Treatments for rheumatic diseases include rest and relaxation, exercise,
proper diet, medication, and instruction about the proper use of joints
and ways to conserve energy. Other treatments include the use of pain
relief methods and assistive devices, such as splints or braces. In severe
cases, surgery may be necessary. The doctor and the patient work together
to develop a treatment plan that helps the patient maintain or improve
his or her lifestyle. Treatment plans usually combine several types of
treatment and vary depending on the rheumatic condition and the patient.
Rest, Exercise, and Diet
People who have a rheumatic disease should develop a comfortable balance
between rest and activity. One sign of many rheumatic conditions is fatigue.
Patients must pay attention to signals from their bodies. For example,
when experiencing pain or fatigue, it is important to take a break and
rest. Too much rest, however, may cause muscles and joints to become
People with a rheumatic disease such as arthritis can participate in
a variety of sports and exercise programs. Physical exercise can reduce
joint pain and stiffness and increase flexibility, muscle strength, and
endurance. It also helps with weight reduction and contributes to an
improved sense of well-being. Before starting any exercise program, people
with arthritis should talk with their doctor.
Exercises that doctors
often recommend include:
* Range-of-motion exercises (e.g., stretching, dance) to help maintain
normal joint movement, maintain or increase flexibility, and relieve
* Strengthening exercises (e.g., weight lifting) to maintain or increase
muscle strength. Strong muscles help support and protect joints affected
* Aerobic or endurance exercises (e.g., walking, bicycle riding) to
improve cardiovascular fitness, help control weight, and improve overall
Studies show that aerobic exercise can also reduce inflammation in
part of a treatment program is a well-balanced diet. Along with exercise,
a well-balanced diet helps people manage
body weight and stay healthy. Weight control is important to people
who have arthritis because extra weight puts extra pressure on some
and can aggravate many types of arthritis. Diet is especially important
for people who have gout. People with gout should avoid alcohol and
foods that are high in purines, such as organ meats (liver, kidney),
anchovies, and gravy.
A variety of medications are used to treat rheumatic diseases. The
type of medication depends on the rheumatic disease and on the
individual patient. The medications used to treat most rheumatic
not provide a cure, but rather limit the symptoms of the disease.
arthritis and gout are exceptions if medications are used properly.
example is Lyme disease, caused by the bite of certain ticks, where
symptoms of arthritis may be prevented or may disappear if the
infection is caught
early and treated with antibiotics.
Medications commonly used to treat rheumatic diseases provide relief
from pain and inflammation. In some cases, the medication may slow
the course of the disease and prevent further damage to joints
or other parts
of the body.
The doctor may delay using medications until a definite diagnosis
is made because medications can hide important symptoms (such as
and swelling) and thereby interfere with diagnosis. Patients taking
either prescription or over-the-counter, should always follow the
doctor's instructions. The doctor should be notified immediately
if the medicine
is making the symptoms worse or causing other problems, such as
an upset stomach, nausea, or headache. The doctor may be able to
or medicine to reduce these side effects.
Analgesics (pain relievers) such as acetaminophen (Tylenol)* and
nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
are used to reduce
the pain caused by many rheumatic conditions. NSAIDs have the added
benefit of decreasing the inflammation associated with arthritis.
A common side
effect of NSAIDs is stomach irritation, which can often be reduced
by changing the dosage or medication. New NSAIDs, including celecoxib
were introduced to reduce gastrointestinal side effects and offer
additional options for treatment. However, even new medications
associated with reactions ranging from mild to severe, and their
long-term effects are still being studied. The dosage will vary
the particular illness and the overall health of the patient. The
doctor and patient must work together to determine which analgesic
the appropriate amount. If analgesics do not ease the pain, the
doctor may use other medications.
* Brand names included in this fact sheet are provided as examples
only, and their inclusion does not mean that these products are
the National Institutes of Health or any other Government agency.
Also, if a particular brand name is not mentioned, this does not
imply that the product is unsatisfactory.
Depending on the type of arthritis, a person may be asked to take
a disease-modifying antirheumatic drug (DMARD). This category includes
medications that are intended to slow or prevent damage to the
joint and thereby prevent disability and discomfort. DMARDs include
sulfasalazine, and leflunomide (Arava).
Biological response modifiers are new drugs used for the treatment
of rheumatoid arthritis. They can help reduce inflammation and
structural damage of the joints by blocking the reaction of a substance
necrosis factor, a protein involved in immune system response.
These drugs include etanercept (Enbrel), infliximab (Remicade),
Corticosteroids, such as prednisone, cortisone, solumedrol, and
hydrocortisone, are used to treat many rheumatic conditions because
inflammation and suppress the immune system. The dosage of these
vary depending on the diagnosis and the patient. Again, the patient
and doctor must work together to determine the right amount of
Corticosteroids can be given by mouth, in creams applied to the
skin, or by injection. Short-term side effects of corticosteroids
swelling, increased appetite, weight gain, and emotional ups and
downs. These side
effects generally stop when the drug is stopped. It can be dangerous
to stop taking corticosteroids suddenly, so it is very important
that the doctor and patient work together when changing the corticosteroid
dose. Side effects that may occur after long-term use of corticosteroids
include stretch marks, excessive hair growth, osteoporosis, high
pressure, damage to the arteries, high blood sugar, infections,
Hyaluronic acid products like Hyalgan and Synvisc mimic a naturally
occurring body substance that lubricates the knee joint. They are
directly into the joint to help provide temporary relief of pain
and flexible joint movement.
