Managing Arthritis is More Than Treating Pain
The goal of treatment is to prevent long-term joint and organ damage.
All you can think about is being able to walk, bend and reach without joint pain. While that directly impacts your daily life, managing your arthritis is about more than just pain relief.
“Pain relief certainly shows that you are on the right track,” says Eric Matteson, MD, professor of medicine and rheumatologist at Mayo Clinic in Rochester, Minnesota. “There is often more that can be done to cool underlying, systemic inflammation and help prevent long-term damage to the joints and other organs that can occur with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS).”
A complete arthritis treatment plan eases pain and inflammation, slows joint and organ damage, and improves physical function and quality of life.
Reach for Remission
Rather than just soothing pain and allowing you to “get by,” doctors have the tools and medicines available to completely quiet many types of inflammatory arthritis. When your symptoms are nearly gone and the doctor says your joints aren’t inflamed anymore, that’s called remission.
If you start treating the disease as soon as you find out you have it, and if you keep taking the medicines your doctor prescribes, you can go into remission. When treated early with DMARDs and biologics, remission rates can be as high as 60% — and sometimes even higher. Even if you don’t get all the way down to zero symptoms, you will have less pain, be able to move better, have a good quality of life, and your chances of developing other problems like heart disease will be less.
Some doctors use a strategy called treat-to-target when working with you to come up with a treatment plan. The idea is that you and your doctor work closely together to decide on a goal (the ideal goal is low disease activity or remission) and a plan to reach that goal. You then have regular checkups to see how you’re doing (every 3 months, for example). Your doctor will adjust your medicines and other treatments until you reach your goal.
There are many ways to measure your disease activity during those checkups. David Pisetsky, MD, PhD, a professor of medicine and immunology and chief of rheumatology at Duke University Medical Center in Durham, North Carolina, says, “We can get inflammation down so people feel no pain, but this doesn’t tell the full story. When inflammation levels are high, it’s easy to see damage on X-rays, but when levels are low, it is more difficult to know what is going on.”
Blood tests like erythrocyte sedimentation rate (ESR or “sed rate”) and C-reactive protein (CRP) measure body-wide inflammation. However, they are not sensitive enough to pick up lower activity that may still be harming your joints and organs. Newer tests (such as Vectra DA) look at many markers to come up with a total disease score. Dr. Pisetsky says doctors are looking at those to see which can best measure low disease activity.
Lifestyle Changes Matter Too
Medicines don’t work on their own. Any medicine will work better if you combine it with lifestyle changes. Losing weight (when needed), keeping your cholesterol and blood pressure under control, and stopping smoking will all improve your health and quality of life.
Physical and occupational therapy, exercise, disease education, and complementary therapies can all be part of your total arthritis wellness plan. Dr. Matteson says, “Combining all, or most, of these elements in your personalized arthritis treatment plan and checking in with your rheumatologist regularly to monitor progress remain the best ways to take back your health and stay pain-free.”
Sticking to Your Medicine Plan Matters
Even if you start to feel better or don’t like medication side effects, and you want to stop taking a medication, don’t. Low-level inflammation throughout your body may still be causing joint and organ damage. It’s important to stick with your treatment plan and talk to your doctor about your concerns. If you don’t take your medicine, your doctor won’t know what is or is not working so she won’t know when or how to switch your medications.
Don’t Settle for “Good Enough”
“What happens is that people achieve a level of tolerable pain, meaning that they can deal with it and live their lives,” says Dr. Pisetsky. “Yes, they could do better, but they are getting along OK and are grateful for that.”
Until you reach low disease activity or remission, don’t give up. You don’t need to settle for just getting by – and you shouldn’t let your doctor either. Just because you feel “okay” doesn’t mean your disease is under control. Keep working with your doctor to find a treatment that eliminates your inflammation and pain.