on itself. Here’s how it works:

Your immune system rushes “defender cells” to the site of any pain and swelling to wipe out the cause of the problem, clean up damaged cells, and repair tissues. Most times, such a defense relieves swelling and pain. Then these immune cells scatter.

In rheumatoid arthritis, however, the defender cells don’t scatter; they grow in number and make tissues in the joint swell and thicken. The cells also release enzymes into the joint space. Over the years, these enzymes can destroy cartilage (tissue at the ends of bones) and, in severe cases, eat away parts of the bone itself. As a result, movement becomes more and more painful.

Rheumatoid arthritis has no cure, but following your doctor’s orders, taking medication, and avoiding joint strain can slow progression of the disease and ease symptoms.
WHAT CAUSES IT?
No one can say just why one person gets rheumatoid arthritis and another doesn’t, but researchers have found a number of risk factors-such as your sex and age-that increase the risk. All are outside your control.

Being a woman
Three times as many women as men get rheumatoid arthritis. It’s the leading cause of women’s need for help with daily activities.

Age
Most people who get rheumatoid arthritis are between 20 and 50, but it can affect anyone, even children.

Family history
Some people may be born with a gene that makes them more likely to get rheumatoid arthritis. But not everyone with this gene will get the disease.
WHAT YOU CAN DO FOR YOURSELF
If you have rheumatoid arthritis, you should be under the care of a physician and you should follow your treatment plan. But there’s a lot you can do for yourself. Make wise choices about rest, exercise, easing stress on your joints, and finding simpler ways to do daily chores.

Protect your joints
Learn to move in ways that are easy on your joints:

Stand straight. Imagine a line connecting your ears, shoulder, hips, knees, and heels. Good posture helps you avoid back pain.
Keep your knees, hips, and ankles at a 90-degree angle when you sit, and support your back with a pillow or rolled-up towel.
Relax and stretch tired, aching areas in your body.
Rest and protect painful joints with splints. But have them fitted by a health professional. Splints that are too tight or left on too long can make joints more painful.
Make everyday chores easier
If you have pain in your hands or fingers:

Use a button hook, made for people with arthritis, to button clothes. Wear clothes that slip on easily, such as loose-fitting tops with large neck and arm holes.
Spray nonstick oil on pans or line them with foil before you cook so you won’t have to scrub hard when you wash them.
Cook with lightweight baking dishes and pots.
Use lever faucets you can turn on and off with your palm.
If you have pain in your knees, shoulder, back, hips, or feet:

Use a long-handled reacher.
Install grab bars near the toilet and in the tub.
Sit on a bath stool when you shower.
When you have symptoms, lift as little as you can. Ask for help.
Wear shoes with orthopedic inserts or shock-absorbing insoles. They can ease pain.
Try over-the-counter pain relievers
Ease mild arthritis pain with over-the-counter (OTC) medications. The four most common are:

Acetominophen (common brand name: Tylenol): For pain relief but not for inflammation. It’s the only one of the four that doesn’t prolong bleeding and that can be taken with acid blockers (such as Pepcid or Tagamet) or antacids (Mylanta, Maalox). It’s safest for children and teenagers because it’s not linked to Reye’s Syndrome. Cautions: Taking larger-than-advised doses for several weeks or with alcohol can cause liver damage. Daily use for several months may damage the kidneys.

Aspirin (common brand names: Bayer, Bufferin, Anacin): For pain and inflammation. Cautions: Aspirin can cause stomach upset-take it with meals or try buffered or coated types. Don’t take it with stomach-acid drugs. More than other OTC pain relievers, aspirin makes blood less able to clot: As a result, it makes bleeding harder to stop. Don’t take it if you have ulcers or other bleeding problems, or for about five days before oral or other surgery. (If you take aspirin every day, ask your doctor if it’s okay to quit.) Aspirin can also trigger asthma attacks. It’s linked to Reye’s Syndrome: Never give aspirin to a child or teenager who might have an illness caused by a virus.

