How to relieve pain and inflammation from rheumatoid arthritis?

Rheumatoid arthritis is a chronic (long-term) disease that causes inflammation and deformation of the joints. Symptoms may come and go or vary, but usually include joint pain, morning stiffness, and limited movement. This condition can be controlled with a combination of treatments.

Rheumatoid arthritis is the second most common form of arthritis and affects 1-2% of the population in Russia. It is three times more common in women than in men. Rheumatoid arthritis occurs in all ethnic groups, climates and altitudes.

basic information

Rheumatoid arthritis results from changes in the body's immune system that (for unknown reasons) attack the soft tissue of the joints, causing inflammation, swelling and pain. If the process continues, damage to the cartilage and other soft tissues can lead to joint deformities.

In a healthy joint, cartilage evenly covers the bone, acting as a cushion and allowing the bones in the joint to slide smoothly over each other. The joint is contained in a joint capsule, which is lined with synovium (synovium). The synovium produces synovial fluid, a clear fluid that lubricates and nourishes the joint. The surrounding muscles, tendons and ligaments support the joint, allowing it to move smoothly and without pain.

Rheumatoid arthritis causes inflammation and thickening of the usually thin synovium, which leads to the accumulation of synovial fluid and causes pain and swelling. In addition, the cartilage and bones inside the joint can be damaged and destroyed, leading to loss of function and joint deformity.

Rheumatoid arthritis can affect any joint in the body, but usually affects the small joints in the hands and feet. As the disease progresses, other, larger joints may be affected. Joints are usually affected symmetrically (both the left and right sides of the body).

The condition can develop at any age, although it is most likely to develop between the ages of 25 and 50.

Arthritis symptoms

It should be remembered that rheumatoid atritis is a chronic, progressive disease. First, one or two joints are affected, after a while other joints begin to become inflamed. Then the pathological process covers not only the joints, but also other tissues, including internal organs (the so-called extra-articular manifestations of rheumatoid arthritis).

During the latent (latent) period of the disease, patients experience weakness, rapid fatigue, sudden weight loss, sweating, and muscle pain.

Most often, rheumatoid arthritis begins with the following symptoms:

• swelling and pain in the joints (as a rule, inflammation symmetrically affects the small joints of the hands and feet, arthritis of the fingers, arthritis of the foot occurs);
• aching muscle pain;
• increased body temperature;
• morning stiffness in the joints.

In the later period of arthritis, in the absence of adequate treatment, deformation of the joints in the hands and fingers occurs. The fingers bend and become like the neck of a swan or the fin of a walrus. Pain and impaired finger movement do not allow the patient to make even the simplest movements associated with self-care.

1 MRI of joints

2 Diagnosis of arthritis

3 X-ray of joints

The skin on the hands becomes thinner, and small, pea-sized rheumatoid nodules form under the skin.

The pain spreads to the forearm and shoulder area. With arthritis of the shoulder joint, stiffness of the muscles of the shoulder girdle and neck occurs. This leads to muscle atrophy.

When the toes are affected (arthritis of the foot), deformation of the toes to the outside is noted. It becomes very difficult for the patient to choose shoes.

Inflammation of the knee joint (arthritis of the knee joint) interferes with normal walking.

Arthritis of the hip joint is not common and is accompanied by severe pain in the groin area. Ultimately, this can lead to necrosis of the femoral head and disability.

With this disease, inflammation of the ankle joint (ankle arthritis) is relatively rare.

With rheumatoid arthritis, joint deformation may develop, which leads to limited mobility and loss of ability to work. In addition, the autoimmune process in this pathology can affect vital organs - the heart, lungs, gastrointestinal tract, kidneys, eyes, and nervous system. Therefore, if stiffness and progressive pain in the joints appear, do not try to “relieve” them with painkillers - make an appointment with a rheumatologist! Rheumatoid arthritis responds well to treatment if treated early!

Signs and symptoms

Rheumatoid arthritis can develop gradually or very quickly. Signs and symptoms can vary greatly between individuals and can range from mild to very severe. Rheumatoid arthritis is characterized by periods of remission (no symptoms) and exacerbation or “flare” (when symptoms are severe). Sometimes there is an obvious cause for a flare-up (physical or emotional stress, illness), but usually there is no obvious trigger. The course of the disease is individual for each patient and it is impossible to predict the development of the disease.

