Connect with others living with RA

DRUGS & CONDITIONS

RHEUMATOID ARTHRITIS

Arthritis means “inflammation of a joint.” There are more than 100 types of arthritis. Rheumatoid arthritis, or RA, is one of the most common forms of arthritis. In the United States, at least 1.3 million adults have RA. RA can affect all age groups. But most people start having symptoms between the ages of 40 and 60. 

RA is an autoimmune disease. The body’s immune system attacks and destroys germs that can make people sick. In an autoimmune disease, the body’s immune system attacks and destroys the body’s own healthy tissue by mistake. 

With RA, the body’s immune system attacks the joints. The tissue around the joints begins to swell (become inflamed) from this attack. The swelling causes symptoms like warm, stiff and painful joints.

RA can affect any joint in the body. But the smaller joints in the hands and feet are usually affected first. Other parts of the body can become affected over time and as the condition gets worse. RA can affect the whole body. This is called a systemic autoimmune disease.

RA does not affect everyone the same way. Some people have RA symptoms that last a few months or years. Others have RA symptoms that come and go. When RA symptoms get worse it is called a “having a flare.” When they get better or resolve, it is called “being in remission.”

There is no cure for RA. But there are many medicines available to treat and help prevent RA flares and manage symptoms. Starting treatment early is the key to preventing further damage to joints and other parts of the body.

 


This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

This document contains registered trademarks of entities not affiliated with CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. 75-36601B 122215

This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty.

DRUGS & CONDITIONS

SIGNS AND SYMPTOMS

Rheumatoid arthritis (RA) symptoms can vary from one person to another. But some more common symptoms include:

  • Joint pain, tenderness, swelling or stiffness that lasts for six weeks or more
  • Morning stiffness for 30 minutes or more
  • Symptoms in more than one joint
  • Symptoms in the same joint(s) on both sides of the body

Other signs and symptoms may include:

  • Feeling tired
  • Weight loss
  • Fever

RA symptoms may vary from mild to severe. And they may come and go. When symptoms get worse for a period; it is called “having a flare.”

The small joints are usually affected first. Small joints include the:

  • Fingers
  • Wrists
  • Feet
  • Toes

Other areas may become affected, as the condition gets worse. These areas may include:

  • Elbows
  • Shoulders
  • Neck
  • Jaw
  • Knees
  • Ankles

RA is a systemic autoimmune disease. This means the immune system can attack and affect the entire body, not just the joints. See the table below for other body parts affected and symptoms linked to RA.

Possible Body Part(s) Affected and Symptoms Linked to Rheumatoid Arthritis

Body Part(s)

Symptoms

Heart

  • Increased risk of heart disease

Lungs

  • Increased risk of inflammation and scarring of the lung tissue

Eyes

  • Inflammation of different parts of the eye
  • Dryness
  • Pain
  • Redness
  • Sensitivity to light
  • Vision impairment and blindness
  • Mouth
 
  • Dryness
  • Irritation of the gums/gum disease
  • Infection
  • Tooth loss

Skin

  • Lumps under the skin called rheumatoid nodules
  • Open sores or raw patches of skin

Blood

  • Inflammation of the blood vessels
  • A decrease in the number of red blood cells in the body

Nervous System

  • Numbness, tingling or weakness of the arms and legs

 


This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

This document contains registered trademarks of entities not affiliated with CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. 75-36601B 122215

This document contains confidential and proprietary information of CVS/specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty.

DRUGS & CONDITIONS

CAUSES AND RISK FACTORS

The exact cause of rheumatoid arthritis (RA) is not known. Factors that may increase the risk of developing RA may include:

  • Age: RA affects all age groups. But most people start having symptoms between the ages of 40 and 60.
  • Sex: Women are more likely to develop RA than men. About seven out of every 10 patients who have RA are women.
  • Family History: Patients with a family member with RA may have a higher risk of developing the condition.
  • Environment: Smoking, infections and hormones may trigger the body’s autoimmune response.

 


This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

This document contains registered trademarks of entities not affiliated with CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. 75-36601B 122215

This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty.

