Question

My mother have rheumatoid arthritis since 5 year. Now she get unbearable join pain. In last 6 month she has medical history of heart disease.

Dr.Julie Mercy J David · Accepted Answer

The "normal" range (or negative test result) for rheumatoid factor is less than 14 iu/ml. Any result with values 14 iu/ml or above is considered abnormally high, elevated, or positive.
Treatmentthere is no cure for rheumatoid arthritis. But clinical studies indicate that remission of symptoms is more likely when treatment begins early with medications known as disease-modifying antirheumatic drugs (dmards).
Medicationsthe types of medications recommended by your doctor will depend on the severity of your symptoms and how long you've had rheumatoid arthritis.
•nsaids. Nonsteroidal anti-inflammatory drugs (nsaids) can relieve pain and reduce inflammation. Over-the-counter nsaids include ibuprofen (advil, motrin ib) and naproxen sodium (aleve). Stronger nsaids are available by prescription. Side effects may include stomach irritation, heart problems and kidney damage.
•steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, weight gain and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.
•disease-modifying antirheumatic drugs (dmards). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common dmards include methotrexate (trexall, otrexup, others), leflunomide (arava), hydroxychloroquine (plaquenil) and sulfasalazine (azulfidine).
Side effects vary but may include liver damage, bone marrow suppression and severe lung infections.
•biologic agents. Also known as biologic response modifiers, this newer class of dmards includes abatacept (orencia), adalimumab (humira), anakinra (kineret), baricitinib (olumiant), certolizumab (cimzia), etanercept (enbrel), golimumab (simponi), infliximab (remicade), rituximab (rituxan), sarilumab (kevzara), tocilizumab (actemra) and tofacitinib (xeljanz).
These drugs can target parts of the immune system that trigger inflammation that causes joint and tissue damage. These types of drugs also increase the risk of infections. In people with rheumatoid arthritis, higher doses of tofacitinib can increase the risk of blood clots in the lungs. Biologic dmards are usually most effective when paired with a nonbiologic dmard, such as methotrexate.
Therapy
your doctor may send you to a physical or occupational therapist who can teach you exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks, which will be easier on your joints. For example, you may want to pick up an object using your forearms.
Assistive devices can make it easier to avoid stressing your painful joints. For instance, a kitchen knife equipped with a hand grip helps protect your finger and wrist joints. Certain tools, such as buttonhooks, can make it easier to get dressed. Catalogs and medical supply stores are good places to look for ideas.
Surgeryif medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and improve function.
Rheumatoid arthritis surgery may involve one or more of the following procedures:
•synovectomy. Surgery to remove the inflamed lining of the joint (synovium) can be performed on knees, elbows, wrists, fingers and hips.
•tendon repair. Inflammation and joint damage may cause tendons around your joint to loosen or rupture. Your surgeon may be able to repair the tendons around your joint.
•joint fusion. Surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief when a joint replacement isn't an option.
•total joint replacement. During joint replacement surgery, your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic.
Surgery carries a risk of bleeding, infection and pain. Discuss the benefits and risks with your doctor.
Rheumatoid arthritis
multiple joint pains / early morning painit is called as rheumatic arthritis. Treatment goals
•to protect the joint from further damages.
•provide pin relief.
•prevent deformity and disabilities.
•increase functional capacity.
•improve flexibility and strength.
•encourage regular exercise.
•improve general fitness.
Physiotherapy modalities
- hot/cold applications- electrical stimulation- hydrotherapy and spa therapy
rehabilitation treatment technique
- rest and splinting
- compression gloves
- assistive devices and adaptive equipment
- massage therapy
- therapeutic exercise
- patient education
assistive devices and adaptive equipment
occupational therapy improves functional ability in patients with ra. Occupational therapy interventions such as assistive devices and adaptive equipments have beneficial effects on joint protection and energy conservation in arthritic patients.Assistive devices are used in order to reduce functional deficits, to diminish pain, and to keep patients' independence and self-efficiency. Loading over the hip joint may be reduced by 50% by holding a cane. In fact, most of these instruments are originally designed for patients with neurologic deficits; therefore, certain adaptations may be needed for them to be used in patients with arthritis. Elevated toilet seats, widened gripping handles, arrangements related with bathrooms, etc. Might all facilitate the daily life. The procedures needed to increase compliance of the patient with the environment and to increase functional independence are +mainly determined by the occupational therapist. Massage therapy that improves flexibility, enhances a feeling of connection with other treatment modalities, improves general well being, and can help to diminish swelling of inflamed joints. Massage is found to be effective on depression, anxiety, mood, and pain.
Therapeutic exercise
