Category: Knee Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease that affects millions of people worldwide. It is characterized by joint inflammation, pain and stiffness, which can significantly affect a person’s quality of life. Understanding the mechanisms behind inflammation in rheumatoid arthritis is crucial for developing effective treatments and improving patient outcomes.

Introduction

Rheumatoid arthritis is a chronic inflammatory disease that mainly affects the joints. It is an autoimmune disease in which the body’s immune system mistakenly attacks its own tissues, leading to inflammation and damage. This chronic inflammation can lead to joint deformity, loss of function and disability if left untreated. Therefore, gaining insight into the mechanisms that drive inflammation in rheumatoid arthritis is crucial.

What is inflammation?

Inflammation is a natural process that occurs when the body’s immune system responds to injury or infection. It involves the release of various chemical signals and the activation of immune cells to protect the body and promote healing. While acute inflammation is a temporary response to a specific trigger, chronic inflammation, as seen in rheumatoid arthritis, persists for an extended period of time. It is this inflammation that causes the symptoms seen in RA.

Inflammation in rheumatoid arthritis

Rheumatoid arthritis is characterized by persistent inflammation in the synovial joints, mainly affecting the hands, feet and wrists. The synovium, a thin membrane that lines the joints, becomes inflamed, leading to pain, swelling and stiffness. If left untreated, this inflammation can gradually damage the joints, cartilage and surrounding tissues.

Inflammatory mechanisms in rheumatoid arthritis

The inflammatory process in rheumatoid arthritis involves a complex interplay of immune cells, cytokines and genetic factors. Initially, immune cells such as macrophages and dendritic cells are activated, causing an immune response. These cells produce pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), and interleukin-6 (IL-6), which play an important role in promoting inflammation and joint destruction . .

The role of the immune system

In rheumatoid arthritis, the immune system plays a crucial role in causing inflammation. T cells and B cells, two types of lymphocytes, are mainly involved in the inflammatory process. T cells recognize specific antigens and release cytokines that further activate immune cells and enhance the inflammatory response. B cells produce autoantibodies that target the body’s own tissues, contributing to tissue damage and inflammation.

Inflammatory mediators

Several inflammatory mediators contribute to the persistent inflammation that occurs in rheumatoid arthritis. Prostaglandins, leukotrienes and cytokines are among the key players in the inflammatory cascade. Prostaglandins and leukotrienes are lipid mediators that promote vasodilation, increase vascular permeability, and recruit immune cells to the site of inflammation. Cytokines, such as TNF-alpha, IL-1 and IL-6, enhance the immune response and support the inflammatory process.

Inflammation and joint damage

The chronic inflammation in rheumatoid arthritis can lead to irreversible joint damage. The continued presence of inflammatory mediators and immune cells promotes the destruction of cartilage and bone. Over time, this can result in joint deformities, loss of mobility and functional limitations. Early intervention to control inflammation is crucial in preventing or minimizing joint damage.

Inflammation and systemic effects

Inflammation in rheumatoid arthritis not only affects the joints, but can also have systemic consequences. Chronic inflammation increases the risk of developing cardiovascular diseases, such as heart attack and stroke. Additionally, it can lead to osteoporosis, a condition characterized by weakened bones, making people more susceptible to fractures. Controlling inflammation in rheumatoid arthritis is therefore essential for overall health and well-being.

Current treatment methods

Treatment for rheumatoid arthritis aims to reduce inflammation, relieve symptoms and prevent joint damage. Conventional medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and corticosteroids, are often prescribed to control inflammation and manage pain. Biological therapies, such as TNF inhibitors and interleukin blockers, target specific inflammatory pathways and have revolutionized the treatment of rheumatoid arthritis.

Possible future directions

Research into inflammation in rheumatoid arthritis is constantly evolving, leading to the development of new treatment methods. Emerging therapies, including Janus kinase (JAK) inhibitors and small molecule inhibitors, show promise in targeting specific molecules involved in the inflammatory process. Personalized medicine, based on an individual’s genetic profile, is also an area of ​​active research, aimed at optimizing treatment outcomes and minimizing side effects.

Lifestyle and diet adjustments

In addition to medical interventions, lifestyle changes can play an important role in controlling inflammation in rheumatoid arthritis. Regular physical activity, tailored to individual capabilities, helps reduce joint stiffness and maintain joint flexibility. Following an anti-inflammatory diet rich in fruits, vegetables, whole grains and omega-3 fatty acids can provide essential nutrients and possibly ease symptoms.