DRUGS & CONDITIONS

DIAGNOSIS

There isn’t one test to diagnose rheumatoid arthritis (RA). If RA is suspected, a person will usually see a doctor who specializes in arthritis. These doctors are called rheumatologists. To confirm or diagnose RA, a rheumatologist may:

  • Perform a medical and family history
  • Conduct a physical exam
  • Order blood tests
  • Order imaging tests
  • Rule out other conditions

Medical and Family History

The rheumatologist will ask questions that may include:

  • When did symptoms begin?
  • Do symptoms come and go?
  • What makes symptoms feel better? What makes them feel worse?
  • Which joints are involved?
  • Is there a history of or any current autoimmune conditions?
  • Do any family members have RA or other autoimmune conditions?

Physical Exam

The rheumatologist will examine the body, including each joint, and check for swelling, redness, warmth, pain and range of motion.

Blood Tests

Several blood tests can be given to help a rheumatologist diagnose RA. For example:

  • Rheumatoid factor is an antibody––a protein the immune system uses to fight off foreign substances. Not everyone with RA tests positive for rheumatoid factor. But in time, about eight out of 10 people with RA will have rheumatoid factor in their blood.
  • Erythrocyte sedimentation rate (ESR) or "sed rate" measures how fast red blood cells (erythrocytes) fall to the bottom of a tube of blood. The faster the cells drop, the greater the level of inflammation happening in the body.
  • C-reactive protein (CRP) is made by the liver. It increases or decreases in response to inflammation. A high CRP can mean that RA is very active or a person is having a flare (healthy tissue is being attacked).
  • Complete blood count (CBC) measures the three types of blood cells: red cells, white cells and platelets. People with RA often have too few red cells. This is called anemia. A high white cell count may mean infection is present. And a high platelet count can be due to inflammation.
  • Cyclic citrullinated peptide (CCP) antibody test is a good test to help diagnose RA. High CCP is found in up to seven out of 10 people with RA.

Imaging Tests

Imaging or radiology tests pass different forms of energy (x-rays, sound waves or magnetic fields) through the body creating pictures of certain body parts. Rheumatologists may order these tests such as an x-ray, ultrasound or magnetic resonance imaging (MRI) scan to look for joint inflammation and damage. This information can help diagnose RA. The imaging tests may be repeated to look for changes in the same joint(s) and new damage.

 


This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

This document contains registered trademarks of entities not affiliated with CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. 75-36601B 122215

This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty.

DRUGS & CONDITIONS

TREATMENT

Rheumatoid arthritis (RA) is a lifelong health condition that has no cure. It is important to start treatment as soon as an RA diagnosis is confirmed. Early treatment is the key to preventing further damage to joints and other body parts.

The goals of RA treatment are:

  • Stop inflammation
  • Relieve symptoms
  • Slow down or prevent joint damage
  • Prevent damage to other body parts
  • Preserve physical function, mobility and safety
  • Address emotional health and well-being

There are many medicines currently available to treat RA. The treatments are focused on two categories:

  • Relieving symptoms
  • Modifying disease activity

 


This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

This document contains registered trademarks of entities not affiliated with CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. 75-36601B 122215

This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty.

DRUGS & CONDITIONS

Relieving Symptoms

Nonsteroidal anti-inflammatory drugs, or NSAIDS, can be used for treating RA symptoms like pain and joint inflammation. Examples include celecoxib, ibuprofen, and naproxen sodium. However, they can cause serious side effects, can’t always be used for extended periods of time and are not appropriate for everyone. NSAID side effects can include heart and blood vessel disease, stomach upset and bleeding in the stomach or intestines. 

Some NSAIDs are available over-the-counter. Others are only available with a prescription. NSAIDs can be taken by mouth or applied directly to the joint in either a cream or patch. The doctor will determine if an NSAID is appropriate and which one is best. People should not self-treat with over-the-counter NSAIDs or other products, including supplements, without talking to their doctor first. 

Corticosteroids are also a treatment option for patients with RA. They can be used to help manage the pain and inflammation caused by RA. Some examples include prednisone, prednisolone, methylprednisolone and cortisone. Corticosteroids can have serious side effects, especially when given in high doses for a long time. The rheumatologist will try to find the lowest dose of corticosteroid and use it for the shortest period, while still keeping RA under control.
 


This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

This document contains registered trademarks of entities not affiliated with CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. 75-36601B 122215

This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty.

DRUGS & CONDITIONS

MODIFYING DISEASE ACTIVITY

Medicines called disease-modifying antirheumatic drugs (DMARDs) can reduce or prevent joint damage, preserve function and help maintain quality of life. All people with RA should ask their doctor about DMARD therapy.

