Let's Talk About Rheumatoid Arthritis Treatment

没有治疗类风湿性关节炎,但不t let that get you down. There are more effective medications than ever before. In fact, early and aggressive treatment can slow down the progression of RA, prevent permanent joint damage, and even lead to remission. Yep, we saidremission.更妙的是，如果你能在半年到一年内得到控制症状，很可能是疾病都会对你的生活影响最小。备份你吃药用大量的（低影响）锻炼，挤满了炎症作战食物的饮食，健康的睡眠和压力管理策略，你会用自己的方式很好地生活在你的条件生活。我们知道：说起来容易做，但有风湿病的工作将有助于找到合适的治疗方法适合你。幸运的是，你有很多选择。

What is Rheumatoid Arthritis Again?

Let's refresh: Rheumatoid arthritis is an autoimmune disease, which means the immune system turns its sights on healthy tissue in the body, causing inflammation.

关节炎的这种形式的靶向滑膜，组织该线接头。典型地，该衬里是细弱，并可以产生一个明确的流体，其允许关节自由移动。但是，当膜发炎，流体变得厚，并开始积聚，把痛苦压在周围的神经。发生这种情况时，可出现疼痛，僵硬，甚至发红。炎症字面上加热的联合，使它感到温暖。

但是，RA不仅是关节的疾病。它是一种全身性疾病，会影响你的心脏，肺，眼睛等。这也正是及时治疗是非常重要的。

What Is the Goal of Rheumatoid Arthritis Treatment?

The goal of treatment is pretty simple: to keep you moving in all the ways you need to. That means reducing—and ideally stopping—the pain and inflammation of RA. The ultimate target is what doctors call remission, or no disease activity. Still, low-disease activity—like a little stiffness in the morning from time to time, instead of extreme stiffness every day—is also a reasonable goal.

什么是款待到目标的方法？

如果你曾经设置一个巨大的目标，为自己，那么你知道你有计划你的步骤去实现它和一小试错沿途做准备。这几乎概括了“治疗靶”（T2T）策略，它具有缓解（或至少低疾病活动）为目标的方法：文件放初诊患者在吃药的时候了，密切监测进展情况，并adjust the scripts and doses frequently until they’ve hit that goal.

这是一个更积极的态度比医生花了几十年前，当有较少的监控，更谨慎的处理，和难怪这里，成功的标准较低。治疗到现在的目标是去到了RA治疗，它的帮助患者活得更长，更健康的生活。

One study suggestsT2T may improve your chances of remission by 50%。The reason: Shooting for a specific target seems to encourage doctors to change up therapies as they need to, leading to better outcomes. It makes sense: When the goal is remission, you’re more likely to achieve it.

早期干预的重要性

Still, the treat-to-target strategy works best the sooner you catch RA—ideally within three to six months of the first signs of disease. Diagnose and treat early, according to the research, and you’re more likely to have a better long-term outcome. RA that’s left untreated, however, can lead to permanent joint damage within as little as two years. And because RA’s a systemic disease that can affect anywhere in the body, it can also lead to serious health complications like a weakened immune system, lung problems, and heart disease.

Luckily, doctors have grown better at spotting and treating RA. If you haven’t been diagnosed with RA but you’re concerned (for example, maybe you have a family history of RA),watch out for symptoms：疼痛，肿胀，僵硬或在手和脚，持续超过30分钟的小关节的早晨。底线：如果犯罪嫌疑人的时候，不要把关闭主叫你的医生。

What are the Medications for Rheumatoid Arthritis?

Medication is the cornerstone of RA treatment. And these days, you have more options to choose from, making it easier to find the best treatment that works for you.

Five types of drugs are commonly used to treat RA. Here they are, listed in the order in which they’re often typically prescribed:

• 传统的DMARDs：These “disease-modifying anti-rheumatic drugs” are the first-line therapy for most RA patients. Traditional DMARDs not only relieve symptoms—they slow RA’s progression, doing their job of “down-regulating” (suppressing) the body’s overactive immune system. You can take any of them orally, and methotrexate is also available as an injection. Due to their immune-suppressing nature, DMARDs can come with side effects, like mouth sores, hair loss, stomach upset, infection, fatigue, or liver damage. Those side effects are why you’ll be closely monitored with regular lab tests, weekly to every few months. The most common DMARDs include:

• Trexall (methotrexate)
• Azulfidine (sulfasalazine)
• Arava (leflunomide)
• Plaquenil (hydroxychloroquine)

