Rheumatoid arthritis: progression and pain

As rheumatoid arthritis progresses, the growing synovial membrane spreads and eventually covers the top of the joint cartilage. Fortunately, today's disease-modifying anti-rheumatic drugs can prevent crippling and disability in many cases — if treatment begins early enough.

No two cases of RA proceed in exactly the same way. In fact, experts stress that RA's course in any patient is quite unpredictable. But they have identified four basic ways that the disease progresses — or, in some cases, doesn't.

1. In a few people — perhaps around ten percent who develop it — RA is a temporary problem: These people experience a spontaneous and lasting remission that can't be attributed to any treatment they might be undergoing. When they happen, these spontaneous remissions usually occur within the first two years that people have RA. Another ten percent of RA patients experience remissions, but the disease recurs later.
2. In the second type of RA, patients experience periodic flare-ups — weeks or months of painful, stiff and swollen joints — that alternate with intervals of normal health. Their treatment will depend on whether their joints are damaged during the flare-ups and how well their joints function between flare-ups.
3. In the third type of RA, known as remitting-progressive, patients experience periodic flare-ups without returning to normal health between the attacks. Instead, during the periods between attacks, they have lingering joint inflammation that becomes increasingly more severe with each attack. If it isn't treated properly, remitting-progressive RA can eventually lead to significant joint damage.
4. The fourth type is called progressive RA, which is self-explanatory: The inflammation becomes more severe over time and causes gradually increasing pain, swelling, and — if severe inflammation lasts long enough — joint damage and disability.

• The key is learning how to adjust to a flare without giving in to it.
• When a flare comes on, you'll want to give yourself more rest and protect the inflamed joints from further exertion.
• On the other hand, overprotecting a joint can be counterproductive, since long periods of inactivity can cause the muscles and tendons around a joint to weaken.
• You may also want to consult with your doctor about adjusting your medication in response to a flare.
• Unfortunately, flares are an unavoidable part of arthritis. But knowing you can manage these periodic crises means you don't have to live in dread of them.
• Until the late 1980s, doctors believed that early RA could be managed exclusively with NSAIDs and that disease-modifying anti-rheumatic drugs (DMARDs) weren't needed until joint damage showed up on X-rays.
• They later realized that permanent joint damage can occur even in the first months of RA — despite the use of NSAIDs and long before damage can be seen on X-rays.
• Now, experts agree that use of DMARDs should begin almost as soon as RA is diagnosed.