Managing rheumatoid arthritis is ultimately left up to the individual who suffers from the condition. While doctors and other practitioners can make recommendations concerning the management of rheumatoid arthritis pain and other aspects of the disease, treatment plans that work for some do not work for everyone.
Some courses of action are not appropriate for everyone. Surgery, for example, will only be considered if symptoms are severe or the disease has progressed to a point where joints are severely damaged. One type of surgery removes the damaged synovial membrane, but in many cases the membrane grows back, requiring additional surgeries or other courses of action.
There are several types of prescription drugs for managing rheumatoid arthritis. Each type is associated with an increase in specific health risks. The ones that are simply pain relievers (NSAIDs and COX-2 inhibitors) do nothing to prevent the progression of the disease and we have learned that the side effects of some (Vioxx) can be deadly.
Even the safest pain relievers can eventually damage the kidneys when used at higher dosages for extended periods of time. For occasional use, these drugs are very effective, but for long term management of rheumatoid arthritis, the health risks must be considered.
Corticosteroids may be used orally or by injection on an occasional basis to control or relieve flare-ups, but they cannot be used safely for long term management of rheumatoid arthritis pain. The detrimental side effects of corticosteroids include increased risk of infection, increased risk of diabetes and increased risk of osteoporosis.
Disease Modifying Anti-rheumatic Drugs or DMARD for short are sometimes prescribed in the treatment of rheumatoid arthritis. In most cases, doctors do not understand how or why these drugs work. Some of the drugs are known to have anti-inflammatory effects, while others are known to suppress immune system activity. Sometimes, these drugs cause the disease to go into remission and people may experience extended periods of time without symptoms. In other cases, they are not helpful in managing rheumatoid arthritis pain. If damage to the joints has already occurred, there may always be some level of chronic pain.
New drugs for the management of rheumatoid arthritis called "biologics", sold under the brand names Humira, Enbril, Remicade and others, work by blocking a specific component of the immune system called "tumor necrosis factor" or TNF. It is also believed that these drugs may protect the joints from further damage. Because they are relatively new, the long term safety of these drugs cannot be guaranteed. The known side effects are increased vulnerability to infection and other diseases. Serious infections have been seen in clinical trials.
For many years, we have known that omega-3 fatty acid supplementation is helpful in managing rheumatoid arthritis symptoms, but only recently have scientists begun to understand why this dietary component effectively reduces pain, swollen joints and morning stiffness. Interestingly, scientists in Australia have shown that omega-3 fatty acids block the same immune system component (TNF) that the more risky and much more expensive biologics target.
The University of Maryland Medical Center's website states:
"Most clinical studies investigating the use of omega-3 fatty acid supplements for inflammatory joint conditions have focused almost entirely on rheumatoid arthritis. Several articles reviewing the research in this area conclude that omega-3 fatty acid supplements reduce tenderness in joints, decrease morning stiffness, and allow for a reduction in the amount of medication needed for people with rheumatoid arthritis."
Fatty acids are used by the immune system to create numerous compounds. Some increase inflammation, while others stop the inflammatory process. Compounds derived from omega 6 fatty acids are mostly inflammatory; while those derived from omega 3 fatty acids are mostly anti-inflammatory. They typical American diet is rich in omega 6, but poor in omega 3, which is found mostly in fatty fish and fish oils.
Most people realize that diet plays a role in managing rheumatoid arthritis or any disease. Being overweight or inactive and even having a negative attitude can increase the pain and fatigue associated with rheumatoid arthritis. Drugs only provide short-term relief and have dangerous side effects. Simply taking a fish oil supplement can relieve pain and may protect the joints from further damage, but does not increase the risk of serious infections, because omega 3 fatty acids help the immune system to function normally, in a balanced manner.
The bottom line is that increasing consumption of omega-3 fatty acids, by eating more fish and taking fish oil supplements, while decreasing the consumption of more inflammatory fats through proper diet, is one important component in the long-term management of rheumatoid arthritis.
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