In allopathy, two classes of drugs are used in treating rheumatoid arthritis: fast-acting “first-line drugs” and slow-acting “second-line drugs” (also referred to as disease-modifying antirheumatic drugs or DMARDs).

• The first-line drugs, such as aspirin and cortisone (corticosteroids [Rayos, Celestone, Depo-Medrol, Kenalog]), are used to reduce pain and inflammation.
• The slow-acting second-line drugs, for example methotrexate and hydroxychloroquine (Plaquenil), promote disease remission and prevent progressive joint destruction.

The degree of the destructiveness of RA varies among affected individuals. Those with less destructive RA or disease that has quieted after many active years can manage their RA with rest plus pain control and anti-inflammatory drugs. Early treatment with second-line drugs (DMARD) improves function and minimizes disability and joint destruction, even within months of the diagnosis. Most people require more aggressive second-line drugs, such as methotrexate, in addition to anti-inflammatory agents. Sometimes these second-line drugs are used in combination.

• The areas of the body other than the joints that are affected by rheumatoid inflammation are treated individually. Sjögren’s syndrome can be helped by artificial tears and humidifying rooms in the home or office. Medicated eye drops such as cyclosporine ophthalmic drops and lifitegrast ophthalmic drops (Xiidra) are also available to help the dry eyes in those affected. Regular eye checkups and early antibiotic treatment for infection of the eyes are important. Inflammation of the tendons (tendinitis), bursae (bursitis), and rheumatoid nodules can be injected with cortisone. Inflammation of the lining of the heart and/or lungs may require high doses of oral cortisone.
• In some cases, with severe joint deformity, surgery may be recommended to restore joint mobility or repair damaged joints. Doctors who specialize in joint surgery are orthopedic surgeons. The types of joint surgery range from arthroscopy to partial and complete replacement of the joint. Arthroscopy is a surgical technique whereby a doctor inserts a tube-like instrument into the joint to see and repair abnormal tissues.
• Total joint replacement is a surgical procedure whereby a destroyed joint is replaced with artificial materials. For example, the small joints of the hand can be replaced with plastic material. Large joints, such as the hips or knees, are replaced with metals.

Acetylsalicylate (aspirin), naproxen, ibuprofen, etodolac, and diclofenac are examples of non-steroidal anti-inflammatory drugs (NSAIDs).

NSAIDs are medicines that can reduce tissue inflammation, pain, and swelling.

NSAIDs are not cortisone. Aspirin, in doses higher than those used in treating headaches and fever, is an effective anti-inflammatory medication for rheumatoid arthritis.

Aspirin has been used for joint problems since the ancient Egyptian era.

The newer NSAIDs are just as effective as aspirin in reducing inflammation and pain and require fewer doses per day.

Patients’ responses to different NSAID medicines vary. Therefore, it is not unusual for a medical professional to try several NSAID drugs in order to identify the most effective agent with the fewest side effects.

The most common side effects of aspirin and other NSAIDs include stomach upset, abdominal pain, ulcers, and even gastrointestinal bleeding.

In order to reduce gastrointestinal side effects, NSAIDs are usually taken with food. Additional medicines are frequently recommended to protect the stomach from the ulcer effects of NSAIDs.

These medicines include antacids, sucralfate, proton-pump inhibitors (Prevacid and others), and misoprostol.

Newer NSAIDs include selective Cox-2 inhibitors, such as celecoxib, which offer anti-inflammatory effects with less risk of stomach irritation and bleeding risk.

Corticosteroid medicines can be given orally or injected directly into joints (intra-articular injections) and tissues. They are more potent than NSAIDs in reducing inflammation and in restoring joint mobility and function.

Corticosteroids are useful for short periods during severe flares of disease activity or when the disease is not responding to NSAIDs.

However, corticosteroids can have serious side effects, especially when given in high doses for long periods of time.