Conclusion

Inflammation is a major cause of rheumatoid arthritis and contributes to joint damage and systemic effects. Understanding the complicated mechanisms involved in inflammation can help develop targeted therapies and improve the lives of people with rheumatoid arthritis. By controlling inflammation, maintaining joint function, and taking a comprehensive approach that includes lifestyle changes, people with rheumatoid arthritis can live fulfilling lives with a reduced burden of disease.

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Your immune system is supposed to protect your body, but when you have rheumatoid arthritis (RA), it accidentally attacks healthy joints, tissues, and organs, including the eyes and lungs. As a result, the chronic autoimmune disease causes pain, swelling, stiffness and loss of function in the joints. It can also cause other symptoms, including fatigue, loss of appetite and dry eyes.

RA affects 1.5 million Americans and there is no cure. But it can be managed with medications and lifestyle changes.

Women’s health

Women’s Health magazine featured four women – including Mariah Leach, founder of Mamas Facing Forward – discussing the diagnosis of rheumatoid arthritis, how they cope and what they’ve learned from living with RA.

4 women get real about living with rheumatoid arthritis

Women’s health

Relief could be on the way for people with painful hand osteoarthritis after a Monash University and Alfred Health-led study found that an affordable existing drug could help. Until now, no effective treatment existed.

Published in The Lancetthe article examined methotrexate, a cheap, effective treatment for inflammatory joint diseases such as rheumatoid arthritis and psoriatic arthritis. It has been widely used in Australia and worldwide since the early 1980s.

Researchers found that methotrexate reduced symptoms in people with hand osteoarthritis (OA). A weekly oral dose of 20 mg for six months had a moderate effect on reducing pain and stiffness in patients with symptomatic hand osteoarthritis.

Hand osteoarthritis is a debilitating condition that causes pain and affects function, interfering with daily activities such as dressing and eating. It can significantly reduce the quality of life. About one in two women and one in four men will experience symptoms of hand osteoarthritis by the time they turn 85.

About half have inflamed joints, which cause pain and are associated with significant joint damage. Despite the high prevalence and burden of disease, no effective medications exist.

Senior author Professor Flavia Cicuttini, head of Monash University’s Musculoskeletal Unit and head of rheumatology at The Alfred, said the study identified the role of inflammation in hand osteoarthritis and the potential benefit of targeting patients experiencing painful hand osteoarthritis.

“In our study, as in most osteoarthritis studies, pain improved in both the placebo and methotrexate groups in the first month or so,” Professor Cicuttini said.

“However, pain levels remained the same in the placebo group but continued to decrease in the methotrexate group at three and six months, while still decreasing. The pain improvement in the methotrexate group was twice as much as in the placebo group.

“Based on these results, the use of methotrexate may be considered in the treatment of hand osteoarthritis with an inflammatory pattern. This provides physicians with a treatment option for this group, which tends to sustain more joint damage.”

Professor Cicuttini said that in patients with hand osteoarthritis and inflammation, the effects of methotrexate were visible after about three months and it was very clear after six months whether it was working.

At that point, patients and their doctors can decide whether to continue or stop. This is very similar to what we are currently doing with other forms of inflammatory arthritis.”

Professor Flavia Cicuttini, Monash University

The NHMRC-funded randomized, double-blind, placebo-controlled trial of 97 people assessed whether methotrexate 20 mg weekly reduced pain and improved function compared to placebo in patients with symptomatic hand osteoarthritis and synovitis (inflammation) for six months.

Participants with hand osteoarthritis and MRI-detected inflammation were recruited from Melbourne, Hobart, Adelaide and Perth.

Professor Cicuttini said the results could provide relief for people with hand osteoarthritis, which was particularly common in women during the menopause.

“Further studies are needed to determine whether the effect of methotrexate lasts longer than six months, how long we should treat patients and whether methotrexate reduces joint damage in patients with hand osteoarthritis and associated inflammation,” she said.

Professor Cicuttini now plans to conduct a follow-up study to answer these questions, specifically whether women who develop hand osteoarthritis around menopause and often have severe pain and joint damage can benefit.

When I first started thinking about getting pregnant after being diagnosed with rheumatoid arthritis, I was eager to hear from other women who had succeeded in this goal. At the time there wasn’t much social media, but I did find a great book called Arthritis, Pregnancy and the Path to Parenthood. It contained quotes and advice from real women, and I found it invaluable.

