Rheumatoid Arthritis Treatment NYC by Marc Bystock L.Ac. 

What is Rheumatoid Arthritis?

Rheumatoid Arthritis (RA) is a chronic inflammatory disease that affects the joints, causing pain, redness, stiffness, swelling, and reduced mobility. Rheumatoid arthritis is classified as an autoimmune disorder in which the immune system attacks the body’s own tissues. It affects over 1.5 million people living in the United States, and over three-quarters of those people are women. RA most often begins between the ages of 30 and 60, although it can start at any age.

Rheumatoid arthritis typically attacks the joints and their linings in the hands, knees, and feet. It is often worse in the morning hours, with the condition improving as movement increases throughout the day. Most often, RA affects the same joints bilaterally.

Rheumatoid arthritis can become systemic, spreading throughout the body like wildfire, even attacking organs such as the lungs, skin, eyes, heart, blood, nerves, and kidneys. In addition, those affected may feel fatigued throughout the day and generally understand that they do not feel well.

RA symptoms typically come and go from total remission to a massive flare-up signaling pain and inflammation. 

Joint cartilage serves to prevent friction between bones. It acts as a shock absorber, allowing joint movement to occur more smoothly and without pain. Rheumatoid Arthritis causes significant inflammation, leading to cartilage breakdown and wear. Eventually, joints may fuse to protect against further erosion. Other common symptoms include:

• Joint inflammation, swelling, redness, stiffness
• Pain may be worse in the morning 
• Fatigue (sleeping a lot)
• Not feeling well
• Poor appetite
• Fever

Rheumatoid arthritis increases the risk of having other disorders:

• Osteoporosis - a condition of brittle bones that may become weak and fracture
• Sjogren’s syndrome - an autoimmune disorder causing dry mouth and dry eyes
• An overall increase in infections
• An increase in measured body fat percentage
• Carpal tunnel syndrome - an increase in pressure on the nerve that serves the wrist, causing pain and lack of movement in the wrist joint
• Cardiovascular disorders - RA can increase the inflammation surrounding the heart
• Lung disease - RA can lead to an increase in inflammation of the lung tissue, causing shortness of breath

How is Rheumatoid Arthritis Diagnosed?

Rheumatoid arthritis can be challenging to diagnose in the early stages because it can mimic other diseases. Your healthcare provider should examine your joints for range of movement and flexibility, redness, swelling, and muscle strength. Blood and imaging tests should be ordered from a medical laboratory, including:

• Erythrocyte sedimentation rate (ESR) - may indicate inflammation
• C-reactive Protein (CRP) - may indicate systemic inflammation
• Rheumatoid Factor - measures rheumatoid proteins in your blood
• Anti-cyclic citrullinated peptide (anti-CCP) - an antibody in most rheumatoid arthritis patients
• Magnetic Resonance Imaging (MRI)  - may look for the severity of systemic tissue damage
• X-Ray - can look at and track the progression of arthritis in the joints and surrounding structures

What is the Conventional Treatment for Rheumatoid Arthritis?

Both researchers and clinicians agree that there is no cure for Rheumatoid Arthritis. However, remission is a real goal that will keep symptoms low and the patient comfortable without pain or flare-ups. Nonsteroidal anti-inflammatory drugs (NSAIDS) can be used to dampen inflammation and pain. NSAIDS are over-the-counter medications. Their side effects include gut inflammation and kidney disease.

Corticosteroids like prednisone are prescribed to reduce inflammation and pain and slow joint damage. Their side effects include thinning of bones, gaining excess weight, and type 2 diabetes. Disease-modifying anti-rheumatic drugs (DMARDs) include methotrexate, which is used to slow down the inflammatory and joint-destructive processes. 

Biological Medications, also known as biological response modifiers, include Humira and Embrel. These drugs are selective in their effects on specific pathways in the immune system. The intended outcome is to lower inflammation and joint damage. Side effects include an increased risk of infections and blood clots in the lungs.

Physical therapy may be prescribed to learn new exercises that strengthen the affected area and benefit the surrounding tissues. Surgery is the last step if all of the above measures fail. The surgical removal of inflamed synovial tissue that surrounds the joint is termed a synovectomy.

If a tendon becomes weakened or tears, then tendon surgery may be required. Surgery may be required to fuse joints whenever a joint replacement is not appropriate.

A joint replacement is the last measure to repair the inflammatory damage of Rheumatoid Arthritis. The necrotic or damaged joint is surgically removed and replaced with a prosthesis, which may be made from metal and plastic. The number of total hip and knee replacement surgeries is on the increase as the number of RA and osteoarthritis patients is increasing.