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Chapter-042 Rheumatoid Arthritis

BOOK TITLE: Ramamurthy's Decision Making in Pain Management: An Algorithmic Approach

Author
1. MS Eckmann
ISBN
9789386261458
DOI
10.5005/jp/books/14128_43
Edition
3/e
Publishing Year
2018
Pages
2
Author Affiliations
1. UT Health San Antonio, San Antonio, TX, USA
Chapter keywords
Rheumatoid arthritis, RA, erythrocyte sedimentation rate, ESR, C-reactive protein, CRP, rheumatoid factor, ACPA, NSAID

Abstract

This chapter describes about the rheumatoid arthritis (RA). RA is a systemic autoimmune disorder that stems from a breakdown in self-tolerance which can be promoted by environmental factors like smoking. Pain in RA patients is highly correlated with psychological stress relating to fears of debility, loss of self-image, and change in lifestyle. Education and counseling has been shown to reduce pain by up to 19% in this population. Nonsteroidal anti-inflammatory drugs (NSAIDs) are initial pharmacologic treatment for pain from RA, though they are limited by gastrointestinal (GI) and renal side effects. Noninvasive modalities for treating RA pain have been attempted, including hydrotherapy, transcutaneous nerve stimulation, paraffin dips, diathermy, ultrasound application, fluidotherapy, hot packs, and ice. The success of these treatments was largely based on patient satisfaction. More than 90% of patients with severe, incapacitating RA have shown excellent pain relief following total hip or knee replacement. Surgery should be entertained as an option whenever the patient has intractable pain, severe deformity, or joint instability.

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