Rheumatoid arthritis: flare management and similarities to osteoarthritis

Successfully taking charge of arthritis means riding out a flare so that it causes the least amount of aggravation and despair. Here's some information to get you on the right track to manage it.

• For people diagnosed with any type of arthritis, the word "flare" becomes an important part of their vocabulary.
• Things may be going along smoothly — so smoothly you've almost forgotten you have arthritis — and then, suddenly, a flare.
• Arthritis flares are times when things go bad: inflammation, pain and stiffness resurface with a vengeance.
• Flares can be set off by many different things — overdoing it at the gym, lack of sleep or even emotional stress.
• Flares can severely challenge the patience — sometimes even the sanity — of people with arthritis.

• In March 2000 Health Canada approved the Prosorba column, the first non-drug alternative for adults with moderate to severe RA who cannot tolerate disease-modifying anti-rheumatic drugs (DMARDs).
• During a two-hour process, the patient's blood is removed and passed through a machine that separates the plasma (liquid part of the blood) from the blood cells.
• The plasma is then passed through the Prosorba column, a device about the size of a coffee mug.
• The filtered plasma is then recombined with its blood cells, and the blood is reinfused into the patient.
• The Prosorba treatment (once a week for 12 weeks) can cause dramatic improvement in RA patients.
• Although researchers don't fully understand the column's mechanism of action, they believe it filters out proteins involved in the immune system's attack on the joints.

Age of occurrence: Rheumatoid arthritis (RA) usually develops between the ages of 20 and 50, but can occur at any age. Osteoarthritis (OA) is a disease of middle and old age and rarely occurs before age 45.

Pattern of disease: RA often strikes symmetrically, meaning it affects both wrists, the knuckles on both hands, etc. OA rarely affects both joints (e.g., both wrists) at once.

Speed of onset: About 20 percent of RA cases develop suddenly, within weeks or months. OA develops slowly, with cartilage breakdown usually occurring over several years.

Extent of illness: In addition to causing joint damage, RA can cause fatigue, fever, anemia and weight loss and damage the heart and other organs. OA is limited to the joints.

Joints affected: RA usually affects many joints, including the wrists (which are affected in almost all RA cases), knuckles, elbows, shoulders,ankles, feet and neck (but usually spares the rest of the spine). OA most commonly affects the knees, hips, feet, hands and spine; sometimes it affects the knuckles and wrists; and rarely affects the elbows and shoulders.Hand involvement: RA affects many of the hand joints, but usually not the knuckles closest to the fingernails. OA affects the knuckles closest to the fingernails more often than other joints of the hand.Morning stiffness:

• A treatment that may actually cure rheumatoid arthritis was reported back in late 2000 at the annual scientific meeting of the American College of Rheumatology.
• Developed by researchers at University College in London, the treatment involves depleting the blood of B-lymphocytes; these immune cells form antibodies that cause much of the joint destruction that occurs in RA.
• Even now, research is still ongoing, but B lymphocyte depletion still looks good as a treatment option.
• Recent studies suggest that fewer people are developing rheumatoid arthritis than in previous years, but no one knows the reason why.