Rheumatoid arthritis: the pain in everyday life

Around 1 in 100 people are affected by rheumatoid arthritis, making it the most common form of rheumatism. Unlike fibromyalgia, the joints are chronically inflamed in this rheumatic disease. The immune system turns against its own body. Rheumatoid arthritis is therefore an auto-immune disease and if the early warning signs of rheumatoid arthritis are recognized at an early stage, the onset, course and intensity of the disease can be influenced. According to experts, the optimal diagnosis period is a maximum of 12-16 weeks after the first symptoms of the disease appear. Rheumatoid arthritis can be well treatable with early medication and lifestyle adjustments. Unfortunately, early diagnosis remains difficult due to limited space in specialist rheumatology facilities and lack of access to important information. Many early warning signs that the body signals to sufferers are noticed too late or are not correctly classified, which is why a diagnosis is not made until later.

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How can the symptoms of rheumatoid arthritis be treated?

Treatment for chronic joint pain usually consists of a combination of different medications.

On the one hand, anti-inflammatory and pain-relieving “non-steroidal anti-inflammatory drugs” are used. Supplemented with glucocorticoids, such as cortisone, the inflammation of the joints is treated. Various biologics are used in an attempt to limit the body's auto-immune response by intercepting pro-inflammatory messenger substances.

97% of those affected are also treated with DMARDs. The acronym stands for disease-modifying anti-rheumatic drug. These drugs target the inflammatory processes in the immune system and prevent the joint structure from being attacked and destroyed. However, this effect does not occur immediately. It can take around 4-16 weeks for the effect of the medication to become apparent. The overall aim of this therapy is remission. This means that the inflammation is controlled and the arthritis does not progress any further. The dosage of the medication should be regularly adjusted and adapted under medical advice, as side effects can occur.

The active ingredient cortisone reduces joint pain for many sufferers, as it can stop the acute inflammation. This may sound good at first glance, but long-term treatment with cortisone is associated with many side effects. Taking it can cause water retention in the body, which leads to weight gain in the long term. This can lead to increased joint stress, which in turn is counterproductive for the already inflamed joints. Cortisone can also cause porous bones in the long term, as it is deposited in the bones and disrupts the metabolism of healthy bone growth. Despite the side effects, cortisone is a frequently used medication for the treatment of pain in patients with rheumatoid arthritis.

Treatment with the medication described aims to reduce pain, but is not always equally effective. It can happen that the inflammation of the joints seems to be under control, but the pain is still almost unbearable. Rheumatoid arthritis therefore depends on many different individual factors.Persistent pain can be caused by inflammation in the body that spreads beyond the joints. In addition, the patient's perception of pain can be sensitized, which in turn intensifies the central perception of pain. If nerves are also affected by inflammation in addition to the joints, neuropathic pain signals can intensify the pain due to a malfunction of the affected nerve

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What influences pain?

Pain is a complex phenomenon and is influenced by the interplay of biological, psychological and social factors. This is illustrated by the so-called bio-psycho-social model.

This model states that pain in patients with rheumatoid arthritis should not only be recognized as a purely biological phenomenon, but that psychological and social aspects should also be taken into account. What does this mean in concrete terms? If you are affected by pain, it can be influenced by various factors.

• Biological factors (bio):
  These include tissue damage, inflammation, nerve injuries, but also the influence of medication.
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• Psychological factors (psycho):
  Anxiety, stress, depression and other psychological processes can influence pain. However, psychological interventions such as cognitive behavioral therapy, relaxation techniques, stress management, mindfulness and acceptance, and learning coping strategies can have a positive influence on the perception of pain.
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• Social factors (social):
  Inadequate social and/or medical support as well as social pressure can influence pain. Conversely, the creation of supportive social networks, self-help groups, involvement of family and friends can provide (emotional) support and thus support pain reduction.

Understanding the interaction of these three factors allows for better individualized care and treatment of rheumatoid arthritis.

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What can have a positive influence on mental health?

A healthy environment, as little stress as possible and a balanced daily routine can contribute to mental health. How those affected deal with pain naturally differs from person to person. However, there are consistent, pain-improving research findings that help many sufferers to deal with their pain: acceptance of it. Mindfulness- and acceptance-based interventions can improve some symptoms of rheumatoid arthritis by providing increased disease acceptance. These include painful inflammation, low mood, anxiety, and quality of life.

By accepting the pain, sufferers regain some control over their body. This control can be further intensified through the concept of self-efficacy. In the article you can read what self-efficacy means and how it can have a positive influence on dealing with pain.

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Many paths with the same goal: less pain and more freedom

You have now read a lot about the symptoms and progression of rheumatoid arthritis, the development of pain and the factors associated with pain management.

Unfortunately, there is no simple, universal recipe. Nevertheless, hopefully you have been able to take away new information that will help you either as a relative or as a sufferer.

In our blog you will find further articles containing information about the many symptoms of rheumatic diseases, their progression and methods of dealing with chronic pain.