By Dr. Amod Manocha, Pain Management
The cause of Rheumatoid arthritis (RA) is not fully understood, although it is believed that it is an autoimmune disorder wherein the immune system of the body attacks healthy tissues. In RA the synovium (a thin layer of cells lining the joints) becomes inflamed, releasing chemicals which cause further damage to the nearby structures such as cartilage, bones, tendons & ligaments. This inflammation of the joints leads to multiple symptoms, one of them being pain.
Although there’s no permanent cure for rheumatoid arthritis, early treatment can reduce the risk of joint damage and long term disability. The treatment in RA is aimed at reducing inflammation and relieving symptoms such as pain. Good control reduces the chances of joint damage and long term complications. Managing pain in rheumatoid arthritis is one of the most important facets of the treatment and requires a multi-modal approach. Uncontrolled pain can lead to immobility and further problems.
Some techniques for the management of pain are mentioned below.
1. Pain medications including anti-inflammatories: There are many types of pain medications which can range from mild to strong. Sometimes special class of medications called Disease-Modifying Drugs and Biologics are used for the treatment. Your specialist will select the right medications for you, minimising the chances of side effects.
2. Interventional Pain Procedures: These may be required to deal with the flare-up episodes or the resulting chronic pain. Procedures may include joint injections, neurotomies, radio-frequency treatment, platelet-rich plasma injections etc. Sacroiliac joint injections and Radiofrequency ablation is a commonly performed procedure for buttock pain originating from RA involving the sacroiliac joint. Radiofrequency ablation for neck and low back pain, joint injections, Peritendinous injections are some of the other commonly performed procedures required for patients suffering from rheumatoid arthritis. Most pain procedures can be performed in ODP or daycare setting.
3. Physiotherapy and Occupational Therapy: A physiotherapist may help you improve your muscle strength and joint flexibility. Low-impact activities such as swimming, cycling, walking put less strain on joints and are better tolerated. An occupational therapist can provide you with support for your joints, such as a splint and give you advice on how to protect the joints.
4. Dietary changes & weight Management: Although there is no strong evidence linking dietary change to rheumatoid arthritis, it is not uncommon for patients to report worsening of symptoms after they have eaten certain foods. Generally, a Mediterranean diet, based on vegetables, fruits, nuts, beans, fish and unsaturated fats such as olive oil, is recommended. A few types of foods, especially certain fish found in colder waters are a rich source of omega-3 fatty acids, are considered good in reducing joint inflammation. Some people find that items such as sugar, alcohol, white flour, processed meats, gluten-rich foods aggravate their symptoms. Overweight people suffer more from arthritis pain as the extra weight adds to the pressure on the joints and hence reducing weight can help offload the joints, in turn, reducing the pain.
5. Complementary therapies: These include heat and cold compression, acupuncture, transcutaneous electrical nerve stimulation (TENS); massage. In most cases, there’s little or no evidence these are effective in the long term, although some people may experience short-term benefit from these.
6. Surgery: Some people with rheumatoid arthritis need surgery to replace part or all of a joint or to correct resulting deformities.