These side effects include weight gain, facial puffiness, thinning of the skin and bone, easy bruising, cataracts, risk of infection, muscle wasting, and destruction of large joints, such as the hips.

Corticosteroids also carry an increased risk of contracting infections.

These side effects can be partially avoided by gradually tapering the doses of corticosteroids as the patient achieves improvement in symptoms.

Abruptly discontinuing corticosteroids can lead to flares of the disease or other symptoms of corticosteroid withdrawal and is discouraged.

Thinning of the bones due to osteoporosis may be prevented by calcium and vitamin D supplements.

16 Early Rheumatoid Arthritis (RA) Signs & Symptoms

While early signs and symptoms of RA can be mimicked by other diseases, the warning signs and symptoms are very characteristic of rheumatoid disease. The 16 early RA symptoms and signs discussed in this article include the following:

1. Fatigue.
2. Joint pain.
3. Joint tenderness.
4. Joint swelling.
5. Joint redness.
6. Joint warmth.
7. Joint stiffness.
8. Loss of joint range of motion.
9. Many joints affected (polyarthritis).
10. Limping.
11. Joint deformity.
12. Both sides of the body affected (symmetric).
13. Loss of joint function.
14. Anemia.
15. Fever.
16. Depression.

RA symptoms come and go, depending on the degree of tissue inflammation. When body tissues are inflamed, the disease is active. When tissue inflammation subsides, the disease is inactive (in remission).

Remissions can occur spontaneously or with treatment and can last weeks, months, or years. During remissions, symptoms of the disease disappear, and people generally feel well. When the disease becomes active again (relapse), symptoms return. The return of disease activity and symptoms is called a flare.

The course of rheumatoid arthritis varies among affected individuals, and periods of flares and remissions are typical.

What does rheumatoid arthritis feel like?

When the disease is active, RA symptoms and signs can include:

• fatigue,
• loss of energy,
• lack of appetite,
• low-grade fever,
• muscle and joint pain,
• joint redness,
• joint swelling,
• joint tenderness,
• joint warmth,
• joint deformity,
• rheumatoid nodules,
• stiffness,
• loss of joint range of motion,
• loss of joint function, and
• limping.

People with active inflammation of joints from RA can also experience:

• depression,
• anemia
• frustration, and
• social withdrawal.

Muscle and joint stiffness are usually most notable in the morning and after periods of inactivity. This is referred to as morning stiffness and post-sedentary stiffness. Arthritis is common during disease flares. Also, during flares, joints frequently become warm, red, swollen, painful, and tender. This occurs because the lining tissue of the joint (synovium) becomes inflamed, resulting in the production of excessive joint fluid (synovial fluid). The synovium also thickens with inflammation (synovitis).

Rheumatoid arthritis usually inflames multiple joints and affects both sides of the body. In its most common form, therefore, it is referred to as asymmetric polyarthritis.

• Early rheumatoid arthritis symptoms may be subtle.
• The small joints of both the hands and wrists are often involved.
• Early symptoms of RA can be painful and prolonged stiffness of joints, particularly in the morning.
• Symptoms in the hands with rheumatoid arthritis include difficulty with simple tasks of daily living, such as turning doorknobs and opening jars.
• The small joints of the feet are also commonly involved, which can lead to painful walking, especially in the morning after arising from bed.
• Occasionally, only one joint is inflamed. When only one joint is involved, arthritis can mimic the joint inflammation caused by other forms of arthritis, such as gout or joint infection.
• Chronic inflammation can cause damage to body tissues, including cartilage and bone. This leads to a loss of cartilage and erosion and weakness of the bones as well as the muscles, resulting in joint deformity, loss of range of motion, destruction, and loss of function.
• Rarely, rheumatoid arthritis can even affect the joint that is responsible for the tightening of our vocal cords to change the tone of our voice, the cricoarytenoid joint. When this joint is inflamed, it can cause hoarseness of the voice.
• Symptoms in children with rheumatoid arthritis include limping, irritability, crying, and poor appetite.