DMARDs stop the body’s immune system from attacking healthy joint tissue that leads to damage. DMARDs are more helpful when they are started early. They work slowly and sometimes it can take three to four months before any results appear. The rheumatologist may prescribe a medicine that relieves symptoms, such as a corticosteroid or NSAID, to help manage pain and inflammation while the DMARD starts to work.

DMARDs can be categorized into two groups: non-biologic and biologic (see table below for examples). Nonbiologic DMARDs, like most medicines, are made from chemicals. These are available in pill form and/or given as a shot. Biologic DMARDS are proteins that are created in a laboratory to act like/be similar to certain proteins made by the body. These medicines must be given as a shot or infused directly into a vein (intravenously).

 

Non-biologic DMARDs

Biologic DMARDs

  • Hydroxychloroquine
  • Leflunomide
  • Methotrexate
  • Sulfasalazine
  • Adalimumab
  • Certolizumab pegol
  • Etanercept
  • Golimumab
  • Infliximab

 

Doctors choose the most appropriate treatment based on the severity of symptoms, possible side effects and the risks versus benefits of each therapy. Currently available DMARDs (as of June 2015) are listed in the table below.

FDA-Approved DMARDs for RA*

Name**

How given

Selected, possible side effects

Selected additional information

Non-biologic DMARDs

Hydroxychloroquine

Orally

Vision changes: sensitivity to light, reading/seeing difficulties, seeing light flashes or streaks

Hearing changes: difficulty hearing, ringing in the ears

Muscle weakness

Rash

  • Use in patients with mild disease

  • Eye exams are needed

Leflunomide

Orally

Diarrhea, nausea, stomach pain

Rash

Hair loss

 

  • Use alone or in combination with another DMARD

  • Reserve for patients who fail initial therapy

  • Blood work to check liver function and blood counts are needed

  • Do not take if pregnant or nursing

Methotrexate

Orally

- or -

SC injection (shot)

Diarrhea, stomach pain

Reddening of the skin

Sores in mouth or on lips

Sensitivity to sunlight

  • First-line DMARD agent for most patients with RA

  • Use alone or in combination with a DMARD

  • Do not take if pregnant/nursing or have an active infection

Sulfasalazine

Orally

Nausea

Abdominal discomfort

Headache

Skin rash

Mouth sores

Itching

 

  • Use alone or in combination with a DMARD

  • Blood work to check liver function and blood counts are needed

  • Do not take if allergic to aspirin or sulfa-containing medicines

  • Do not take if glucose-6-phosphate dehydrogenase deficient

  • Increases sensitivity to sun

Biologic DMARDs

Abatacept

IV infusion

- or -

SC injection (shot)

Headache

Upper respiratory infection

Common cold

Sore throat

Nausea

  • Selective costimulation modulator

  • Use alone or in combination with another DMARD other than a TNF

  • Do not use with a TNF inhibitor

  • May lower body’s ability to fight certain infections

  • TB testing required prior to therapy

  • COPD may develop more frequently

  • Do not use in combination with live vaccinations

Adalimumab

SC injection (shot)

Infections (upper respiratory, sinus)

Injection site reactions (redness, rash, swelling, itching, bruising)

Headache

Rash

  • TNF inhibitor

  • Use alone or with MTX or other non-biologic DMARDs

  • Do not use with abatacept or anakinra 

  • TB testing required prior to therapy

  • May lower body’s ability to fight certain infections (TB, fungal, bacterial, viral)

  • May increase risk of cancer

  • Do not take with active hepatitis B liver disease

  • May worsen or cause: nervous system problems, blood problems, heart failure, liver problems, lupus-like syndrome, psoriasis

  • Do not use in combination with live vaccinations

Anakinra

SC injection (shot)

Injection site reactions (redness, swelling, bruising, itching, stinging)

Sore throat

Runny nose

Headache

Nausea

Diarrhea

Sinus infection

Joint pain

Flu-like symptoms

Stomach pain

  • IL-1 inhibitor

  • Use with MTX

  • Do not use with a TNF inhibitor

  • TB testing required prior to therapy

  • May lower body’s ability to fight certain infections

  • Do not take with active hepatitis B liver disease

  • Do not use in combination with live vaccinations

  • Blood work is needed (neutrophils) 