Fatigue can be one of the symptoms of rheumatoid arthritis that is difficult for people to cope with. Other symptoms may include:

• Joint pain (the main symptom of rheumatoid arthritis)
• Swelling of the joint (often accompanied by redness and increased temperature in the area)
• Joint stiffness (usually worse in the morning and after periods of rest)
• Muscle pain
• Mild fever
• Loss of appetite
• Skin and nail changes
• Anemia may also occur, often exacerbating feelings of fatigue and a general feeling of ill health.

Because rheumatoid arthritis is a systemic disease (meaning it can affect the entire body), symptoms can be similar to having the flu. Rheumatoid arthritis can cause problems in other parts of the body. These include:

• Inflammation of blood vessels (vasculitis)
• Inflammation of the mucous membrane of the lungs or heart
• Dry eyes and mouth.

About a quarter of people with rheumatoid arthritis develop small, hard, movable lumps under the skin called rheumatoid nodules. They usually appear under the skin around joints and on the tops of the arms and legs. Rarely, rheumatoid nodules can occur on the tissue membranes that cover the lungs and on the lining of the brain and spinal cord. Rheumatoid nodules usually do not cause any problems and usually do not require treatment.

About one in six people with rheumatoid arthritis develop significant joint deformity as a result of damage to cartilage, bone, and supporting structures such as ligaments and tendons.

NSAID therapy

• List of anti-inflammatory drugs used for arthrosis: names

Analgesics are universal drugs that can help relieve joint pain. But in order to quickly relieve inflammation, the cause of pain, non-steroidal anti-inflammatory drugs are indicated at the initial stage of treatment.

What are their advantages over other means:

• their action is aimed simultaneously at relieving pain, inflammation and swelling;
• have a wide range of applications;
• effective in treating all pathologies of bones and joints.

List of drugs from the non-steroidal anti-inflammatory group that are recommended to be taken to relieve arthritis pain:

• Aspirin. Advantages of the drug: a universal antipyretic and analgesic drug. Disadvantages: its anti-inflammatory activity is inferior to new generation drugs (Indomethacin, Diclofenac), irritates the gastrointestinal mucosa.
• Diclofenac (Naklofen). Advantages of the drug: the analgesic and anti-inflammatory effect occurs quickly and is long-lasting. Available in all dosage forms (tablets, suppositories, injection solutions, gel for external use).
• Indomethacin. Advantages: an effective pain reliever with pronounced anti-inflammatory properties, with a wide range of applications. Available for oral administration (tablets) and as an external agent (ointment). Disadvantages: high degree of gastrotoxicity, prescribed with caution to elderly patients.
• Ibuprofen. Advantages: low degree of gastrotoxicity with a minimal list of side effects. Available in tablets, rectal suppositories and syrup. Disadvantages: the degree of anti-inflammatory activity is the lowest. Able to relieve pain with inflammation in mild arthritis and pathology of small joints (hand, foot).

Non-steroidal anti-inflammatory drugs have a number of contraindications and side effects. The dosage and duration of treatment should be selected by the doctor individually.

New generation NSAIDs for oral administration

For the relief of joint inflammation with pain, new generation non-steroidal anti-inflammatory drugs are considered one of the most effective drugs. What are the advantages of this line of drugs:

• anti-inflammatory and analgesic activity is not lower than drugs of the “old” generation;
• minimal list of contraindications;
• minimal side effects on the body;
• approved for long-term use, which is especially important in the treatment of joint diseases;
• do not accumulate in the body;
• do not affect or inhibit processes in the central and peripheral nervous system;
• indicated for all pathologies of joints and bone structures;
• are available in all dosage forms.

