Lifestyle Changes:

It is important to maintain a balance between rest (which will reduce inflammation) and moderate exercise (which will relieve stiffness and weakness). Studies have suggested that even as little as 3 hours of physical therapy over 6 weeks will help people with RA, and that these benefits are sustained.

The goal of exercise is to:

• Maintain a wide range of motion
• Increase strength, endurance, and mobility
• Improve general health
• Promote well-being

In general, doctors recommend the following approaches:

• Start with the easiest exercises, stretching and tensing of the joints without movement.
• Next, attempt mild strength training.
• The next step is to try aerobic exercises. These include walking, dancing, or swimming, particularly in heated pools. Avoid heavy impact exercises, such as running, downhill skiing, and jumping.
• Tai chi, which uses graceful slow sweeping movements, is an excellent method for combining stretching and range-of-motion exercises with relaxation techniques. It may be of particularl value for elderly patients with RA.

A common -sense approach to exercise is the best guide:

• If exercise is causing sharp pain, stop immediately.
• If lesser aches and pains continue for more than 2 hours afterwards, try a lighter exercise program for a while.
• Using large joints instead of small ones for ordinary tasks can help relieve pressure, for instance, closing a door with the hip or pushing buttons with the palm of the hand.

Diet

Many patients with RA try dietary approaches, such as fasting, vegan diets, or eliminating specific foods, that seem to worsen RA symptoms. There is little scientific evidence to support these approaches but some patients report anecdotally that they are helpful.

In recent years, a number of studies have suggested that the omega-3 fatty acids contained in fish oil may have anti-inflammatory properties useful for RA joint pain relief. The best source of fish oil is through increased consumption of fatty fish such as salmon, mackerel, and herring. Fish oil supplements are another option, but they may interact with certain medications. If you are thinking of trying fish oil supplements, talk to your doctor first.

Miscellaneous Supportive Treatments

Various ointments, including Ben Gay and capsaicin (a cream that use the active ingredient in chilli peppers), may help soothe painful joints.

Orthotic devices are specialized braces and splints that support and help align joints. Many such devices made from a variety of light materials are available and can be very helpful when worn properly.

A number of specially designed appliances and devices are available to ease daily activities.

Managing Psychological and Emotional Conditions

Although the influence of stress or emotions on the progression of RA is not fully known, having a history of major depression that persists or reoccurs seems to increase the pain, disability, and fatigue. Stress management alone cannot reduce pain, but it may be very helpful in helping people deal with their condition.

Alternative and Integrative Medicine

People often turn to alternative therapies or nontraditional remedies to relieve the pain of rheumatoid arthritis. Although there is no definitive evidence to support their efficacy, some alternative procedures -- such as acupuncture, massage, mineral baths (balneotherapy), relaxation techniques, biofeedback, and hypnosis -- are not harmful and may be a useful adjunct to standard treatments.

Herbal Remedies

Herbal remedies used for RA include boswellia, equisetum arvense (horsetail), devil's claw, borage seed oil, and many others. To date, no evidence supports their efficacy.

Researchers are currently conducting studies to determine if supplements extracted from the turmeric spice can help prevent joint inflammation. The Chinese medicine herb Tripterygium wilfordii Hook F (TwHF) is also being investigated for its anti-inflammatory properties.

Generally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been a number of reported cases of serious and even lethal side effects from herbal products. Always check with your doctor before using any herbal remedies or dietary supplements.