Rheumatoid Arthritis Care

The core of care for rheumatoid arthritis (hereinafter referred to as RA) has never been "radical cure", but through standardized medication + daily detailed adjustments, the inflammation level is controlled within a safe range, joint function is preserved to the greatest extent, and normal quality of life is not affected - this is currently a recognized care goal in the field of rheumatism and immunity worldwide, without exception.

The 62-year-old Aunt Zhang who I met in the outpatient clinic last week is a typical example. She was diagnosed with RA three years ago. Some time ago, she heard from patients in the community that "taking medicine hurts the liver, and it can be cured by applying hot compresses and exercises." She stopped methotrexate privately, applied a hot towel to her fingers for half an hour every day, and kneaded a fitness ball vigorously. As a result, in less than a month, her proximal finger joints were swollen like small carrots, and she couldn't even hold chopsticks. When she arrived, her erythrocyte sedimentation rate soared to over 80, which was higher than when she was first diagnosed.

Many people have argued about whether RA should be moved or maintained. In fact, the focus of rheumatology and rehabilitation departments is indeed different: most rheumatologists will advise you to move as little as possible during the acute phase (that is, when joints are red, swollen, hot and painful, and inflammation indicators are elevated), and do not carry heavy objects or touch cold water to avoid aggravation of inflammation.； But the point of view of the rehabilitation department is a little more advanced. Even in the acute stage, you can also perform isometric contraction of the muscles. For example, you can gently clench a fist with your fingers, hold it for 3 seconds and then release it. This can avoid muscle atrophy without moving the joints. Both statements are correct, but it depends on what stage you are at. I myself often tell patients that when it hurts, just rest, and when it doesn’t hurt, move slowly. Don’t be brave and don’t lie down, it’s better than anything else.

Let’s talk about the taboos that everyone is most concerned about. I have seen too many patients who dare not eat this or touch that. They even stopped eating eggs and milk, for fear that the "food" will induce inflammation. In fact, there is currently no evidence-based medical evidence to prove that a certain type of food will directly cause RA attacks. Unless you obviously feel that your joint pain worsens after eating something, for example, some people feel pain after eating seafood, and some people feel uncomfortable after eating iced drinks, so just avoid them. Do not blindly avoid other foods, which may lead to malnutrition, loss of immunity, and recurrence of inflammation. Not long ago, there was a 30-year-old female patient who lost 15 pounds after dieting for half a year. Her albumin was extremely low during the follow-up test. Instead, she relapsed twice in a row. The gain outweighed the loss.

Daily tips at home are more useful, and they are all practical experiences I have gained from working as a rheumatology nurse for almost 10 years: For example, don’t use twisting movements if you can. After washing, don’t twist the towel hard, just squeeze it into a ball to squeeze out the water. Try to replace doorknobs and faucets with long handles, so you don’t need to twist with your fingertips. Don’t hook plastic bags with your fingers when shopping for groceries. Carrying a cloth bag with a wide shoulder strap saves effort. These small details may seem inconspicuous, but they can save a lot of pain on the joints over time. Oh, by the way, there is also warmth in winter. Don’t listen to the nonsense about “freezing to improve immunity”. RA patients’ joints are most sensitive to cold. Wearing gloves and knee pads when going out is more effective than any health care product.

There are also many people asking whether they can do moxibustion, plasters, or massage? This also depends on the situation. When the joints are red, swollen and hot in the acute stage, if you apply heating plasters or moxibustion on the joints, it will simply add fuel to the fire and make the pain worse. ； If your joints always feel cold and stiff during the remission period, moxibustion at areas such as Zusanli and Guanyuan, or a light massage from a regular physical therapy department, can indeed relieve the discomfort, but remember that all these are auxiliary and cannot replace the anti-rheumatic drugs prescribed by your doctor. Don’t put the cart before the horse.

I also found that many patients have a misunderstanding: they always focus on the indicators of erythrocyte sedimentation rate and C-reactive protein. As long as the indicators are normal, they will endure it even if their joints hurt so much that they can't sleep. In fact, it is not necessary. RA care is very individualized. Your subjective feelings are as important as the indicators. If you feel uncomfortable, tell the doctor in time to adjust the plan. There is no need to endure it.

After all, there is really no standard answer to RA care, and you don’t need to copy other people’s experiences. Some people are okay if they walk 10,000 steps a day, while some people get joint pain if they walk an extra 2,000 steps. What suits you is the best. To put it bluntly, don’t act blindly or forcefully, and get along well with your joints. It’s not difficult to go to work, take care of your children, or dance in the square.