Ibuprofen (common brand names: Advil, Motrin, Nuprin): For pain and inflammation. Cautions: Ibuprofen can cause bleeding in people with ulcers if taken for more than two weeks, or with stomach-acid drugs. Like aspirin, it can cause stomach upset (take it with meals or milk) and may trigger asthma attacks. Don’t take ibuprofen if you’ve had an allergic reaction to any other painkiller. Also, it may cause fluid buildup. Daily use for several months can cause kidney problems.

Naproxen sodium (common brand name: Aleve): For minor aches and pains or arthritis. Naproxen works for longer than the other three painkillers. For chronic pain, that’s important. Cautions: Follow dose limits carefully. Don’t give it to children under age 12. Don’t use it in the last three months of pregnancy. Don’t take naproxen if you’ve had an allergic reaction to any other painkiller. Naproxen can cause mild heartburn, or stomach upset or bleeding (drink an 8-ounce glass of water with each dose).

Try hot and cold treatments
To relax your muscles and relieve pain, take a hot bath or shower in the morning. Swimming in a heated pool can help. So can a hot pack or electric pad applied for 20 minutes at a time, three or four times a day, for chronic pain. Using a heat lamp is okay, too, as long as you place a towel over your skin to avoid burning.

During flares-the times of swelling and pain-cold treatments can help. Use cold packs (sold in most drugstores), ice cubes wrapped in a towel, or a bag of frozen vegetables. Apply for 10 to 15 minutes at a time, three or four times a day.

Rub on pain relievers
Unlike drugs that are swallowed or injected and affect your entire body, these creams and gels work only on the area they are rubbed into, so they have fewer side effects. One type of rub-on painkiller contains capsaicin, an extract of cayenne peppers. Spread on a joint, it disrupts pain signals before they get to the brain. The cream may sting slightly at first, but the stinging goes away after a few weeks of use. Other products contain menthol, oil of wintergreen, or camphor. These stimulate nerve endings, distracting the brain’s attention from joint pain.

Exercise
It can be confusing to be told to both rest and exercise if you have rheumatoid arthritis. A good rule is to rest when you hurt and exercise when you feel better. Regular gentle exercise helps make your muscles stronger and movement easier.

Swimming and walking are good choices because both strengthen muscles without stressing joints. You’ll enjoy these activities more if you first massage stiff or sore areas and relax your joints and muscles with heat. Also, try gentle stretching and strengthening and range-of-motion exercises for 10 to 15 minutes before you swim or walk, such as leg lifts and arm raises with weights. If it’s hard for you to hold hand weights, try Velcro weights that attach to your wrists.

You may have to ease off your exercise routine for a while when you have flares. But you can still do water exercises when you have symptoms. Stand in water up to your shoulders or chest to exercise, or sit in shallow water. In deeper water, use a float ring.

Get lots of rest
Rheumatoid arthritis can make you tire easily. Be sure to rest during flares. Cut down on activities such as walking, bending, and climbing stairs. (But keep up your stretches and range-of-motion exercises so your muscles won’t get weak and stiff.)

If you have a flare you may need extra sleep. Sometimes people with arthritis need more than 10 hours a night. A firm mattress and light but warm covers will help.

Also, try a cervical pillow for neck pain. Your doctor or a health aid store can suggest one.

You may find, too, that a brief daily nap is helpful.

Keep your attitude positive
You may need to work through feelings of frustration or the blues. Some helpful tips:

It may be hard to admit that there are things you can no longer do, but be patient. Take time to adjust, then try out new activities.
Find a family member or friend who listens well and ask whether you can share your frustrations about arthritis.
Join an Arthritis Foundation support group. Studies show that these groups help people reduce pain and remain active. To find one in your area, call the foundation; it’s listed in the white pages of your phone book.
Be cautious about folk remedies
Many unproven treatments are touted as cures for rheumatoid arthritis, including bee venom, copper bracelets, mineral springs, snake venom, and large doses of vitamins. Some can do real harm. For example, snake venom may trigger a life-threatening reaction. Always ask your doctor first before trying a new treatment.
WHAT YOUR DOCTOR CAN DO FOR YOU
Your doctor can help you understand and decide which approaches-medications, lifestyle changes, or both-are best for you.