Diagnosis

There is no singular test for diagnosing rheumatoid arthritis. The diagnosis is based on the clinical presentation. Ultimately, rheumatoid arthritis is diagnosed based on a combination of the following:

• Presentation of the joints involved.
• Characteristic joint swelling and stiffness in the morning.
• The presence of blood rheumatoid factor (RF blood test or RA test) and citrulline antibody.
• The presence of rheumatoid nodules and radiographic changes (X-ray testing).

Understand that many forms of joint disease mimic rheumatoid arthritis.

• The first step in the diagnosis of rheumatoid arthritis is a meeting between the doctor and the patient. The doctor reviews the history of symptoms. Then the doctor checks the joints for inflammation, tenderness, swelling, and deformity and looks for rheumatoid skin nodules. Rheumatoid nodules are firm lumps or bumps under the skin, most commonly over the elbows or fingers). The doctor will also check other parts of the body for inflammation. Certain blood and X-ray tests are often obtained. The diagnosis will be based on the pattern of symptoms, the distribution of the inflamed joints, and the blood and X-ray findings. Several visits may be necessary before the doctor can be certain of the diagnosis.
• Joint inflammation helps to distinguish rheumatoid arthritis from common types of arthritis that are not inflammatory, such as osteoarthritis or degenerative arthritis. The distribution of joint inflammation is also important to the doctor in making a diagnosis. In rheumatoid arthritis, the small joints of the hands and fingers, wrists, feet, and knees are typically inflamed in a symmetrical distribution (affecting both sides of the body). When only one or two joints are inflamed, the diagnosis of rheumatoid arthritis becomes more difficult. The doctor may then perform other tests to exclude arthritis due to infection or gout. The detection of rheumatoid nodules (described above), most often around the elbows and fingers, can suggest the diagnosis.
• Abnormal antibodies can be found in the blood of people with rheumatoid arthritis with simple blood testing. An antibody called “rheumatoid factor” (RF) can be found in 80% of patients with rheumatoid arthritis. Patients with rheumatoid arthritis and rheumatoid factor are referred to as having “seropositive rheumatoid arthritis.” Patients who are felt to have rheumatoid arthritis and do not have positive rheumatoid factor testing are referred to as having “seronegative rheumatoid arthritis.”
• Citrulline antibody (also referred to as anti-citrulline antibody, anti-cyclic citrullinated peptide antibody, and anti-CCP antibody) is present in 50%-75% of people with rheumatoid arthritis. It is useful in the diagnosis of rheumatoid arthritis when evaluating cases of unexplained joint inflammation. A test for anti-citrullinated protein antibodies helps in looking for the cause of previously undiagnosed inflammatory arthritis when the rheumatoid factor is not present. Citrulline antibodies have been felt to represent the earlier stages of rheumatoid arthritis in this setting. Citrulline antibodies also have been associated with more aggressive forms of rheumatoid arthritis. Another antibody called the “antinuclear antibody” (ANA) is also frequently found in people with rheumatoid arthritis.
• It should be noted that many forms of arthritis in childhood (juvenile inflammatory arthritis) are not associated with blood test positivity for rheumatoid factors. In this setting, juvenile rheumatoid arthritis must be distinguished from other types of joint inflammation. These include plant thorn arthritis, joint injury, arthritis of inflammatory bowel disease, and rarely joint tumors.
• A blood test called the erythrocyte sedimentation rate (sed rate) is a crude measure of the inflammation of the joints. The sed rate measures how fast red blood cells fall to the bottom of a test tube. The sed rate is usually faster (high) during disease flares and slower (low) during remissions. Another blood test that is used to measure the degree of inflammation present in the body is the C-reactive protein (CRP). Blood testing may also reveal anemia, since anemia is common in rheumatoid arthritis, particularly because of chronic inflammation.
• The rheumatoid factor, ANA, sed rate, and C-reactive protein (CRP) tests can also be abnormal in other systemic autoimmune and inflammatory medical conditions. Therefore, abnormalities in these blood tests alone are not sufficient for a firm diagnosis of rheumatoid arthritis.
• Joint X-rays may be normal or only show swelling of soft tissues early in the disease. As the disease progresses, X-rays can reveal bony erosions typical of rheumatoid arthritis in the joints. Joint X-rays can also help monitor the progression of the disease and joint damage over time. Bone scanning, a procedure using a small amount of a radioactive substance, can also be used to show inflamed joints. MRI scanning can also be used to show joint damage.
• The doctor may elect to perform an office procedure called arthrocentesis. In this procedure, a sterile needle and syringe are used to drain joint fluid out of the joint for study in the laboratory. Analysis of the joint fluid in the laboratory can help to exclude other causes of arthritis, such as infection and gout. Arthrocentesis can also help relieve joint swelling and pain. Occasionally, cortisone medicines are injected into the joint during arthrocentesis to rapidly relieve joint inflammation and further reduce symptoms.