Certolizumab pegol

SC injection (shot)

Upper respiratory infection

Rash

Urinary tract (bladder) infection

  • TNF inhibitor

  • Do not use with another biologic

  • TB testing required prior to therapy

  • May lower body’s ability to fight certain infections (TB, fungal, bacterial, viral)

  • May increase risk of cancer

  • Do not take with active hepatitis B liver disease

  • May worsen or cause: nervous system problems, blood problems, heart failure, lupus-like syndrome

  • Do not use in combination with live vaccinations

Etanercept

SC injection (shot)

Upper respiratory infections

Headache 

Injection site reactions (redness, swelling, itching, or pain)

  • TNF inhibitor

  • Use alone or with MTX

  • Do not use with abatacept, anakinra, or cyclophosphamide

  • TB testing required prior to therapy

  • May lower body’s ability to fight certain infections (TB, fungal, bacterial, viral)

  • May increase risk of cancer

  • Do not take with active hepatitis B liver disease

  • May worsen or cause: nervous system problems, blood problems, heart failure, lupus-like syndrome, autoimmune hepatitis, psoriasis

  • Do not use in combination with live vaccinations

Golimumab

SC injection (shot)

Upper respiratory infections

Injection site reactions (redness, swelling, itching, pain, bruising, or tingling)Viral infections (flu, oral cold sores)

  • TNF inhibitor

  • Use with MTX

  • Do not use with abatacept or anakinra

  • TB testing required prior to therapy

  • May lower body’s ability to fight certain infections (TB, fungal, bacterial, viral)

  • May increase risk of cancer

  • Do not take with active hepatitis B liver disease

  • May worsen or cause: nervous system problems, blood problems, heart failure, lupus-like syndrome, psoriasis

  • Do not use in combination with live vaccinations

Infliximab

IV infusion

Respiratory infections (sinus infections and sore throat)

Headache

Rash

Cough

Stomach pain

  • TNF inhibitor

  • Use with MTX

  • Do not use with abatacept or anakinra

  • TB testing required prior to therapy

  • May lower body’s ability to fight certain infections (TB, fungal, bacterial, viral)

  • May increase risk of cancer

  • Do not take with active hepatitis B liver disease

  • May worsen or cause: nervous system problems, blood problems, heart failure, lupus-like syndrome, psoriasis

  • Do not use in combination with live vaccinations

Rituximab

IV infusion

Infusion reaction (hives/rash, itching, swelling, difficulty breathing, weakness, dizziness, racing heart, chest pain)

Severe skin or mouth reactions (sores/ulcers, blisters, peeling, rash)

Fever, chills

Nausea

Headache

Joint pain

Itching

Upper respiratory infection

Swelling

Throat irritation

  • Selective B-cell inhibitor

  • Use in patients who have failed a TNF inhibitor

  • Use in combination with MTX

  • Do not take with active hepatitis B liver disease

  • May increase risk of PML

  • May lower body’s ability to fight certain infections (fungal, bacterial, viral)

Tocilizumab

IV infusion

- or -

 SC injection (shot)

Upper respiratory infection

Headache

Increased blood pressure

Injection site reactions (burning or itching)

Risk of bowel tear

  • IL-6 inhibitor

  • Use in patients who have failed a DMARD

  • Use alone or in combination with MTX or other non-biologic DMARD

  • Do not use with another biologic DMARD

  • May lower body’s ability to fight certain infections (TB, fungal, bacterial, viral)

  • May increase risk of certain cancers

  • Blood work is needed (neutrophils, platelets, liver enzymes, cholesterol)

  • Do not use in combination with live vaccinations

Tocilizumab

Orally

Upper respiratory infection

Diarrhea

Headache

Nasal congestion

Runny nose

  • Janus kinase inhibitor

  • Use in patients who have failed MTX

  • Use alone or in combination with MTX or other non-biologic DMARD

  • Do not use with another biologic DMARD or potent immunosuppressant such as azathioprine and cyclosporine

  • May lower body’s ability to fight certain infections (TB, fungal, bacterial, viral)

  • May increase risk of lymphoma

  • Blood work is needed (lymphocytes, neutrophils, hemoglobin, liver enzymes, lipids)

  • Do not use in combination with live vaccinations 

 

