Table 812 Treatment options for patients with rheumatoid arthritis

Anti-inflammatory agents

Nonsteroidal anti-inflammatory drugs Celecoxib Corticosteroids Disease modifying antirheumatic drugs Leflunomide

Soluble interleukin-1 receptor therapy

Anakinra Tumor necrosis factor inhibitors Etanercept Infliximab Methotrexate Hydroxychloroquine Sulfasalazine Intramuscular gold Cytotoxic agents Cyclosporin A Azathioprine Cyclophosphamide feet, and cervical spine. The joints may be swollen and tender, and over time there occur significant deformities of the hands, including ulnar deviation and the swan-neck and boutonniere deformities of the fingers. Patients with rheumatoid arthritis experience a number of systemic problems arising from the inflammatory processes of the disease, including subcutaneous nodules, anemia, vasculitic processes, entrapment neuropathy, interstitial nephritis, and effusions (pericardial and pleural). Treatment endeavors directed at patients with rheumatoid arthritis are listed in Table 8-12.

Because there is so much loss, disability, and discomfort accompanying arthritic conditions, it is not surprising that significant mood disturbances can accompany the disorder. Depression appears to be the most prevalent psychological disturbance accompanying osteoarthritis and rheumatoid arthritis. Pain severity among patients with arthritis was found to be correlated with the presence of depression—higher among those who were depressed, compared with nondepressed patients or those with only a remote history of depression (Frank et al. 1988). The relationship between pain severity and mood disturbances is not exclusive to depression, however. Ratings of pain severity have also been associated with other unpleasant emotional states, such as anger and anxiety (Huyser and Parker 1999). In addition, functional impairments and perceived disability associated with arthritic conditions are likewise related to these emotional states. Depression and anxiety may interfere with treatment adherence (e.g., lack of participation in an exercise program and weight loss). Consequently, psychopharmacologic agents, although not directly analgesic in arthritic conditions, may indirectly reduce emotional distress and perceived functional impairments and thereby reduce perceived pain severity and facilitate treatment.

Psychological variables may mediate levels of pain and disability as well. Cognitive approaches—including a propensity to catastrophize, overgeneral-ize, or selectively abstract—appear to be related to perceived levels of distress and disability associated with arthritic conditions (Smith et al. 1988). Patients with passive coping strategies (e.g., wishful thinking, self-blame) have been found to have poorer functional abilities than those with more active, problem-solving approaches (Young 1992). Thus, psychotherapies (e.g., CBT) might be particularly advantageous in improving functional adaptations in patients with arthritic conditions by addressing cognitive distortions and fostering improved coping strategies.

Arthritis Joint Pain

Arthritis Joint Pain

Arthritis is a general term which is commonly associated with a number of painful conditions affecting the joints and bones. The term arthritis literally translates to joint inflammation.

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