In recent years, tremendous strides in understanding how RA develops has led to the development of targeted therapies.
The aggressive use of disease-modifying anti-rheumatic drugs (DMARDS) such as methotrexate, in combination with biologic therapies has resulted in sustained effectiveness, improved tolerability, and better response levels. The result has been a significant reduction in joint damage and work-related disability.
Remission is now the norm rather than the exception in patients who are seen early. The concept of a narrow window of opportunity- usually the first 3 to 6 months of disease- where aggressive therapy can prevent deformity and disability has also been recognized as a major reason for the improved prognosis.
Despite these advances, several problems still remain. A large number of patients stop treatment for a variety of reasons including lack of response and side effects. It is unclear whether the new drugs being used can actually help joint damage to heal. Long-term side effects also remain a concern.
So how do rheumatologists make the decision to change therapy?
The first question that needs to be resolved is "what is an inadequate response?" The definition is not an easy one.
There are actually three answers. The first is what is called primary failure where the drug doesn't lead to any kind of improvement right from the outset. Secondary failure occurs when the drug works initially but then over time, the beneficial effects fade. Finally there are side effects and other toxicity issues to consider.
Another very important factor is the patient's own feelings as to how they are doing. What are considered are both pain relief as well as ability to function with activities of daily living.
Added to this mix is the result of different imaging modalities such as magnetic resonance imaging, ultrasound, and plain x-ray. Of these three, plain x-ray is the least sensitive and least useful method.
Laboratory parameters that measure systemic inflammation such as the erythrocyte sedimentation rate (ESR) and C-reactive protein are also used in decision-making.
Some rheumatologists advocate the use of measuring devices of disease activity. They have the following names: Disease Activity Score (DAS), Disease Activity Index (DAI), and Global Arthritis Score(GAS). These measuring devices all involve analyzing different disease parameters, scoring them, then coming up with a number. The higher the number or score, the worse the patient is doing. These different scoring methodologies have a few things in common. They usually incorporate some count of swollen and tender joints. They also usually require adding in one of the laboratory measures of inflammation. Some also add in the results of a patient's Health Assessment Questionnaire. This latter item tallies the patient's ability to perform routine daily activities. Finally some methods also incorporate a patient self-assessment.
There is no consensus as far as which tool is the best to use. There is growing interest though in using the tools more often than they are being used now. Stay tuned.
Rheumatoid Arthritis Alternative Treatments
When you are diagnosed with rheumatoid arthritis you start of with medicine and treatments your doctor prescribes for you, some of these remedies will work for you while others have so many side effects that it is worse then the illness itself. usually it takes people one ore two years in the regular health care before they start looking for other remedies. A rheumatoid arthritis diet is one of these alternative remedies we want to inform you about.
Of course the symptoms vary, rheumatoid arthritis is a disease where people react totally different to the disease itself but also to the medicine. Some people have severe pains every day and others have mild pain but do have very inflamed joints. Also the way they react to medication can be completely different. Some really have very good results with the prescription drug their doctor gave them while others have severe side effects. All of this is because rheumatoid arthritis is an illness of the immune system and people have a tendency to react different to it.
Is rheumatoid arthritis diet an alternative to regular treatment?
People usually only start looking at alternatives when the regular treatment is not working or the side effects are to severe. A rheumatoid arthritis diet is such an alternative. There has always been much discussion about rheumatoid arthritis diets although you should not see it as a diet in the traditional sense. In fact it is just a list of foods that you should avoid and a list that most people have good results with. But just as with the regular treatments, rheumatoid arthritis diet is something you should experiment with a little. Regular doctors usually do not recommend a rheumatoid arthritis diet because they say it is never proved to be effective and everybody reacts different on it, they are right people do react different on it but they also react different on the regular prescription drugs. So that is a lousy argument especially when you know how many people are suffering from this disease.
It is a diet that you should discus with your doctor because the diet increases the intake of omega-3 fatty acids and as the name already said this can be an increasing of the total amount of fat. We say it can be, because if you look at the other recommendations fresh vegetables and fruits and the things you should avoid the total amount of fat can be much less than your regular diet depending on what you are eating right now. Fatty acids, omega-3, can be found in soybean oil, fish oil, walnuts, avocado oil, walnuts and canola oil.
This might seem like a large amount of fats but these fats are in the food you eat, fish oil can be eaten in many fatty fish like salmon and many other fish. And because you avoid fats from fried and processed foods you will probably eat less fat in total. you should also avoid alcohol and coffee
A healthy weight is also important
There is one aspect on a rheumatoid arthritis diet that your doctor would agree with, you have to become and stay on a healthy weight. So its is not the list of foods where there is an agreement about but the fact that with a good healthy weight your rheumatoid arthritis symptoms will be much less and that is a good thing to remember in a world with people who are getting more and more obese.
Both Nathan Wei & Jonathan Mitchell are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.
Nathan Wei has sinced written about articles on various topics from Arthritis Pain, Health and Arthritis Signs. Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info:. Nathan Wei's top article generates over 550000 views. to your Favourites.
Jonathan Mitchell has sinced written about articles on various topics from Arthritis Signs, Hair Loss and Arthritis Signs. Jonathan Mitchell knows from personal experience what it means to wake up with pain. On his blog he tells you about subjects ranging from. Jonathan Mitchell's top article generates over 3600 views. to your Favourites.
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