COPD=chronic obstructive pulmonary disease; DMARDs=disease-modifying antirheumatic drugs; FDA=U.S. Food and Drug Administration; IL=interleukin; IV=intravenously or in the vein; MTX=methotrexate; Orally=by mouth or swallowed; PML=progressive multifocal leukoencephalopathy; RA=rheumatoid arthritis; SC=subcutaneously or under the skin; TB=tuberculosis; TNF=tumor necrosis factor 
*Everyone responds to medicines differently. Doctors will choose the most appropriate treatment based on the severity of RA, possible side effects, and the risks/benefits of each therapy. Available DMARDs as of June 2015 are listed.
**Generic or chemical name only

 


This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

This document contains registered trademarks of entities not affiliated with CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. 75-36601B 122215

This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty.

DRUGS & CONDITIONS

LIFESTYLE CHANGES

Dealing with rheumatoid arthritis (RA) can be a challenge, but you should try to keep up your usual daily activities. A healthy lifestyle can help manage your RA symptoms for a better quality of life. For example:

  • Rest. Fatigue is one of the most common RA symptoms and can be a side effect of some RA medicines. It is important to rest often, especially when having a flare (RA is active).  

  • Exercise. Exercise is a key part of successful RA treatment. Physical activity can help improve your muscle strength, keep joints flexible and increase overall stamina and flexibility. Exercise can improve heart and lung function, too. Low-impact exercises such as walking and yoga can be good options. Your rheumatologist or physical therapist can recommend the best exercise plan based on your joint health, symptoms, fitness level and abilities.

  • Eating a balanced diet. Eating healthy is smart for everyone, including people with RA. A healthy diet can help keep your immune system strong. Some studies also suggest a diet high in antioxidants (for example: fish, vegetable, fruits and olive oil) may help limit or manage inflammation.

  • Managing stress. Stress can worsen RA symptoms. Yoga, massage, meditation, support groups, seeing a counselor and staying connected to friends and family may help you cope.

  • Quit smoking. Smoking can worsen your RA symptoms.

  • Avoid or reduce alcohol intake. Alcohol and most medicines used in the treatment of RA do not mix.

 


This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

This document contains registered trademarks of entities not affiliated with CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. 75-36601B 122215

This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty.

DRUGS & CONDITIONS

STAYING ON TRACK

RA is a long-term health condition that may take extra time, energy and planning to care for. We understand staying on track can be difficult. Following these tips can help you stick to your treatment and healthy lifestyle for your best results.

Take medicines as scheduled

  • It’s best to take your medicine exactly as prescribed. Some medicines for RA may take a while to start working. And some have side effects. You should never change or stop medicines without talking to your rheumatologist.

Use medicine reminders

Set a standing alarm on the cell phone. Use the CVS Specialty™ mobile app―anyone can download and use it free from Google® Play or Apple® iTunes® stores

  • Post a sticky note where it can be seen easily. For example, on your bathroom mirror or refrigerator
  • Schedule tasks or appointments on the computer
  • Use a pill box or make a check-off chart

Make and keep rheumatologist, imaging and blood work appointments

  • Rheumatologists may order X-rays, MRIs, blood work or other tests to check your response to treatment. Write down and keep all visits. Skipping them could affect your treatment goals.

Join a support group

  • Join an in-person or online support group. Talking to others living with RA may help you cope with treatment and everyday challenges.

Work with the entire health care team

  • Work closely with doctors, pharmacists, nurses, laboratory and other providers. Stay in touch and don’t be afraid to ask questions.
  • CVS Specialty can help you manage your RA and get the best outcomes from their treatment, including managing side effects and staying on track. 1-800-237-2767 to speak to a pharmacist or nurse specially-trained in caring for you and other patients with RA.

Go online

  • Refill medicines on time so there are no breaks in your treatment. Visit www.CVSspecialty.com to create a secure, online specialty prescription profile to manage your RA treatment anywhere, anytime. Just visit our homepage and register in a few easy steps.

 


This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

This document contains registered trademarks of entities not affiliated with CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. 75-36601B 122215

This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty.

DRUGS & CONDITIONS

COMMON QUESTIONS

We know living with rheumatoid arthritis (RA) requires extra care. With CVS Specialty™ Pharmacy, you can count on the support of your own CVS Specialty RA CareTeam, led by clinicians who are specially trained in RA. They help you manage your RA and stay on track with your treatment—so you can focus more on living your life. Whether it’s about side effects, how to take your medicine, or ideas on how to stay healthy, they’re always ready to help.