• NSAIDS:因为DMARDs治疗可能需要几周或几个月建立以治疗水平在你的系统，你的医生可能会在此期间，以帮助减轻疼痛和炎症处方非甾体抗炎药。当然，你可以找到他们过度的柜台，但对RA症状，你可能需要一个处方剂量水平（或about twicewhat you’ll find in OTC versions). The benefits of NSAIDs, or nonsteroidal anti-inflammatory drugs, are that they work fast, relieving pain within just hours. Still, established side effects (stomach upset and bleeding, impaired kidney function, and increased heart disease risk) make these meds a short-term fix only. Common NSAIDs include:

• Bufferin, Bayer (aspirin)
• Disalcid (salsalate)
• Advil, Motrin (ibuprofen)
• 的Aleve（萘普生）
• Relafen (nabumetone)
• Celebrex (celecoxib) (COX-2 inhibitor), a subclass of NSAIDs that have a lower risk of internal bleeding or stomach ulcers—a common side effect of other NSAIDs that are used in large doses for a long time.

• Corticosteroids:These steroid hormones are another short-term option you can use while waiting for DMARDs to kick in. Your doc might also use corticosteroids to treat severe flare-ups, or in more advanced cases in combination with other drugs. They can be taken orally, intravenously, or injected right into the joint. The most common is Deltasone (prednisone). Steroids can have serious side effects with long-term use (anything longer than 8 to 12 weeks), including high blood sugar, high blood pressure, bone loss, and glaucoma. When you’re ready to come off them, you’ll need to do so slowly over a few weeks (called a steroid taper), while your adrenal glands return to their role of pumping natural cortisone on their own. Steroids can have serious dose-dependent side effects. Infection can be a side effect but it might be okay to leave out as most patients are on lower-doses of steroids.

• 生物DMARDs：如果不单独达成传统DMARD治疗低疾病活动度，医生可能引入生物药剂。Biologics have been a total game changer对于RA的治疗，因为他们第一次来到现场二十年前。从活细胞，生物制剂，也被称为生物反应调节剂基因工程，采取超针对性的方法：他们在零上的特定蛋白质燃料炎症，而不是影响你的整个免疫系统。如同任何药物，他们可以有副作用，包括头痛，恶心，感染的风险增加，因为它们能抑制你的免疫反应。可用的生物制剂：

  • 肿瘤坏死因子（TNF）抑制剂put the brakes on tumor-necrosis factor, a protein that’s overproduced in people with RA and the main cause of the first inflammation. TNF-inhibitors are delivered by self-injection or IV infusion, depending on the drug, which include:

    • Cimzia (certolizumab)
    • Enbrel (etanercept)
    • Humira (adalimumab)
    • 是Remicade（英利昔单抗）
    • SIMPONI（戈利木单抗）

  • B-cell inhibitors,像的Rituxan（利妥昔单抗），是通过IV和杀B淋巴细胞可产生火花的炎症给药。

  • Interleukin-1 (IL) blockers,like Kineret (anakinra), are self-injected daily; they target interleukin-1, an inflammatory compound in the body.

  • Interleukin-6 inhibitors,如自注射Kevzara（的sarilumab）和IV施用的Actemra（托珠单抗），也可作为自我管理，停止白细胞介素6附着于细胞和触发炎症蛋白。

  • T-Cell inhibitors,like Orencia (abatacept), latch on to the surface of T-cells (aka inflammation-causing white blood cells). It’s administered via IV.

• Janus kinase (JAK) inhibitors:These newer synthetic drugs (also called targeted DMARDs) are another powerful option for treating RA when biologics fail, or if you just hate needles and prefer to pop a pill instead. They’re highly targeted, blocking precise pathways inside immune cells. They’re potent and they act fast, but they can be expensive. DMARDs are used with biologics. Only a minority of patients achieve remission from DMARDs alone, in which case rheumatologists will generally add another medicine (another DMARD of a biologic) instead of discontinuing the first one. Medications used in combination is the norm and very common in rheumatoid arthritis. So far, three are approved for clinical use:

  • Olumiant (baracitinib)
  • Rinvoq (upacitinib)
  • Xeljanz (tofacitinib)

It can take a few tries to find the right meds (you need to give each one at least a few months to kick in), and once you do, you’ll likely be on the drugs indefinitely, though your doc might tweak adjustments depending on your symptoms.