But I also discovered a problem: the book started by talking about the possibility of changing some of your medications before getting pregnant, and then skipped straight to being pregnant. But wait! If I stop taking my meds, won’t I flare up? And if I’m in pain, how can I ever get pregnant? Is there a chapter missing from this book about trying to get pregnant while living with arthritis?

That’s the question I asked Iris Zink, a rheumatology nurse who recently wrote a book with Jenny Thorn Palter about intimacy and chronic illness. (The book is called “Sex – Interrupted” and you can read my review of it here!) Their book recommends many alternatives to intercourse – which I think is generally good advice for maintaining intimacy in a relationship while dealing with a chronic illness! But what if you want to start a family? If you’re trying to get pregnant, you actually have to have sex!

Iris and I decided to have a discussion about a topic we haven’t seen anyone else talk about: the challenges many women face when actually trying to conceive while living with a chronic illness. I share my personal experiences, and Iris shares her expert advice this video!

Consumers know it’s fall when stores start offering Halloween candy and flu shots — and the airwaves and mailboxes fill with ads for Medicare options.

It’s annual open enrollment time again for the 65 million Americans covered by Medicare, the federal health program for the elderly and some people with disabilities.

From October 15 to December 7, participants in the traditional program or Medicare Advantage plans, which are offered by private insurers, can change their coverage. (First-time enrollees typically sign up within a few months of their 65th birthday, whether during open enrollment season or not.)

There are a few new features for 2024, including a lower out-of-pocket limit for some patients on expensive medications.

Whatever happens, experts say, it’s a good idea for beneficiaries to examine their current coverage, because health and drug plans may have made changes, including to the pharmacies or medical providers in their networks and how much prescriptions cost.

“The advice is to check, check and check again,” says Bonnie Burns, a consultant with California Health Advocates, a nonprofit Medicare advocacy program.

But as anyone in the program or who helps friends or family members with coverage decisions knows, it’s complicated.

Here are a few things to keep in mind.

Know the Basics: Medicare vs. Medicare Advantage

People in traditional Medicare can see any participating doctor or hospital (and most do participate), while those in Medicare Advantage must choose from an itemized list of providers – a network – that is unique to that plan. Some Advantage plans offer a broader network than others. Always check whether your preferred doctors, hospitals and pharmacies are covered.

Because traditional Medicare does not cover prescriptions, members should also consider signing up for Part D, the optional drug benefit, which includes a separate premium.

Conversely, most Medicare Advantage plans include drug coverage, but be sure to check before you enroll because some do not. These private plans are heavily advertised, often touting that they offer “extras” not available in traditional Medicare, such as dental or vision coverage. Read the fine print to see what restrictions, if any, are placed on such benefits.

Those age 65 and older who are new to traditional Medicare can purchase a supplemental or “Medigap” policy, which covers many out-of-pocket costs, such as deductibles and copays, which can be significant. Generally, beneficiaries have six months after enrolling in Medicare Part B to purchase a Medigap policy.

So switching from Medicare Advantage to traditional Medicare during open enrollment could pose problems for those who want to purchase a supplemental Medigap policy. That’s because private insurers offering Medigap plans, with some exceptions, can turn away applicants with health problems, or increase premiums or limit coverage of pre-existing conditions.

Some states offer beneficiaries more guarantees that they can switch Medigap plans without answering health questions, although the rules vary.

To make all this even more confusing, there is a second open enrollment period each year, but it is only for those with a Medicare Advantage plan. They can change their plans or return to traditional Medicare from January 1 to March 31.

Drug coverage has changed – for the better

Beneficiaries who have enrolled in a Part D drug plan or receive drug coverage through their Medicare Advantage plan know that there are many copays and deductibles. But by 2024, some of these expenses will disappear for those who need a lot of expensive medicines.

President Joe Biden’s Inflation Reduction Act places a new annual cap on Medicare beneficiaries’ out-of-pocket costs for medications.

“That policy is going to help people who are taking very expensive medications for conditions like cancer, rheumatoid arthritis and hepatitis,” said Tricia Neuman, senior vice president and head of KFF’s Medicare policy program.

The cap will greatly help beneficiaries who fall into Medicare’s “catastrophic” coverage — an estimated 1.5 million Americans in 2019, according to KFF.

Here’s how it works: The cap is triggered after patients and their drug plans together spend about $8,000 on medications. KFF estimates that this means about $3,300 in out-of-pocket expenses for many patients.

Some people could reach the limit within one month, given the high prices of many drugs for serious conditions. After the limit is reached, beneficiaries will not have to pay anything out of pocket for their medications that year, saving them thousands of dollars annually.