Stages of rheumatoid arthritis

The American College of Rheumatology has developed a system for classifying rheumatoid arthritis that is primarily based on the X-ray appearance of the joints. This system helps medical professionals classify the severity of your rheumatoid arthritis concerning cartilage, ligaments, and bone. The system defines the four stages of RA as follows:

Stage I (early RA)

• No damage was seen on X-rays, although there may be signs of bone thinning

Stage II (moderate progressive)

• On X-ray, evidence of bone thinning around a joint with or without slight bone damage
• Slight cartilage damage is possible
• Joint mobility may be limited; no joint deformities were observed
• Atrophy of adjacent muscle
• Abnormalities of soft tissue around the joint are possible

Stage III (severe progression)

• On X-ray, evidence of cartilage and bone damage and bone thinning around the joint
• Joint deformity without permanent stiffening or fixation of the joint
• Extensive muscle atrophy
• Abnormalities of soft tissue around the joint are possible

Stage IV (terminal progression)

• On X-ray, evidence of cartilage and bone damage and osteoporosis around joint.
• Joint deformity with permanent fixation of the joint (referred to as ankylosis).
• Extensive muscle atrophy.
• Abnormalities of soft tissue around the joint are possible.

Rheumatologists also classify the functional status of people with rheumatoid arthritis as follows:

• Class I: completely able to perform usual activities of daily living.
• Class II: able to perform usual self-care and work activities but limited in activities outside of work (such as playing sports, and household chores).
• Class III: able to perform usual self-care activities but limited in work and other activities.
• Class IV: limited in ability to perform usual self-care, work, and other activities.

There is no known cure for rheumatoid arthritis in allopathy.

To date, the goal of allopathic treatment in rheumatoid arthritis is to reduce joint inflammation and pain, maximize joint function, and prevent joint destruction and deformity. Early medical intervention has been shown to be important in improving outcomes. Aggressive management can improve function, stop damage to joints as monitored on X-rays and prevent work disability.

Optimal RA treatment involves a combination of medicines, rest, joint-strengthening exercises, joint protection, and patient (and family) education. Treatment is customized according to many factors such as disease activity, types of joints involved, general health, age, and patient occupation. RA treatment is most successful when there is close cooperation between the doctor, patient, and family members.

Homeopathic treatment for Rheumatoid Arthritis

Rhus toxicodendron

Pains – tearing pains relieved by motion, worse from sitting and worse when rising from a sitting position, or on first commencing to move; relieves when warm. Damp weather, cold and the approach of storms aggravate.

The character of the Rhus tox pains is “stiffness and soreness”, paralyzed sensation, and even stitches, sprains, wrenches, etc.

Ledum palustre

Ledum Paul is a best choice for arthritis and gout. The great symptom is – acute, tearing pains in the joints; weakness of the limbs and numbness and coldness of the surface; Pain going from below upwards; Pain in small joints; Nodes form in them and the pains travel up the limbs. The pains are made worse from warmth. The effusion into the joints is scanty and it soon hardens and forms the nodosities.

