The latest prosthetic joints have a lifespan of 10 to 20 years, and some function may not be restored after a damaged joint is replaced by a prosthetic one. Find out more about knee replacement and hip replacement. Many people with rheumatoid arthritis try complementary therapies, such as:.
In most cases, there's little or no evidence these are effective in the long term, although some people may experience short-term benefit from them. There's no strong evidence to suggest that specific dietary changes can improve rheumatoid arthritis, although some people with rheumatoid arthritis feel their symptoms get worse after they have eaten certain foods. If you think this may be the case for you, it may be useful to try avoiding problematic foods for a few weeks to see if your symptoms improve.
But it's important to ensure your overall diet is still healthy and balanced. A Mediterranean-style diet, which is based on vegetables, fruits, legumes, nuts, beans, cereals, grains, fish and unsaturated fats such as olive oil, is recommended.
There's also little evidence supporting the use of supplements in rheumatoid arthritis, although some can be useful in preventing side effects of medicines you may be taking.
For example, calcium and vitamin D supplements may help prevent osteoporosis if you're taking steroids, and folic acid supplements may help prevent some of the side effects of methotrexate.
There's some evidence to suggest that taking fish oil supplements may help reduce joint pain and stiffness caused by rheumatoid arthritis.
Page last reviewed: 28 August Next review due: 28 August The DMARDs that may be used include: methotrexate leflunomide hydroxychloroquine sulfasalazine Methotrexate is usually the first medicine given for rheumatoid arthritis, often with another DMARD and a short course of steroids corticosteroids to relieve any pain.
These may be combined with biological treatments. Common side effects of methotrexate include: feeling sick loss of appetite a sore mouth diarrhoea headaches hair loss The medicine can also affect your blood cells and liver, so you'll have regular blood tests to monitor this.
Side effects from biological treatments are usually mild but include: skin reactions at the site of the injections infections feeling sick a high temperature headaches Some people may also be at risk of getting more serious problems, including the reactivation of infections such as tuberculosis TB if they have had them in the past. This medicine is usually used in combination with methotrexate.
Further information National Rheumatoid Arthritis Society NRAS : JAK inhibitors Medicine to relieve pain In addition to the medicines used to control the progression of rheumatoid arthritis, you may also need to take medicine specifically to relieve pain. Painkillers In some cases, you may be advised to use painkillers, such as paracetamol or a combination of paracetamol and codeine co-codamol , to relieve the pain associated with rheumatoid arthritis.
Steroids Steroids are powerful medicines that can help reduce pain, stiffness and inflammation. They can be given as: a tablet for example, prednisolone an injection directly into a painful joint an injection into a muscle to help lots of joints They're usually used to provide short-term pain relief — for example, while you're waiting for DMARD medicines to take effect or during a flare-up.
Steroids are usually only taken for a short time because long-term use can have serious side effects, such as: weight gain osteoporosis weakening of the bones easy bruising muscle weakness thinning of the skin Further information National Rheumatoid Arthritis Society NRAS : managing the pain of rheumatoid arthritis Supportive treatments Your doctor may also refer you to other services that might be able to help you with your rheumatoid arthritis symptoms.
Steroid injections Most people can safely have corticosteroid injections, but they should be avoided or used with caution if you have an ongoing infection or a blood clotting disorder such as haemophilia. Steroid inhalers and sprays There is generally no reason why someone shouldn't be able to use a steroid inhaler or steroid spray, but these should be used with caution in people with ongoing infections, such as tuberculosis TB. Pregnancy Corticosteroids are generally safe to use during pregnancy.
Breastfeeding If a woman needs to take steroid tablets while she is breastfeeding, a type called prednisolone is usually recommended, because it is thought to have the least chance of causing the baby any adverse effects. Medicines that interact with them Corticosteroids can interact with other medicines, and the effects of either medicine can be altered as a result. Anticoagulant medicines Anticoagulant medicines are medications that make the blood less sticky. Anticonvulsants Anticonvulsants are medicines used to prevent seizures fits and are often used to treat epilepsy , but they can reduce the effectiveness of corticosteroids.
