What is Rheumatoid Arthritis?
Rheumatoid arthritis is a debilitating form of arthritis that is caused by the body’s own defenses. In patients with autoimmune diseases like rheumatoid arthritis, the immune system, which is designed to protect the body from foreign invaders, gets confused and starts to attack healthy tissue; in the case of rheumatoid arthritis, the immune system attacks otherwise healthy joints. This afront by the immune system causes inflammation that destroys cartilage and the synovium, a tough capsule surrounding a joint that, together with the synovial fluid, holds it in place.
Symptoms of Rheumatoid Arthritis
One of the most obvious signs of rheumatoid arthritis is a recurrent, constant pain in the joints. This pain is often accompanied by swelling, stiffness, and muscle pain in the musculature surrounding a joint. Other common symptoms of rheumatoid arthritis include severe fatigue, mild fever, loss of appetite, changes to the skin and nails, and anemia. If left untreated, rheumatoid arthritis will only worsen.
What is Synovial Fluid?
Synovial fluid is a gel-like fluid that fills most of the joints of the body. It is encapsulated in and created by the synovium, which surrounds the joints and helps stabilize all of its components. It is a clear, slightly viscous fluid that lubricates the joint and allows it to move freely throughout its entire range of motion. Synovial fluid is also important because it is the medium through which oxygen and other nutrients are delivered to the cartilage, which does not have a blood supply of its own.
How Does Too Much Synovial Fluid Cause Rheumatoid Arthritis Pain?
As rheumatoid arthritis progresses, the synovium, which produces synovial fluid, swells and thickens, producing an excess of synovial fluid. This, in turn, leads to further swelling and inflammation which causes pain and stiffness in the joint. The excess of synovial fluid also has long-term consequences, as the accumulation stretches out the synovium, which helps hold a joint together. Once the swelling subsides, the synovium stays stretched out, making the joint far less stable.
Treatment Options for Pain Management in Rheumatoid Arthritis
Because there is no known cure for rheumatoid arthritis, all of the treatment options available to sufferers are aimed at controlling the pain associated with the condition. The other, secondary goals of treatment are to reduce inflammation, minimize the damage to the joint, and increase the mobility of the joint as much as possible.
Some of the therapies most often used in the treatment of rheumatoid arthritis include:
Physical therapy is the first-line treatment for joint pain. It includes a variety of strengthening, stretching, and cardiovascular exercises that work together to help strengthen and stabilize the joint in pain. Physical therapy has a very good track record of helping control joint pain and has the added benefit of helping overall health by improving cardiovascular health and total body strength.
There are a number of creams that can be rubbed into a painful joint to provide immediate relief from joint pain. These generally include ingredients like capsaicin, menthol, or salicylates, which work by warming the joint to attract blood and promote healing. While this relief is short-term, topical creams can be safely used for a long period of time, so they can be used for as long as they provide relief.
Opioid and non-opioid pain medication can be used to reduce or eliminate joint pain. While there is increased scrutiny being placed on the long-term administration of opioid pain medications, the treatment absolutely can be used in certain situations. And other, non-opioid, pain medications like Tylenol, non-steroidal anti-inflammatory drugs (NSAIDs), or steroids can also be used to reduce inflammation and control joint pain.
Massage is a very popular complementary therapy that aims to use soft tissue manipulation to reduce pain and inflammation in the muscles that support the spine. There are a number of different kinds of massage, including deep tissue, Swedish, relaxation, and trigger point, each of which can be used to target specific types of pain.
Acupuncture is a complementary treatment modality that has been used for centuries in traditional Chinese medicine and has emerged as a popular therapy in the West in the last twenty to thirty years. The goal of acupuncture is balancing the extremes—“yin” and “yang”—of “qi,” the body’s life force. This is accomplished using strategically placed needles along the meridians, pathways through which “qi” flows through the body.
There are a number of pain management injections that can be used to treat joint pain. These include steroid injections, and trigger point injections. These injections seek to reduce or eliminate joint pain by either blocking pain signals from the joint or helping to repair or replace the damaged soft tissues that help cushion the joint space.
Platelet-rich Plasma (PRP) Therapy
Platelet-rich plasma therapy is a regenerative medicine procedure that uses the body’s own platelets, coupled with their healing growth factors, to promote healing in a damaged joint. A PRP injection is created by drawing blood and processing it in a centrifuge to get an injection with a much higher concentration of platelets than would normally be present. This preparation is then injected into the joint space under imaging guidance to promote healing in the damaged cartilage.
Radiofrequency ablation is a pain management procedure that uses high-frequency sound waves to ablate, or burn, the nerves that relay pain signals from a joint to the brain. Once ablated, these nerves are no longer able to relay pain signals, which provides significant joint pain relief.