Counseling Points - March 2008 - (Page 4)

Introduction Rheumatoid arthritis (RA) is a chronic, immune-mediated, inflammatory disease that has no known cure. The disorder primarily affects the joints and often manifests as a systemic illness involving a variety of organ systems.1 Because joint destruction begins within a few weeks of symptom onset, early diagnosis and treatment are crucial to decrease impairment of physical function and halt disease progression. A delay in therapy of as little as 3 months has been demonstrated to cause irreversible joint damage.2,3 Optimal treatment involves a comprehensive program that includes pharmacological as well as nonpharmacological modalities aimed at reducing pain and discomfort, preventing deformities and loss of joint function, and maintaining a productive and active life.3 Electrical Stimulation Electrical stimulation is often used to relieve RA joint pain. The most commonly applied method of electroanalgesia is transcutaneous electrical nerve stimulation (TENS). This therapy utilizes low-voltage electrical current for pain relief. Electrodes are placed on the area of pain or at a pressure point, creating a circuit of electrical impulses that travels along nerve fibers. While TENS has been demonstrated to effectively alleviate RA pain, it only provides short-term (6 to 24 hours) relief.4 Hydrotherapy/Balneotherapy Hydrotherapy/balneotherapy is one of the oldest forms of treatment for arthritic pain. RA patients bathe in warm water that may include minerals and/or aromatherapy herbs. The objective of balneotherapy is to increase range of motion (ROM), improve muscle strength, and relieve muscular spasms. Although there is a lack of robust scientific evidence about this modality of treatment, it has been reported to increase muscle, tendon, and ligament relaxation, and promote overall well-being.5 Nonpharmacological Treatment Strategies A variety of nonpharmocological treatment approaches have been investigated to manage the symptoms of RA and improve overall well-being for patients (Table 1). Table 1. Common Nonpharmacological RA Treatment Modalities Physical Therapy Approaches Hot/cold applications Rehabilitation Patient education • general • specific Patient support groups Patient resource/materials Behavior modification Relaxation techniques Stress management Complementary/Alternative Medicine Botanicals Orthopedic Surgery Reconstruction • tendon • ligament Arthroplasty Electrical stimulation TENS Vitamin/minerals dosing in unconventional amounts Dietary approaches Balms/liniments Magnets Acupuncture Hydro/balneotherapy (spa therapy) Therapeutic exercise Rest Low-level laser therapy Synovectomy Osteotomy Joint debridement Decompression • spinal cord • peripheral nerve Assistive devices • splints • orthoses • household modification • home/work/walking devices Meditation Tai chi Yoga Prayer for health purposes Massage Chinese medicine Homeopathy Chiropractic TENS=transcutaneous electrical nerve stimulation. COUNSELING POINTS™ 4

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Counseling Points - March 2008 Welcome Pharmacological and Nonpharmacological Treatment of Rheumatoid Arthritis

Counseling Points - March 2008

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