It is important to note that this new limit will not apply to medications administered to patients, usually in doctor’s offices, such as many cancer chemotherapeutics. These drugs are covered by Medicare Part B, which pays for doctor visits and other outpatient services.

According to the Medicare Rights Center, next year Medicare will also expand opportunities for some low-income beneficiaries to qualify for low- or zero-premium drug coverage with no deductibles and lower copayments.

Insurers offering Part D and Advantage plans may also have made other changes to drug coverage, Burns said.

Beneficiaries should consult their plan’s “formulary,” a list of covered medications, and how much they will have to pay for the medications. Be sure to note whether prescriptions require a co-pay, which is a fixed dollar amount, or coinsurance, which is a percentage of the drug cost. In general, copayments mean lower out-of-pocket costs than coinsurance, Burns said.

Help is available

In many parts of the country, consumers can choose from more than 40 Medicare Advantage plans. That can be overwhelming.

Medicare’s online plan finder provides details on the Advantage and Part D drug plans available by zip code. Allows users to view details about each plan’s benefits, costs, and healthcare provider network.

Insurers are expected to keep their supplier directories up to date. But experts say enrollees should contact directly the doctors and hospitals they would most like to confirm that they are participating in a particular Advantage plan. People concerned about drug costs should “check to see if their pharmacy is a ‘preferred pharmacy’ and if it is in network” under their Advantage or Part D plan, Neuman said.

“There can be a significant difference in out-of-pocket expenses between one pharmacy and another, even in the same plan,” she said.

To get the most complete picture of estimated drug costs, Medicare beneficiaries should look up their prescriptions, dosages and their pharmacies, says Emily Whicheloe, education director at the Medicare Rights Center.

“For people with specific drug needs, it’s also a good idea to contact the plan and say, ‘Hey, will you still cover this drug next year?’ If not, change to a plan,” she said.

Additional enrollment assistance can be obtained for free through the State Health Insurance Assistance Program, which operates in all states.

Beneficiaries can also ask questions through a toll-free Medicare hotline: 1-800-633-4227 or 1-800-MEDICARE.

Insurance brokers can also help, but with a caveat. “Working with a broker can be fun for that personal touch, but know that they may not represent all plans in their state,” says Whicheloe.

Whatever you do, avoid telemarketers, Burns said. In addition to TV and mail ads, many Medicare beneficiaries are inundated with phone calls promoting private plans.

“Hang up,” Burns said.

This article was adapted from khn.org, a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling and journalism.

Okay, so I wanted to get back into doing more resistance training. Currently my resistance training involves my dogs pulling on the leash when we go for walks. While that certainly gives me a solid upper body workout, it is neither consistent nor conducive to gradually building strength and capacity.

I also do archery, which is also a great upper body workout. I usually shoot about 4 times a week with a recurve bow. It’s also a lot of fun. My bow weighs about 36 pounds, so I’m fairly strong. Possibly, more accurately, “fairly strong for someone living with multiple chronic illnesses.”

Although I get tired quickly. Part of the reason I want to do a good resistance training program is to get stronger for archery so I can shoot longer and have longer archery sessions. To build my endurance and increase my strength. If it’s easier to pull back a 36-pound bow, I can do it longer. Maybe I can even go every day.

So that was the idea.

I started two weeks ago and created a very simple program for myself.

This is what I did.

Upper body exercises

All exercises consist of 3 sets of 10 repetitions.

Bench press – 15kg

Curved dumbbell rows – 8 kg

Seated shoulder press – 3 kg

Biceps curls – 5 kg

Overhead Triceps Extension – 5kg Plate

Lateral raises – 3 kg

Lower body exercises

Goblet squats body weight to sitting level and stands up

Dumbbell lunges bodyweight

Romanian deadlifts 20kg

Calf increases body weight

Dumbbell increases body weight

My upper body was fine. I hardly had any pain anymore. But it’s a very easy, lightweight start. That’s what I was aiming for, and I got it right for my upper body.

Now my lower body was something completely different.

I woke up that night around 1am in terrible pain. And I mean *terrible*. It was an electric, diffuse, terrible pain through my legs. I’ve heard others call it an “electric storm in my muscles” and that’s a good description. A painful electrical storm.

I had no control over my legs, they wouldn’t do what I wanted. Or they would…eventually. The response was slow. Talk about ‘delay’. Standing was almost impossible and walking was almost impossible used to be impossible, until I discovered that my legs were responding, just very slowly.