Diabetes medication Corticosteroids can decrease the effectiveness of medications used to treat diabetes. HIV medication Corticosteroids, including steroid inhalers, can sometimes interact with a type of medication known as protease inhibitors such as ritonavir used to treat HIV.
Live vaccines Some vaccinations contain a weakened form of the infection they are designed to protect against. Examples of live vaccines include: the measles, mumps and rubella MMR vaccine the BCG vaccine for tuberculosis TB As corticosteroids can weaken your immune system and make you more vulnerable to infection, you should avoid any live vaccine until at least three months after your course of corticosteroids has finished.
Non-steroidal anti-inflammatory drugs Non-steroidal anti-inflammatory drugs NSAIDs are a group of commonly used painkillers, such as ibuprofen , that are available over the counter at pharmacists. Side effects Corticosteroids are powerful medications that can sometimes have a wide range of side effects. They will only be used if the potential benefits are thought to outweigh this risk. The risk of experiencing side effects largely depends on: the type of steroid you're taking — steroid tablets oral corticosteroids are more likely to cause side effects than inhalers or injections the dose — the higher the dose, the greater the risk of developing side effects the length of treatment — for example, you're more likely to develop side effects if you take steroid tablets for more than three weeks your age — young children and the elderly are more likely to experience side effects Some of the main side effects are listed below, but this is not a complete list.
Steroid inhalers Inhaled steroids usually have few or no side effects if used at normal doses. However, they can sometimes cause: a sore mouth or throat minor nosebleeds difficulty speaking or a hoarse or croaky voice a cough oral thrush Rinsing your mouth out with water after using your medication can help to prevent oral thrush, and using a device called a spacer with your medication can help to prevent many of the other problems.
Steroid injections Steroids that are injected into muscles and joints may cause some pain and swelling at the site of the injection. Steroid tablets Short, occasional courses of steroid tablets taken for no longer than three weeks are very unlikely to cause troublesome side effects.
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Also on NHS inform. For example, if the hip joints are affected, a hip replacement may be carried out. As the symptoms of AS develop slowly and tend to come and go, you'll need to see your rheumatologist or GP for regular check-ups. They'll make sure your treatment is working properly and may carry out physical assessments to assess how your condition is progressing. This may involve further sets of the same blood tests or X-rays you had at the time of your diagnosis.
Page last reviewed: 11 July Next review due: 11 July In most cases treatment involves a combination of: exercise physiotherapy medicine Physiotherapy and exercise Keeping active can improve your posture and range of spinal movement, along with preventing your spine becoming stiff and painful. Types of physiotherapy recommended for AS include: a group exercise programme — where you exercise with others an individual exercise programme — you are given exercises to do by yourself massage — your muscles and other soft tissues are manipulated to relieve pain and improve movement; the bones of the spine should never be manipulated as this can cause injury in people with AS hydrotherapy — exercise in water, usually a warm, shallow swimming pool or a special hydrotherapy bath; the buoyancy of the water helps make movement easier by supporting you, and the warmth can relax your muscles Some people prefer to swim or play sport to keep flexible.
Painkillers You may need painkillers to manage your condition while you're being referred to a rheumatologist.
Codeine If necessary, you may also be prescribed a stronger type of painkiller called codeine as well as paracetamol. Codeine can cause side effects, including: feeling sick being sick constipation drowsiness Biological treatments Anti-TNF medicine If your symptoms cannot be controlled using painkillers or exercising and stretching, anti-tumour necrosis factor TNF medicine may be recommended.
Secukinumab works by blocking the effects of a protein involved in triggering inflammation. Corticosteroids Corticosteroids have a powerful anti-inflammatory effect and can be taken as tablets or injections by people with AS.
Serial blood samples were collected up to 12 hours after dosing, and plasma codeine and morphine concentrations were measured by radioimmunoassay. There was no significant difference between smokers and nonsmokers in either codeine or morphine areas under the plasma concentration-time curves AUCs , with either route of administration.
The relative codeine bioavailability in these groups was
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