Calcarea Carbonica

It is an important medicines for Osteoarthritis especially of knee joints. There is mild swelling and pain in the deeper portion of the joint, pain generally worse in cold damp weather.

Like Rhus tox in Calcarea carb the pain is also aggravated when getting up from a sitting position and also by walking. Best for fatty and obese constitutionally and tendency to catch cold easily – patients.

Rhododendron

Rheumatic pains which wander from joint to joint with swelling, worse before or during thunderstorm, cold or wet or unsettled weather. Better from warm wrapping. Enlargement of joints not due to gouty deposits but – Arthritic nodes.

Kalmia Latifolia

Kalmia have wandering pains, and it is especially useful in pains affecting the chest i.e. the cost chondral articulation. It has also tearing pain in legs, without swelling; neuralgic type of pain. The pain from the chest portion shoot down into the stomach and abdomen (could be cardiac pain). Sometimes the pain from chest traverse downwards in arm. The pain is always attended or succeeded by numbness of the part.

Colchicum

Great remedy for gout. The typical case calling for colchicum is where the swelling is red or pale, with extreme tenderness to touch, a tendency to shift about from joint to joint, and pains worse on the slightest motion. The smaller joints, fingers, toes, wrist and ankles, are affected; the pains are very violent, patient can not bear to have the parts touched or to have anyone near him, worse towards evening,  a red big toe joint – Inflamed

If the general symptoms of great prostration of the muscular system and abdominal bloating be present colchicum is the remedy.

China Officianalis

Pains in limbs and joints, sprained; worse, slight touch; relieves with hard pressure. Sensation as of a string around limb. Joints swollen; very sensitive, with dread or open air. Debility, trembling, with numb sensation. Weariness of joints; worse, mornings and when sitting.

Causticum

This is one of the primary homeopathic medicines used to treat rheumatoid arthritis when there are joint deformities. The patient weakens over time and the muscles lose strength eventually. The patient feels extremely restless during the night and the restlessness is associated mostly with the legs. Contractions in the tendons likely result in deformities and intense pain. The pain is tearing in nature. Due to weakness of the forearm muscles, the patient may not have a firm grip on anything. The pain usually improves by keeping the affected the area warm.

Caulophyllum Thalictroides

This is an effective medicine for rheumatoid arthritis. It is used when small joints are affected more, compared to the larger joints in the limbs. Arthritis of fingers. The pain keeps on changing positions all the time within a small span of time. Severe drawing, erratic pain and stiffness in small joints, fingers, toes, ankles, etc. Aching in wrists. Cutting pains on closing hands. Erratic pains changing place every few minutes. Gradually shifting pains.

Abrotanum

Limbs – Inability to move. Marasmus of lower extremities, Soreness and lameness; worse mornings. Chilblains itch; frostbitten limbs. Gout in wrists and ankles. Inflammatory rheumatism before swelling begins; metastatic rheumatism, metastasis of rheumatism from joints to heart; to spine etc.

Berberis Vulgaris

pains in the arms, Pains in the shoulder, Cramps like pains, acute pains radiates to the hand and to the fingers – Aching, digging, violent pains in the back of the hand, with sensation of heaviness. Urticarial spot on the back of the hand. Small warts in the fleshy part of the hand, under the thumb.-Sensation in the extremity of the finger, as if caused by subcutaneous ulceration. Flat wart on the finger. Redness of the hands, with itching.

Neuralgic pain under nails; tender to touch, paralysis in the knees while walking, Stitches between metatarsal bones, burning pains in the toes.