every joint should be moved in the rom at least once per day in order to prevent contracture. In the case of acutely inflamed joints, isometric exercises provide adequate muscle tone without exacerbation of clinical disease activity. Moderate contractures should be held for 6 seconds and repeated 5–10 times each day.
Dynamic exercise therapy in improving joint mobility, muscle strength, aerobic capacity and daily functioning in patients with rheumatoid arthritis (ra).
Finally, in chronic stage with inactive arthritis, conditioning exercises such as swimming, walking, and cycling with adequate resting periods are recommended. They increase muscle endurance and aerobic capacity and improve functions of the patient in general, and they also make the patient feel better.
It might be due to lack of blood circulation which is the reason for you to have scrotum pain / back pain. You have to do basic aerobic exercises for you to become fit and also to maintain the blood circulation and tone.
Patient education
in patients with ra, sociopsychological factors affecting the disease process such as poor social relations, disturbance of communication with the environment, and unhappiness and depression at work are commonly encountered. The treatment of rheumatic diseases should provide education and information to their patients about their condition and the various physical therapy and rehabilitative options that are available to improve their quality of life.
Passive treatments for rheumatoid arthritis
•cold therapy reduces circulation, which ultimately decreases swelling. For example, a cold compress may be placed on the painful area.
•cold therapy in acute phase •dosage 10-20mints/1-2 times a day.
•heat therapy eases muscle tension and gets blood to flow more quickly to the painful area. For example, a moist, warm cloth may be used to promote circulation.
•heat therapy in chronic phase
•dosage 20-30mints/1-2 times a day.
•hydrotherapy involves reducing your ra-related pain and other symptoms with water. With hydrotherapy, you will be submerged in warm water to relieve your symptoms.
•massage can help reduce muscle tension and promote good circulation. It's also a fantastic way to help you manage stress (especially important for people with rheumatoid arthritis).
•transcutaneous electrical nerve stimulation (tens) works by blocking pain signals from getting to your spinal cord. It also helps decrease muscle spasms.
•tens short term pain relief (6 to 18 hrs)
•ultrasound creates warmth using sound waves, whichenchanes circulation and decreases joint pain, inflammation, and stiffness.
Exercise for acute phase:
•preformed exercise at least once a day.
•general assisted movement through normal range (joint mobilisation).
•isometric-“static movements” helps to maintain muscle tone without increasing inflammation.
Exercise for the chronic phase:
•can progress the above exercise to include use of light resistance.
•postural/core stability exercises.
•swimming/walking/cycling to maintain cardiovascular fitness.
•gentle stretch for areas that become tight, such as knees &calves.
Regular exercises:
•maintaing muscle strength is important for joint stability & preventing injury.
•muscles can become weak following reduced activity.
•pain signals from yours nerves and swelling can both inhibits muscles.
•muscle length can be affected by prolonged positions immobilization and tightness can limit daily activities.
Alternative therapies:
•thi chi.
•musical therapy.
•yoga therapy.
•relaxation techniques.
•pilates.
Active treatments for rheumatoid arthritis
•flexibility and strengthening exercises improve your range of motion and help you build muscle strength. Yoga and pilates are flexibility and strengthening exercises.
•low-impact aerobic exercise is gentle but effective at helping you manage rheumatoid arthritis symptoms. Light walking is an example of this type of exercise.
Your physical therapist will let you know how often to do these exercises. For example, you may need to do a few specific exercises 3 times a day, or your physical therapist may recommend a routine that incorporates 30 minutes of low-impact aerobic exercise a day and 30 minutes of strengthening exercises every other day.
If your pain is more in the proximal joints, ie.in the upper limbs if the pain is present in the fingers/wrist and in the lower limbs it the pain is present in the toes/ ankle, then we shall definitely say it is rheumatic arthritis. Wear elbow brace and wrist brace which will make her to feel warm and that will make the joints become firm. Hot water fermentation will helpknee cap will also help to prevent the damaged cartilagesif your pain is more in the distal joints, ie. In the upper limbs if the pain is present in the fingers/wrist and in the lower limbs it the pain is present in the toes/ ankle, then we shall definitely say it is rheumatic arthritis. If your proximal joints (ie. Shoulder, hip & knee has pain) then you can pour hot (warm) water in that area to reduce the inflammation. If you have pain in the distal joints ie. Wrist, fingers, ankle, toes then you can wear either elbow brace or wrist brace which will help you to feel warm and very protective.
And also immerse the distal joints in the hot water tub which will help you to reduce the pain.
Knee pain during driving or watching movie.
It might due to lack of movements in the knee while the joints are immobilized during driving and while watching movies. It is important that you need to have movements in and around the knee so that the blood flow will not be disturbed.

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