The list of new generation drugs includes:

• Movalis with the main active ingredient meloxicam. Blocks enzymes involved in the process of inflammation. An effective analgesic, anti-inflammatory and antipyretic drug. Dosage forms: suppositories, tablets, injection solutions.
• Celecoxib with the main active ingredient celecoxib. Dosage form: capsules. Gives a powerful analgesic and anti-inflammatory effect.
• Nimesulide with the main active ingredient nimesulide. In addition to the analgesic, anti-inflammatory and decongestant effect, it thins the blood. Nimesulide also has antioxidant properties. In recommended dosages it does not cause adverse reactions, and unlike older generation non-steroidal drugs, it does not have a destructive effect on cartilage structures. Nimesulide is an inhibitor of active substances that destroy collagen and cartilage structures. Available in tablets, powder, syrup and external gel.

New generation drugs cannot be combined with each other in treatment. It will not be possible to achieve a double effect that relieves pain and inflammation, and the risks of developing unwanted side effects will increase several times.

Means for topical treatment

For joint pain, external agents with a non-steroidal anti-inflammatory base are indicated in complex treatment.

Manufacturers of external products advertise them as a panacea that can completely relieve pain and heal joints.

They are not effective as a monocomponent in treatment. External agents will give results only if they are used in combination with other painkillers and anti-inflammatory drugs.

• Comparison of NSAIDs for arthrosis: which painkiller to choose

But nevertheless, external means have their advantages:

• Local use of gels and creams makes it possible to achieve the required concentration of active substances directly in the pathological focus.
• Absorption of medicinal components occurs slowly, without the risk of overdose.
• External remedies are accessible, easy to use, and suitable for treatment at home.
• External forms have fewer contraindications and minimal side effects.
• There is no risk of overdose.

Effective external remedies for joint pain include:

• Indomethacin ointment;
• Dolgit cream;
• Piroxicam ointment;
• Fastum gel;
• Dicloran ointment;
• Voltaren gel;
• Ketoprofen ointment.

These drugs have identical therapeutic effects. They are indicated for all forms of arthritis, acute stage of gout, osteochondrosis and other inflammatory diseases accompanied by pain. In addition to analgesic and anti-inflammatory properties, external agents increase joint mobility and eliminate morning stiffness.

Typically, external agents are applied 3-4 times a day, with a course of treatment lasting from 10 to 14 days.

Causes of rheumatoid arthritis

The cause of rheumatoid arthritis is unknown. It is clear, however, that many factors are involved in the development of the condition. Possible factors for the development of rheumatoid arthritis include:

Genetic (hereditary) factors:

The condition appears to run in families, suggesting that genetic factors may influence its development.

Infectious agents.

It is possible that rheumatoid arthritis is caused by an abnormal response of the body's immune system (autoimmune response) to certain infections.

Hormonal factors.

Changes or deficiencies in certain hormones may be associated with the development of rheumatoid arthritis.

Lifestyle factors:

Smoking is a risk factor for developing rheumatoid arthritis

Therapeutic exercise for rheumatoid arthritis

The rate at which rheumatoid arthritis develops varies from person to person and will be characterized by periods of remission and worsening of symptoms. In most cases, there is no obvious cause of the disease.

rheumatoid arthritis: causes and symptoms

There are a huge number of symptoms of this disease. The main ones include:

1. joint pain.
2. Painful sensations in the muscles.
3. Change in skin color.
4. Minor deformation of nails.
5. Lack of desire to eat.
6. Mild fever.
7. Development of small and mobile lumps under the skin (rheumatoid nodules).

The symptoms of this disease should not be confused with those of the flu. They may be similar, since rheumatoid arthritis is a systemic disease. By starting treatment prematurely, severe symptoms can be avoided.

The main factors in the development of the disease include:

1. Genetic factor (the disease is inherited).
2. Infectious factor (weak immune system).
3. Lifestyle factor (presence of bad habits).
4. Hormonal factors (lack of or changes in hormones).

Description of exercise therapy

Physiotherapy is a medical discipline that uses physical activity performed by patients to treat diseases. After exercise therapy, patients experience a surge of strength and vigor, as well as a decrease in stiffness and pain in the affected areas.

It must be prescribed to patients by the attending physician. Typically, exercise therapy consists of various gymnastic exercises, walking and swimming. These procedures can also be supplemented with massage sessions, which allow you to relax after training.