Learn about RA to take more charge of your health. To help you get started, we’ve listed some common questions other RA patients have asked us. Didn’t find your answers here? Call your RA CareTeam at 1-800-237-2767—anytime—to learn more.
 

Click on a question below to jump to the answer.
 

What are the symptoms of rheumatoid arthritis (RA)?

How does rheumatoid arthritis (RA) affect me?

What are rheumatoid arthritis (RA) flares?

How can rheumatoid arthritis (RA) treatment help me?

How is rheumatoid arthritis (RA) treated?

How long will it take before my disease-modifying anti-rheumatic drug (DMARD) will start working?

If I have a flare, does that mean my rheumatoid arthritis (RA) treatment isn’t working?

Can I take over-the-counter medicines to help improve my pain?

Is there anything more I can do to help my rheumatoid arthritis (RA) in addition to medicine?

Does anyone have back pain from rheumatoid arthritis (RA)?

Is it normal to feel weak all over?

Is there a certain time of day I should take methotrexate and folic acid?

How soon after noticing symptoms can I be diagnosed with rheumatoid arthritis (RA)?

Can rheumatoid arthritis (RA) cause tooth decay?

My voice is very hoarse after a severe rheumatoid arthritis (RA) flare. Could it be due to my RA?

Why am I sweating so much?

Can Enbrel® (etanercept) cause bleeding?

What are internal nerve stimulators?

My lower legs and ankles feel like rubber—numb and wobbly. Is this from my rheumatoid arthritis (RA)?

I’ve lost my sex drive. Could this be due to my rheumatoid arthritis (RA) medicine?

Where can I find out more about rheumatoid arthritis (RA) and treatments?


What are the symptoms of rheumatoid arthritis (RA)

Your exact RA symptoms may be different than another person’s. And your symptoms may change from time to time. But some more common signs and symptoms include:

  • Joint pain, tenderness, swelling or stiffness lasting for six weeks or longer
  • Morning stiffness for 30 minutes or longer
  • Having symptoms in more than one joint
  • Having symptoms in the same joint(s) on both sides of the body

Some other signs and symptoms include:

  • Loss of energy
  • Low-grade fevers
  • Loss of appetite
  • Dry eyes and mouth from a related health problem called Sjogren’s syndrome
  • Rheumatoid nodules. These are firm lumps under the skin such as in the elbow and hands

RA affects the wrist and finger joints most often. But it can affect any joint, including the joints in your hands, feet, neck, elbows, hips, knees and ankles.

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How does rheumatoid arthritis (RA) affect me?

RA is an autoimmune health condition. This means that your body’s own immune system attacks healthy tissues in and around your joints by mistake. When this happens, fluid builds up in your joints, causing inflammation. RA Inflammation means pain, swelling and stiffness in and around your joints. Over time, this can lead to permanent joint damage. RA can affect other body parts like your eyes and lungs, too.

If RA is left untreated, the joints can become painful and hard to move. And joint damage can even happen in the early stages of RA. The good news is that starting treatment early can help slow down or prevent joint damage.

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What are rheumatoid arthritis (RA) flares?

RA flares are periods of time when RA inflammation is active and symptoms get worse. RA flare symptoms may be mild or severe enough to affect your daily routine. During RA flares, your joints may feel stiffer in the morning than usual. And it may take longer to loosen up your joints and get the day started. RA flares typically last from several days to weeks, but they can last for months or longer.

Your RA may be unpredictable. You may have RA flares even if you’re following your treatment plan. Or you can be in remission for periods of time. Remission is when there are no signs of active disease, with little or no symptoms. Other times, RA flares can happen from stress, an infection or being overly tired. These are called triggers. But you can also have RA flares without a known trigger.

If your RA symptoms don’t go away in a day or two or if flares happen often, talk to your RA doctor or rheumatologist (a doctor who specializes in rheumatic health conditions affecting the joints, bones and muscles). Your rheumatologist may change your RA treatment, including prescribing a steroid medicine like prednisone, to reduce the inflammation and improve your symptoms.

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How can rheumatoid arthritis (RA) treatment help me?