Devices Used in Treatment
Transcutaneous electrical nerve stimulation (TENS) has been found
effective in modifying pain perception. TENS blocks pain messages
to the brain
with a small device that directs mild electric pulses to nerve
endings that lie beneath the painful area of the skin.
A blood-filtering device called the Prosorba Column is used
in some health care facilities for filtering out harmful antibodies
Heat and Cold Therapies
Heat and cold can both be used to reduce the pain and inflammation
of arthritis. The patient and doctor can determine which one
Heat therapy increases blood flow, tolerance for pain, and
flexibility. Heat therapy can involve treatment with paraffin
ultrasound, or moist heat. Physical therapists are needed for
some of these therapies,
such as microwave or ultrasound therapy, but patients can apply
moist heat themselves. Some ways to apply moist heat include
towels or hot packs on the inflamed joint or taking a warm
bath or shower.
Cold therapy numbs the nerves around the joint (which reduces
pain) and may relieve inflammation and muscle spasms. Cold
involve cold packs, ice massage, soaking in cold water, or
and ointments that cool the skin and joints.
Capsaicin cream is a preparation put on the skin to relieve
joint or muscle pain when only one or two joints are involved.
Hydrotherapy, Mobilization Therapy, and Relaxation Therapy
Hydrotherapy involves exercising or relaxing in warm water.
The water takes some weight off painful joints, making it
It helps relax tense muscles and relieve pain.
Mobilization therapies include traction (gentle, steady pulling),
massage, and manipulation. (Someone other than the patient
moves stiff joints
through their normal range of motion.) When done by a trained
professional, these methods can help control pain, increase
joint motion, and
improve muscle and tendon flexibility.
Relaxation therapy helps reduce pain by teaching people various
ways to release muscle tension throughout the body. In one
method of relaxation
therapy, known as progressive relaxation, the patient tightens
a muscle group and then slowly releases the tension. Doctors
can teach patients a variety of relaxation techniques.
The most common assistive devices for treating arthritis
pain are splints and braces, which are used to support
weakened joints or
to rest. Some of these devices prevent the joint from moving;
some movement. A splint or brace should be used only when
by a doctor or therapist, who will show the patient the
correct way to put the device on, ensure that it fits properly, and
for how long it should be worn. The incorrect use of a
or brace can cause joint damage, stiffness, and pain.
A person with arthritis can use other kinds of devices
to ease the pain. For example, the use of a cane when walking
of the weight
placed on a knee or hip affected by arthritis. A shoe insert
(orthotic) can ease the pain of walking caused by arthritis
of the foot or
knee. Other devices can help with activities such as opening
zippers, and holding pencils.
Surgery may be required to repair damage to a joint after
injury or to restore function or relieve pain in a joint
doctor may recommend arthroscopic surgery, bone fusion
(surgery in which bones in the joint are fused or joined
or arthroplasty (also
known as total joint replacement, in which the damaged
joint is removed
and replaced with an artificial one).
Nutritional supplements are often reported as helpful
in treating rheumatic diseases. These include products
for osteoarthritis and fibromyalgia, dehydroepiandrosterone
(DHEA) for lupus, and glucosamine and chondroitin sulfate
on the safety and effectiveness of these products should
be viewed with caution since very few claims have been
the section on "Natural Approaches/Clinical
Myths About Treating Arthritis
At this time, the only type of arthritis that can be
cured is that caused by infections. Although symptoms
types of arthritis
can be effectively
managed with rest, exercise, and medication, there
are no cures. Some people claim to have been cured
special diets, radiation, or other products. However,
there is no scientific evidence that such treatments
some may lead
to serious side effects. Patients should talk to
before using any therapy that has not been prescribed
or recommended by
the health care team caring for the patient.
Work With Your Doctor To Limit Your Pain
The role you play in planning your treatment is very
important. It is vital for you to have a good relationship
work together. You should not be afraid to ask
questions about your condition or treatment. You must understand
tell the doctor
whether or not it is helping you. Research has
shown that patients who are well informed and participate
actively in their own
care experience less pain and make fewer visits
to the doctor.
What Can Be Done To Help?
Studies show that an estimated 18 percent of Americans
who have arthritis or other rheumatic conditions
their activities. People with arthritis may find
that they can no longer
participate in some of their favorite activities,
which can affect their overall
well-being. Even when arthritis impairs only
one joint, a person may have to change many daily activities
protect that joint
damage and reduce pain. When arthritis affects
the entire body, as it does in people with rheumatoid
arthritis or fibromyalgia,
daily activities have to be changed to deal with
pain, fatigue, and other
Changes in the home may help a person with chronic
arthritis continue to live safely, productively,
and with less
pain. People with arthritis
may become weak, lose their balance, or fall.
In the bathroom, installing grab bars in the
and by the toilet,
placing a secure
seat in the tub, and raising the height of the
toilet seat can help. Special
kitchen utensils can accommodate hands affected
by arthritis to make meal preparation easier.
who have rheumatic conditions identify and make
adjustments in their homes
to create a safer, more comfortable, and more
Friends and family members can help a patient
with a rheumatic condition by learning about
how it affects
the patient's life. Friends and family can provide
assistance. Their support, as well as support
from other people who have the same disease,
to cope. The
Arthritis Foundation has a wealth of information
to help people with arthritis.