Hand exercises for rheumatoid arthritis

Rheumatoid arthritis can affect the joints of the fingers, which may become deformed. To prevent the disease and get rid of hand changes, you need to follow the following things:

1. Try not to move your fingers towards your little finger.
2. Don't put too much stress on your fingertips.
3. During sleep, use special devices to immobilize the limb (orthoses).
4. Hold your hands correctly at rest.
5. Try not to tilt your joints in different directions.

There are several sets of exercises for hand lesions. Here is an example of some exercises from the best complexes:

1. Place your hands in front of you and begin to turn them up and then down.
2. Place your hands on a hard surface and begin to lift your hands.
3. Place your hands on a hard surface and begin to raise your fingers.
4. Place your hands clenched into a fist in front of you and begin to turn them clockwise and then counterclockwise.
5. Place your elbows on a hard surface, and then begin to bring them in and out. During this exercise, your hands should be clenched into a fist.
6. Rub your palms together.

All complex exercises must be performed five to seven times, but if pain occurs, you must stop training, as this can lead to complications of the disease. In general, the number of repetitions in the exercises largely depends on the patient’s condition.

Leg exercises for rheumatoid arthritis

Exercise therapy can also help with immobilization of leg joints. Here are some good exercises to do this:

1. "Sliding steps."
2. "Bike".
3. An exercise in which you need to bend your knees and spread them in different directions.
4. Circular movements with a straight leg.
5. Spreading your legs in different directions. While performing this task, you must be in a lying position.

All these exercises must be performed while maintaining the correct breathing rhythm.

Exercises for shoulder injuries

The main exercises for this disease are:

1. Raising and releasing the shoulders.
2. Circular movements of the shoulders.
3. Hugging yourself.
4. Raising and releasing the elbows, previously clasped by the palms.

They can help you relieve shoulder pain.

Ankle exercises for rheumatoid arthritis

Rheumatoid arthritis rarely affects the ankle joint, but such cases also occur. They can lead to disability.

To prevent rheumatoid arthritis in such cases, it is recommended to perform the following exercises:

1. Stand on your toes, leaning on something (for example, a wall).
2. Roll a round object (for example, a ball) with your feet.
3. Make circular movements with your feet.

Tips for performing medicated exercise

There are a few simple tips for more successful physical therapy.

1. Exercise therapy should be performed daily, without shirking your training. During exercises, do not forget about proper breathing. Try to stick to the right rhythm.
2. If the exercises you do become too easy, try increasing the load by increasing the number of sets for each exercise. This should add some challenge to the activity.
3. Don't despair if you find yourself with rheumatoid arthritis. It can be destroyed by daily training. This is not at all difficult to do.
4. After completing your workouts, conduct a muscle relaxation session.

By following these tips, you will increase the speed of your recovery and eliminate some of the bad symptoms of the disease.

Rheumatoid arthritis is a fairly serious disease, but it can be cured. Physical therapy is one of these methods. It must be prescribed by a specialist.

With timely treatment, the development of quite severe symptoms can be prevented.
To do this, you need to periodically undergo diagnostics. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Diagnosis of careumatoid arthritis

There is no single test that diagnoses rheumatoid arthritis. In the initial stages, it can be difficult to distinguish rheumatoid arthritis from other forms of connective tissue inflammation, such as gout, systemic lupus erythematosus, fibromyalgia and others. To diagnose rheumatoid arthritis, your doctor will usually do the following:

• Complete medical history, including any family history of rheumatoid arthritis
• Discussion of current symptoms
• Physical assessment, for example: joints, skin, condition of internal organs
• X-ray and/or MRI
• Blood tests

Two types of blood tests are commonly used to diagnose rheumatoid arthritis:

Immunological tests.

These tests evaluate the levels of proteins and antibodies in the blood, including a protein called rheumatoid factor (RF), antinuclear antibodies (ANA), and sometimes other antibodies. Rheumatoid factor is present in 80% of people with rheumatoid arthritis.

Markers of inflammation

Blood tests may be done to assess erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Both markers are typically elevated in people with rheumatoid arthritis and can be a good indicator of the extent of the disease.