In the past, doctors typically started with mild treatments such as aspirin, then moved on to stronger medicine as a person’s arthritis became worse. But researchers have learned that rheumatoid arthritis does much of its damage in the first few years. As a result, doctors now often use strong drugs early or prescribe several strong medications at the same time. When the disease is under control, the patient stops taking the drugs that have the most side effects, or takes them in smaller doses. By using potent drugs early in treatment, doctors can sometimes arrest the illness before it causes much damage. Only a rheumatologist-a doctor who is an expert in treating inflamed or painful muscles, joints, and tissues-should prescribe this type of therapy.

DRUGS FOR SWELLING AND PAIN:
Nonsteroidal anti-inflammatory drugs (NSAIDs)

These were once the only weapon against rheumatoid arthritis. Today they’re still commonly prescribed, but often along with more potent drugs. You may use aspirin, ibuprofen, or naproxen, along with prescription NSAIDs such as nabumetone, etodolac, and diclofenac. The most frequent problem with these drugs is stomach upset, or bleeding in the stomach after long-term use. To avoid such side effects, your doctor may advise you to use “coated” tablets or to take your medication with meals. Salsalate or trilisate, prescription drugs similar to aspirin, are also easier on the stomach than aspirin, even the coated kind.

COX-2 Inhibitors
In early 1999, the FDA announced its approval of Celebrex (celecoxib) for treatment of osteo- and rheumatoid arthritis. Another drug, Vioxx (rofecoxib), followed soon after. These drugs are COX-2 inhibitors, a new type of painkiller. They seem to ease pain as well as NSAIDs do, but without the same risk of stomach problems. However, it’s still too soon to know about the side effects of long-term use of COX-2s, and some questions have already been raised about safety.

Other pain relievers
If you have severe pain and your arthritis is not very inflamed, or if NSAIDs cause too much stomach discomfort, your doctor may prescribe narcotic analgesics (propoxyphene hydrochloride, acetaminophen with codeine, or tramodol). These help ease pain, but they do have side effects such as constipation, dizziness, nausea, and tiredness. If you taken them for a long period, you may become physically dependent on them.

DRUGS FOR FLARE-UPS:
Glucocorticoids
Glucocorticoids, such as prednisone and cortisone, are similar to cortisol, a hormone your body makes. They can be taken orally or given by injection. They have long been used to treat rheumatoid arthritis because they suppress the immune system and decrease swelling and pain.

They may have side effects if taken in high doses for several months to years, such as weight gain, osteoporosis, thinning of the skin, and cataracts. Work with your doctor to find a dose that’s effective, but low enough to avoid the side effects.

Antirheumatic drugs
This class of drugs, sometimes called DMARDs, can slow or even stop the progression of rheumatoid arthritis. Most take several weeks or months to have an effect.

Methotrexate
This was originally used only to fight cancer, but it’s now also one of today’s most promising weapons against rheumatoid arthritis. It works fast to subdue the body’s immune system. Doctors think it’s fairly safe, except for people with liver or kidney disease, lung problems, or heart failure. If you take methotrexate, your doctor may warn you to drink little or no alcohol to avoid the rare side effect of liver damage. The drug may also cause birth defects. Women who are pregnant or planning to become so must go off their medication for several months beforehand. The drug may also affect bone marrow, which produces blood cells. Your doctor will schedule blood tests to keep an eye on your liver function and blood-cell counts.

Malaria drugs
Chloroquine was first used in World War II to treat malaria, but now, as hydroxychloroquine (Plaquenil), it is prescribed to control inflammation. Symptoms may not improve for three to six months, but side effects are rare. You do need to have your eyes checked once or twice a year to watch for any damage to the retina that may be caused by the drug.

Injectable gold salts
Your doctor gives you a weekly shot for six months or longer. The downside: The drugs don’t always work, and they can take three to six months to show results. Side effects include rashes and kidney problems.

SURGERY:
A surgeon can do a synovectomy, an operation to remove a badly diseased synovial membrane. Also, a seriously damaged joint in the hip, knee, shoulder, elbow, or finger can be replaced with an artificial joint. Hip and knee replacements work especially well to restore movement and ease pain.

PHYSICAL THERAPY:
Your doctor may suggest visits to a therapist who can teach you gentle exercises to preserve your joints and keep your muscles strong.