Final_Paper

COM 172 - Final Paper April 18, 2012 Treatments for Rheumatoid Arthritis Patients Rheumatoid arthritis (RA) is a disease that affects as many as 1.3 million people in the United States alone. (Foundation, 2001) RA is a progressive, chronic illness which currently has no cure. It is classified as a hereditary autoimmune disorder in which the individual’s immune system attacks their own joints causing pain, swelling, inflammation, and even deformity of the joint. The disease targets an area in the joint called the synovial membrane. This part of the joint is responsible for secreting synovial fluid which acts as a lubricant for the joint. When there is plenty synovial fluid the joint is cushioned and lubricated allowing free movement of the joint. RA disrupts the functioning of the synovial membrane, creating inflammation and reducing synovial fluid production, which results in wear and tear on the joint. This inflammation also causes weakness of the ligaments, tendons, and muscles which are meant to help support the joint. Over the long-term this joint damage leads to joint deformity which is a contributing factor to increased risk of falls and other types of injuries to the patient. (Genentech, 2012) The progression of the illness, without treatment, has significant impacts on the life of the patient. As RA progresses people find daily activities to become more difficult to perform; activities such as tying their shoes or buttoning their shirt can cause serve pain. Ultimately many RA patients are forced into disability and eventually become home-bound. If there is a family history of RA it is important to be tested by a rheumatologist as soon as possible. An early and accurate diagnosis can help slow down the course of the illness before disability and deformity set in. The benefits and risks of traditional treatments gives a longer quality of life to RA patients instead to a short term relief of alternative treatments. Even though there is no cure for RA, there are effective treatments which help to reduce the impact and lessen the damage done by the illness. RA patients are generally prescribed drugs from three different families of drugs. In the beginning each patient will be on a “drug cocktail” which includes at least one drug from each family. Obviously mixing drugs in this manner has its own set of risks and requires that the patient’s physician and pharmacist be especially aware of any medical conditions patients may have prior to being diagnosis when mixing these different drug families. The drugs that are more commonly used in the beginning would be NSAIDs, Non-Steroidal Anti-Inflammatory Drugs. These drugs are used to control the symptoms of RA; pain, inflammation, and swelling. This class of drug is not meant to fight the disease itself, they are simply meant to make the patient more comfortable in their daily life and activities. Some of the common medications of this drug family are; Motrin, Mobic, and Naproxen. These medicines are used to help reduce the inflammatory flare ups of the body’s immune system. Unfortunately they also have some serious risks if used for long periods. They are irritating to the lining of the stomach and can cause damage to the patient’s kidneys. (Clinic, 2012) Patients tend to ingest to much of these medications when trying to control the pain. The next step for a patient diagnosed with RA is the acronym DMARD which stands for Disease Modifying Anti-rheumatic Drugs. These drugs are used to try and slow the disease process by modifying the immune system. Methotrexate and Leflunomide were originally used to treat cancer, malaria, and transplant rejection. These DMARD’s are a major part of the drug regimen, which may make a sufficient improvement in movement of joints. This will help with the quality of life of the RA patients. Side effects of these drugs create concern with patients of RA, but many have found the side effects short lived when medication levels are normal. Side effects include diarrhea, skin rash, hair loss and damage to liver. Physicians will normally conduct liver function tests every three months to measure certain enzymes or proteins in your blood. Liver function tests are used to help detect, evaluate and monitor liver disease or damage. In the last ten years there have been significant advances in treating RA, especially for patients who may not respond well to traditional DMARDs. Biologics are used to target specific regions of the immune system instead of large areas of the immune system. Biologics help slow down the progression of RA by controlling the inflammation. These drugs are normally taken by injection or by infusion. At the present time they have not developed biologics that can be taken orally. These drugs have side effects that may cause chronic diseases like tuberculosis, multiple sclerosis and congestive heart failure to flare up when taking biologics. Biologics have shown no effect on fertility on women who are trying to get pregnant, but should consult with their physician when discussing a treatment plan. Patients that have RA may find complementary and alternative medicine (CAM) therapies more effective for the pain and swelling of the joints. Mind-body therapies are some of the most commonly used for RA patients. These include relaxation, imagery, and biofeedback, which may help the physical and psychological wellbeing of the patient. The body responses to stress and may trigger a flare up of the disease. When stress is reduced then the body will be able to heal. Rest and relaxation for stress reduction is always a important part of healing. Patients should also pay close attention to what goes in the body as well. Dietary supplements may not show treatment benefits, but they assist with the reduction of joint inflammation. Fish oil has omega-3s, which allows the body to reduce inflammation and relieving tenderness of joints. Turmeric, which is part of the ginger family, is used like a spice. Turmeric is known for being a natural liver support when used regularly. With Fish oils and turmeric do not have the side effects the traditional drug treatments, but they also may not protect the joint from future damage. Another CAM therapy that is used to treat RA is Acupuncture. Acupuncture is mostly used to control pain of the illness. Patients do not have to rely on pain pills and steroids alone to get relief. RA affects the immune system and acupuncture can improve the immune system. This will help the body fight off other diseases. There are very little side effects and many times it is a red spot at the needle site. Acupuncture may improve your treatment for pain, but you should consult a physician prior to trying it. RA is a complicated illness with no cure at this present time. The traditional treatment for RA increases the chance to have a longer quality of life today than alternative treatments. Alternative treatments will be more solid when accompanied with traditional treatments. RA patients want to be independent and not a burden to family and friend. These treatments incorporated together may give the self-sufficiency RA patients want out of life. Bibliography Clinic, C. (2012, April 12). What Drugs Are USed to Treat Rheumatoid Arhtritis' Retrieved from Clevelandclincic.org: www.my.clevelandclinic.org/disorders/rheumatoid_arthritis.htm Corliss, R. H. (2011). Harvard Medical School Arthritis. Keeping your joints healthy, pp. 18-24. Foundation, A. (2001, April 15). Who Gets Rheumatoid Arthritis. Retrieved from Arthritis Foundation: http://www.arthritis.org/who-gets-rheumatoid-arthritis.php Genentech. (2012, April 02). Progression of RA. Retrieved from www.rheumatoidarthrities.com: www.rheumatoidarthritis.com/ra/understanding-ra/progression-of-ra.htm Soltanian, S. (2008, June). Treatment of Rheumatoid Arthritis with Acupuncture. Oriental Medicine Journal, pp. Vol 16. 28-31.