RA is a lifelong health condition that has no cure. But treatment can help slow or prevent joint damage. That’s why starting your treatment early on is important. Work with your RA doctor to create a treatment plan. Creating and sticking to your RA treatment plan can help:

  • Relieve pain
  • Reduce swelling
  • Slow or stop joint damage
  • Improve how you feel
  • Help you stay active

It may take some time to find the treatment that works best for you, but the right one can help you feel better and be able to live a fuller, more active life.

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How is rheumatoid arthritis (RA) treated?

RA treatments work by either targeting the disease activity or managing symptoms. They can include:

  • Disease-modifying anti-rheumatic drugs (DMARDs). These medicines modify RA disease activity, help slow its progress and prevent joint damage. DMARDs can be grouped into non-biologics and biologics. Non-biologic DMARDs, like most medicines, are made from chemicals. Biologic DMARDS are proteins created in a lab to act like certain proteins made by the body. DMARDs are given by injection (shot), orally (by mouth) and intravenous infusion (into the vein). You and your rheumatologist will decide best treatment plan is for you, including which DMARD.
  • Medicines to improve symptoms. Some medicines can help relieve pain. Others like steroids or non-steroidal anti-inflammatory drugs (NSAIDs) can also reduce inflammation (swelling) and fever.
  • Surgery, if needed. Surgeries like joint revision surgery and replacement may be needed in some people. But most people can manage their RA with DMARDs and other treatments.

Your treatment may change as your RA changes. But your main treatment priority will most likely always be your DMARD. Starting DMARD treatment early is important since active disease can cause lasting, joint damage.

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How long will it take before my disease-modifying anti-rheumatic drug (DMARD) will start working?

You may not notice a change in your rheumatoid arthritis (RA) until you take your DMARD for weeks or even months. When you first start taking your DMARD, your doctor may prescribe other RA medicines like steroids or non-steroidal anti-inflammatory drugs (NSAIDs) to help improve symptoms.

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If I have a flare, does that mean my rheumatoid arthritis (RA) treatment isn’t working?

RA treatments don’t cure RA, but they can help relieve pain and swelling and slow joint damage. You can still have RA symptoms and flares even if you take your medicines exactly as your doctor has told you.

Your rheumatologist will check on a regular basis to see how your RA treatment is working. If you have frequent flares, your rheumatologist may add another medicine or change to a different one.

Always talk to your rheumatologist and RA CareTeam if you are having new or worsening symptoms. Visit your rheumatologist if your symptoms are severe or last more than a few days. Most flares resolve over time. But your rheumatologist may prescribe a steroid or other medicine to relieve symptoms.

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Can I take over-the-counter medicines to help improve my pain?

Always talk to your doctor before taking any over-the-counter medicines, including herbals and supplements.

Over-the-counter medicines like ibuprofen or naproxen sodium are in a group if medicines called non-steroidal anti-inflammatory drugs (NSAIDs). They can help relieve pain and swelling from rheumatoid arthritis. But they can also cause serious side effects, like stomach bleeds, in certain people or if taken the wrong way.

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Is there anything more I can do to help my rheumatoid arthritis (RA) in addition to medicine?

Healthy lifestyle changes can help prevent flares and relieve symptoms. Follow these tips to help manage your RA:

  • Take breaks. Rest helps reduce inflammation and fatigue that can come with a flare.
  • Stay active. As they say, a body in motion stays in motion. Exercise can help your muscles stay strong and flexible around your joints, reduce stiffness and help keep your joint mobility. It can also boost your mood and self-esteem. Ask your doctor or physical therapist about how you can stay active.
  • Take care of your joints. Avoid tasks that can damage or hurt your joints. Talk to your doctor about how to avoid joint damage. And ask what more you can do to protect your joints.
  • Cope with stress. Stress may worsen your RA symptoms. Try taking a warm bath, listening to soothing music or doing deep breathing to help reduce stress.
  • Eat a healthy diet. Having a healthy diet means better weight control and less stress on your joints. Ask your doctor about which foods may help your RA and which ones you should avoid.

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Does anyone have back pain from rheumatoid arthritis (RA)?

RA affects the hips, knees, hands, wrists, feet, elbows and ankles joints most often. But it can also affect some of the joints in the spine and cause pain. With severe RA, the damaged joints in the spine can put pressure on the spinal cord and/or the nerve roots around the spine. And this can cause back pain.