Best-case scenario: You can enjoy months and even years of sustained remission, which can blissfully feel like your RA has packed it up and gone away. However, those periods can be interrupted by flares, periods of increased disease activity that can show up without warning like an unwelcome guest. Depending on the severity of a flare, your doc may decide to switch up your meds.

If you’ve sustained remission long enough, your doctor may de-escalate medications, supervising slowly, tapering one at a time to see how the disease reacts. But few patients can stop drugs altogether without their symptoms returning. About 10% of patients diagnosed early—and diligently treated—achieve remission in the first year, and40%achieve it after two years.

Managing Rheumatoid Arthritis Flares

Flares can last days or even months, and vary in severity. You may be extra tired, have joint stiffness and swelling, feel like you have the flu, or you may have serious pain to manage.

虽然严重的突发可能与皮质类固醇治疗，通常可以在自己的管理更温和的耀斑。如果你是这些人，当火炬来了谁能够感知的一个，你可能会学到查明触发他们摆在首位的事情。

Common culprits include:

• 强调
• Infections (cold and flu)
• Physical trauma like surgery or broken bones
• Giving birth (flares after childbirth are common)
• 可怜的牙齿健康
• Certain foods (like processed snacks, red meat, and high-sugar foods)
• 过劳
• Sudden dramatic changes in weather

If you sense a flare coming on, do whatever you can to carve out extra time to rest. You body can't heal without it!

When is Surgery Required for RA?

手术只针对谁已经遭受永久性的关节损伤导致衰弱疼痛或功能丧失RA患者。如今，通常只有非常严重的或undertreated的情况下发生的。

有两种类型的手术：

• Synovectomy:This surgery removes the inflamed synovial membrane. It may be considered if the pain persists after six to 12 months of treatment. A synovectomy can be performed in the ankle, knee, hip, elbow, shoulder, wrist, or finger. Recovery varies depending on which joint was operated on, but physical therapy usually starts in a day or two.
• Arthroplasty:For more significant joint damage, this surgery may reconstruct or replace the joint. Bones can be reshaped or replaced with metal, ceramic, or plastic parts. More than a million joint replacement surgeries are performed each year in the U.S., mostly of the hip or knee, but the shoulders, elbows, and rarely the joints in the hands and feet may be replaced as well. It’s critical to discuss with your surgeon the types of activities you want to continue after joint replacement. This will help your doctor select the appropriate type of prosthesis and implantation technique, while giving you a deeper dive into the risks and limitations of surgery, which can include infection, blood clots, or loosening of the joint.

其他疗法for RA

Taking your medication is just one thing you can do to help you feel your best. Consider assembling a team of medical specialists (your rheum can refer you) from a variety of fields, like psychiatry, sleep medicine, physical or occupational therapy, or nutrition, who can support you wherever you may need it. Areas they can help with:

• 行使：When you’re in pain, the gym is probably the last place you want to be. But keep an open mind: Research shows that adopting a regular exercise routine can help you feel better. In RA patients specifically, exercise has been shown to reduce pain, boost strength, and improve function. Not only that—exercise can also增加能源和易用性抑郁症, and help prevent heart disease and diabetes (both common with RA). Not used to exercise? Consider working with a physical therapist, who can help come up with a safe, effective plan for you. Doctors recommendjoint-friendly activitieslike cycling, elliptical training, and water aerobics. And don’t forget阻力训练为保持肌肉强度和骨密度的关键。有一个火炬？倾听你的身体。不要害怕你的会话过程中向后退，或采取更频繁的暂停。毕竟，锻炼的任何量总比没有好。
• Sleep:As an RA patient, your sleep is critical—it eases pain sensitivity, keeps stress hormones in check, and lets the brain clear out inflammatory chemicals so you can function better the next day. Plus, RA-related inflammation tends to deplete energy levels, so a solid eight hours of sleep is crucial. The problem? Given how uncomfortable RA is,more than half of people with the condition have trouble sleeping。And some medications, like steroids and Plaquenil, may cause insomnia. Prioritize your sleep by following standard sleep hygiene advice: Dedicate some time in the late evening to relax, and power down your phone at least 30 minutes before bed. Try using pillows for extra support where you need them (like under a painful shoulder or between stacked knees). And consider working with a sleep specialist for extra help. Finally, talk to your rheumatologist if you suspect your meds are keeping you up or you have trouble sleeping due to pain.
• Diet:Most evidence about the role of diet with RA is anecdotal, but some studies suggestcertain foods may be helpful。特别是,地中海饮食,emphasizes fish, olive oil, and vegetables, has been shown to have some positive impact on inflammation, likely due to the omega-3 fatty acids found in some fish, like albacore tuna, herring, lake trout, mackerel, and salmon. Several smaller studies tout the helpful impact of a vegan or vegetarian diet on RA. A healthy diet can also help keep your weight in check, helping RA treatments work better and reducing pressure on achy joints. Still, changing the diet you’ve enjoyed over a lifetime isn’t easy, and you wouldn’t be the first RA patient to struggle with changing it. But you don’t need to become the model of perfect nutrition overnight: Start with small changes that you can sustain over time (like working in a serving of fish each week, and building up to two), and consider working with a registered dietitian for help.
• Mental health/stress management:我们不需要告诉你，焦虑和抑郁可使疼痛加重。抑郁症，绝望，拒绝可能是极大的障碍的治疗。更重要的是，很多RA患者识别压力为RA触发的突发学习管理得好可以提供帮助。尝试冥想，瑜伽休息术（瑜伽完美的人与喜欢RA慢性疾病温和，消除应力的形式），或深呼吸。如果焦虑或抑郁与你的生活或你的能力，功能的干扰，不要犹豫，寻求帮助。