I sat on the steps and lowered myself onto my butt. I didn’t feel safe walking down. I scooted on my butt, but it was the slowest scoot you’ve ever seen! It was more of a painful, slow lowering of my body, step by step, with most of my weight on my arms.

Thank the gods you still have good upper body strength!

This was all a big shock to me. I didn’t expect to react this way…I guess this is what happens when you do it too much when you have CIDP. I know how inflammatory arthritis responds to exercise, and too much exercise. But this neuropathic pain? This is new. A surprise. And not a nice one. But it’s all a learning experience, right?

I took my usual painkillers, opioids, and the pain subsided a bit. But it was still unbearable. I took another dose.

Long story short, I was in pain all day and couldn’t do anything. The next day things got better, but I still spent most of the day lying down. I couldn’t work or deliver my orders. It was the first time that I received NO orders within 24 hours. I pride myself on getting my orders FAST, so that was a big hit for me. I will NOT do that again!

Day 3 my legs started to feel more normal. I walked normally; my legs responded in the normal time. Previously I felt like my upper body was leaning forward and my legs were catching up, way back. Very strange sensation and very unpleasant. Now I felt like I was walking normally, albeit a little slower.

Please note, this is NOT muscle pain due to overdoing it, due to a heavy training. I’ve been a gym junkie my entire adult life. I know what sore muscles in the gym feel like. I’ve had DOMs and the cliche ‘can’t lower yourself onto the toilet because it hurts too much’. I know what it feels like when you’ve been working hard in the gym and overtraining your muscles.

This was NOT that.

This was something completely different. Something I’ve never felt before.

And it took three days for me to feel vaguely normal.

Those three statements were incredibly painful, and I was completely disabled for most of that time. It was a wake-up call.

I made a big mistake.

So.

Solution? Lighten the weight. Reduce the reps. And try again.

I’ve tried. I have failed. I felt terrible. I felt depressed.

So.

I went to my physio because I need support with this. The whole experience was very disappointing, disturbing even. Frustrating too. And even though I knew what to do, I knew how to do it, I didn’t do it right.

I realized I needed some advice, with a dose of support and encouragement. Quality advice. I knew my physio would give me all that.

He gave me two options: do it the easy way. Return it immediately to a small load. Try to do 5 reps, one set of everything. And only increased once every two weeks. And then increase the tax by 10%.

Or do it the hard way. Start with 5 reps, but do 2 sets. If that goes well, increase by 10-20% every week. Whatever makes sense with the weights I use. If things aren’t going well, reduce the weight. And look what happens.

Option one has the advantage that it causes absolutely NO pain. Because I can certainly do very light loads. I know it won’t leave me on the couch for two to three days, it won’t disable me and it won’t hurt. But the downside is that it will be very slow. Working slowly to find my baseline could take weeks from now. Many weeks.

As we know, I am a very impatient person.

Option 2 can cause pain. It might be too much. It may mean that you have to lie on the couch again for a day or two. While this would be very disappointing, my natural optimism (and perhaps my habit of overestimating my abilities) tells me I want to do it this way. If it’s too much, I wait until the pain goes away and reduce it by 20%. And try again.

So today I’m starting over.

I’m going to do the same upper body. It was fine. I might even increase it a bit.

However, the lower body will be much, much less. There will be 2 sets of each.

Squats – 5 reps

Lunges – 5 reps per leg

Romanian deadlifts – 10 kg

Calf raises – 5 reps

Step-ups – 5 per leg

And then I’ll see how I can handle it. This is about a quarter of what I was doing before, even less. So I hope this doesn’t cause me any severe pain. A little pain is fine. And to be expected. Maybe even appreciated as a sign of progress.

But we’ll see.

I keep notes on what’s happening and how I’m going. It should be interesting.

Above all, I will be honest. This is a challenge, and I’ve messed up before. And now I’m trying again, with the support of my physiotherapist.

I don’t want people to think this is a walk in the park, it’s not. It’s a serious undertaking and I hope it will help me maintain muscle strength in my arms and legs. It will take a lot of energy, it will reduce my upright hours, hours of which I currently have too little. And it may not help. But in the worst case even if it doesn’t help. At least I’ll feel like I did everything I could to avoid muscle wasting and further disability.

In four weeks I will go back to the physio to see how I am doing. I will also post progress reports here.

I don’t want people to think this is easy. It’s not. But it IS feasible. And it IS worth it.

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