Colchicum Autumnale

This homeopathic medicine is usually required during chronic stages of rheumatoid arthritis. It affects several tissues such as periosteum, synovial membranes and other muscle tissues. Sharp pain down left arm. Tearing in limbs during warm weather, stinging during cold. Pins and needles in hands and wrists, fingertips numb. Pain in front of thigh. Right plantar reflex abolished. Limbs, lame, weak, tingling. Pain worse in evening and warm weather. Joints stiff and feverish; shifting rheumatism; pains worse at night. Inflammation of knee, gout in heel, cannot bear to have it touched or moved. Tingling in the fingernails. Knees strike together, can hardly walk. Edematous swelling and coldness of legs and feet.

Ledum Palustre

This medicine is used in the cases of rheumatoid arthritis where the rheumatoid starts in the feet and travels upwards spreading to the upper joints of the body. Gouty pains shoot all through the foot and limb, and in joints, but especially small joints. Swollen, hot, pale. Throbbing in right shoulder. Pressure in shoulder, worse motion. Cracking in joints; worse, warmth of bed. Gouty nodosities. Ball of great to swollen. Rheumatism begins in lower limbs and ascends. Ankles swollen. Soles painful, can hardly step on them. Easy spraining of ankle.

Bryonia Alba

Knees stiff and painful. Hot swelling of feet. Joints red, swollen, hot, with stitches and tearing; worse on least movement. Every spot is painful on pressure. Constant motion of left arm and leg (Helleb). all the joints and joint membranes are swollen and affected. The pain experienced is unbearable and increases with motion. The inflamed joints become red and swollen.

Helleborus Niger

Automatic motion of one arm and leg. Limbs heavy and painful. Stretching of limbs. Thumb drawn into palm. Vesicular eruption between fingers and toes.

Antimonium Crudum

Twitching of muscles. Jerks in arms. Arthritic pain in fingers. Nails brittle; grow out of shape. Horny warts on hands and soles. Weakness and shaking of hands in writing followed by offensive flatulence. Feet very tender; covered with large horny places. Inflamed corns. Pain in heels.

Arnica Montana 

Gout. Great fear of being touched or approached. Pain in back and limbs, as if bruised or beaten. Sprained and dislocated feeling. Soreness after overexertion. Everything on which he lies seems too hard. Deathly coldness of forearm. Cannot walk erect, on account of bruised pain in pelvic region. Rheumatism begins low down and works up.

Stellaria Media

Rheumatoid pains in different parts of the body. Sharp pain in small of back, over kidneys, in gluteal region, extending down thigh. Pain in shoulders and arms. Synovitis. Bruised feeling. Rheumatic pains in calves of legs.

Actaea Spicata 

Tearing pains in loins. Rheumatic pains in small joints, wrist, fingers, ankles, toes. Swelling of joints from slight fatigue. Wrist swollen, red, worse any motion. Paralytic weakness in the hands. Lame feeling in arms. Pain in knee. Sudden lassitude after talking or eating.

Sanguinaria Canadensis

Rheumatism of right shoulder, left hip-joint and nape of neck. Burning in soles and palms. Rheumatic pains in places least covered by flesh; not in joints soles of feet burn. Right-side neuritis; better touching the part.

Pulsatilla

Drawing, tensive pain in thighs and legs, with restlessness, sleeplessness and chilliness. Pain in limbs, shifting rapidly; tensive pain, letting up with a snap. Numbness around elbow. Hip-joint painful. Knees swollen, with tearing, drawing pains. Boring pain in heels toward evening; suffering worse from letting the affected limb hang down. Veins in forearms and hands swollen. Feet red, inflamed, swollen. Legs feel heavy and weary.

I (Dr Qaisar Ahmed) prefer combination of above-mentioned medicines in highly diluted potencies.

P. S: This article is only for doctors having good knowledge about Homeopathy and allopathy, for learning purpose(s).

For proper consultation and treatment, please visit our clinic.

None of above-mentioned medicine(s) is/are the full/complete treatment, but just hints for treatment; every patient has his/her own constitutional medicine.

To order medicine by courier, please send your details at WhatsApp– +923119884588

Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.

  Senior research officer at Dnepropetrovsk state medical academy Ukraine.

Location:  Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.

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