3 Simple Pain Relievers

• 热与冷：它是如此简单，但你可能会找到一个温暖的淋浴或浴缸的作品对你僵硬，关节疼痛奇迹。热减少肌肉紧张和促进血液循环，这可能有助于关节感觉更好。也可以尝试热敷或甚至陷入一个新鲜来自该干燥器帽衫。冷敷，在另一方面，可以帮助减少RA耀斑后发炎，肿胀，和酸痛。
• Topical creams:Applying creams or lotions containing capsaicin (an extract from chili peppers!) may soothe minor joint pain. Ditto for those with camphor, menthol, or turpentine oil. Try capsaicin infused Capzasin HP Crème or J.R. Watkins White Cream Liniment, which has both camphor and turpentine oil. Topical pain relievers also available by prescription, such as Pennsaid.
• Splints:Your rheumatologist may recommend splints for your trouble spots. During severe episodes, splints will help relieve pain by immobilizing your joints.

Are There Any Natural Remedies for Rheumatoid Arthritis?

Most natural remedies don’t have enough data to support definitive claims about their benefits. But some evidence suggests these two may be helpful:

• 鱼油：Possibly the most thoroughly studied dietary therapy for RA, fish oil is a direct source of omega-3 fatty acids. Moderate-quality research shows that fish oil supplements may reduce RA-related pain. Omega-3s may interfere with the formation of inflammatory molecules called prostaglandins, which in excess may contribute to RA. Still, fish oil can irritate your gut and may interfere with blood clotting and increase stroke risk when taken with aspirin or other NSAIDs. Be sure to talk to your doctor before taking it.
• 姜黄：The RA community is increasingly interested in the potential anti-inflammatory effects of this golden spice. Several small studies show that turmeric and its major ingredient (curcumin) may help treat arthritis symptoms just as effectively as pain medicines like ibuprofen. Try it in smoothies, soups, and curries—its health benefits may need more research, but its deliciousness is well documented.

我应该对RA任何补充？

Some people with RA may need more of certain vitamins and minerals. The best source is always food, but if you need a little extra help you might consider adding a supplement.

Some of the commonly recommended RA supplements include:

• 叶酸：这种合成的维生素B9形式可以帮助管理methotrexate side effects. In fact, a recentCochrane评价发现只有1毫克的叶酸，每天足以服用这种药物帮助患者。
• Vitamin C:至关重要的免疫功能，维生素C是一种慢性疾病谁可能会增加感染的风险的人很重要。
• Vitamin D:Levels of D tend to be low in people with RA. Research suggests RA may make you less sensitive to the nutrient, increasing the need for supplementation. Look for vitamin D3, the most easily absorbed form.
• Calcium:Because RA patients have an increased risk of osteoporosis, your doctor may recommend a calcium supplement, often in combination with vitamin D, which helps improve its absorption.
• 维生素B12：维生素B12（节能键）适当水平可能有助于疲劳作战，共同RA症状。

一直跟你的医生在开始任何新的补充了。她可以命令验血检查的不足，并可以推荐适当的剂量为您服务。