Treatment of rheumatoid arthritis

Treatment for rheumatoid arthritis is aimed at treating symptoms. Treatment goals:

• Reduce pain
• Reduce inflammation
• Minimize and/or prevent joint damage
• Maximize joint movement.

A combination of treatments is usually recommended to achieve these goals. These include:

Medicines

Common types of medications used to treat rheumatoid arthritis symptoms include:

Disease-modifying antirheumatic drugs

These are drugs that are used to treat rheumatoid arthritis. They slow the progression of the disease, helping prevent permanent joint damage. These include methotrexate, leflunomide and hydroxychloroquine. Methotrexate is considered to be the main drug in the treatment of rheumatoid arthritis. These drugs are prescribed only by a doctor if certain tests are performed.

Non-steroidal anti-inflammatory drugs (NSAIDs).

These drugs work by treating inflammation in the joints. Recommended to be taken as prescribed by a doctor

Corticosteroids

These drugs, for example: prednisolone, metypred, act to reduce inflammation and are more powerful due to a different mechanism of action than NSAIDs, but have more side effects. Long-term use may cause dependence.

Biological drugs

These drugs, which are a new type of modifying drugs, target different aspects of the immune system to help slow the progression of the disease. these include adalimumab, etanercept and golimumab. They work more effectively when taken along with a non-biologic modifying drug such as methotrexate.

Physiotherapy

A range of physiotherapy treatments are used to reduce pain, improve movement, strengthen muscles and maintain independence. It is recommended to undergo physical treatment not during an exacerbation period.

Exercise and rest

It is necessary to maintain a balance between exercise and rest. As the disease becomes more active, increased rest may be appropriate. Rest will help reduce fatigue, pain and inflammation. Exercise is important for increasing muscle strength, reducing joint strain and stiffness, and maintaining mobility. A kinesiotherapist can recommend an appropriate exercise regimen.

Joint care

Joint protection techniques can be effective in reducing joint pain and fatigue. An occupational therapist or physical therapist can provide advice on these issues. The use of splints or gentle devices may be suggested.

Surgery for rheumatoid arthritis

When pain is severe and joint deformities do not allow normal functions (walking, self-care), surgery to restore damaged joints may be indicated. This usually involves joint replacement, tendon repair, or removal of inflamed synovium (synovectomy).

Free therapies

All other types of therapy (acupuncture, meditation, relaxation techniques and homeopathy, nutritional supplements) help manage symptoms but should not replace primary therapy.

Pain and its causes

Arthritis pain is one of the main symptoms. It can be aching or pulsating, boring or burning.

Pain is a signal from the body about pathology, requiring attention to it.

Acute, chronic or frequently recurring rheumatic joint pain affects every fourth person. And if several decades ago it was believed that this disease was the lot of older people, now rheumatic pain has become “younger”.

There are several causes of pain in rheumatoid arthritis:

• mechanical overload of the joint;
• injuries;
• inflammatory processes;
• general infectious diseases;
• degenerative changes;
• violation of metabolic processes;
• negative psycho-emotional background, stress, overstrain;
• hypothermia;
• errors in nutrition and lifestyle.

Under the influence of these factors, a large number of special proteins (protease, kinin, prostaglandin, histamine, serotonin) accumulate in the articular and periarticular tissues. The synovium, cartilage and meniscus are not equipped with pain receptors. But a large number of them in the periarticular tissues during inflammation cause severe, pronounced pain.

It can occur either extremely acutely (with a short duration) or last for months.

In rheumatoid arthritis, the symptoms, in addition to severe long-term pain, are accompanied by local inflammation, swelling, and hyperemia of the skin over the joint.

The joint undergoes defiguration (change in shape due to inflammation and swelling) and deformation (change in shape due to damage to bone tissue and fibrous deposits).

Treatment of rheumatoid arthritis is long-term, and drug therapy is considered the main method of treatment. It includes oral and parenteral administration of drugs, intra-articular injections, external procedures in the form of applying ointments, gels, compresses and applications. In addition to painkillers and anti-inflammatory drugs, muscle relaxants, glucocorticoid drugs and chondroprotectors are prescribed.

Self-medication is dangerous and leads to serious, irreversible consequences. Drugs for complex treatment should be selected exclusively by a specialist.