Don’t ignore back pain symptoms. Talk to your rheumatologist right away.

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Is it normal to feel weak all over?

Almost everyone with rheumatoid arthritis (RA) experiences fatigue. Many people describe fatigue as feeling drained and overly tired that doesn’t get better with sleep. Fatigue in RA may be due factors like stress, inflammation (swelling) or medicines like steroids to help relieve flares.

Help manage your fatigue with these lifestyle changes:

  • Eat healthy
  • Exercise on a regular basis
  • Protect your joints with proper support
  • Get a good night’s sleep
  • Take breaks

Other things can cause fatigue or weakness. For example, rheumatoid arthritis (RA) can also damage joints that affect muscles and tendons in the damaged area, causing weakness. So be sure to talk to your rheumatologist to find out why you’re feeling weak. Then work with your doctor to help manage your weakness.

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Is there a certain time of day I should take methotrexate and folic acid?

Methotrexate is a common medicine used to help treat rheumatoid arthritis (RA). It’s usually taken once weekly as a pill you swallow. It can also be taken as a liquid you drink or shot you inject. It can be taken any time, with or without food. But it’s best to take it about the same time of day, on the same day of the week. If you have nausea and vomiting, your rheumatologist may suggest taking methotrexate at night. Your doctor may have other ways to manage or relieve side effects.

One way to reduce certain side effects of methotrexate is by taking a folic acid supplement. Your rheumatologist may tell you to take it once a day. Or sometimes it’s taken once a week, about 24 hours after taking your methotrexate. Always take your medicine exactly as instructed by your rheumatologist, and ask if you are unsure.

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How soon after noticing symptoms can I be diagnosed with rheumatoid arthritis (RA)?

Your rheumatologist will diagnose RA using:

  • Medical history
  • Physical examination (signs and symptoms)
  • Blood tests
  • Other tests like X-rays

It’s best when RA is diagnosed early—within 6 months from when you first have symptoms. But diagnosing RA early can be a challenge because the symptoms of early RA can be similar to other health conditions. These symptoms include fatigue, weakness, muscle soreness, low-grade fever and weight loss. But it’s important to talk to your doctor if you have these symptoms. Early diagnosis means earlier treatment which can help slow or stop joint and body damage.

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Can rheumatoid arthritis (RA) cause tooth decay?

Yes. Studies have shown a strong link between RA and teeth and gum problems. And dental problems are common in people with RA. Teeth and gum problems may be due to a few things:

  • Having RA can keep you from your daily activities, including brushing your teeth and flossing. This can increase your chances of having dental problems.
  • Your RA medicine can affect the way your body fights bacteria, including ones in your mouth that lead to plaque.
  • Sjögren’s syndrome is health condition that can happen in people with RA. It causes the body to make less saliva. Saliva normally protects your teeth and gums to help prevent diseases. Less saliva means less protection and more problems.

People with RA should take good care of their teeth to help prevent decay, loss and gum problems. Schedule regular dental exams, eat smart, brush your teeth and floss. Talk to your dentist or rheumatologist if you have trouble taking care of your teeth due to stiff, painful hands or jaws. They might send you to an occupational therapist who can help find ways to make dental care easier, including using special assistive devices.

Newer studies have linked tooth loss to RA severity. Work with your rheumatologist to get your RA under control to better protect your joints and teeth.

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My voice is very hoarse after a severe rheumatoid arthritis (RA) flare. Could it be due to my RA?

Voice changes can be a symptom of RA. It can affect a joint in your vocal cords. This may change your voice or affect your ability to talk. You may overlook voice changes due to other RA symptoms like stiffness or pain. But be sure to talk to your rheumatologist if you notice any changes in your throat or voice. Your doctor may prescribe medicines like steroids to help protect your vocal joint.

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Why am I sweating so much?

Sweating has been linked to rheumatoid arthritis (RA). Increased sweating can also a side effect of some RA medicines like Remicade® (infliximab) or Rituxan® (rituximab). There may be other reasons for sweating more. Talk to your doctor to find the exact cause and right treatment.

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Can Enbrel® (etanercept) cause bleeding?

According to manufacturers, bleeding is a rare but serious side effect of a type of medicines called tumor necrosis factor (TNF) blockers (also called anti-TNFs), including Enbrel. Your body may not make enough blood cells to help fight infections or stop bleeding while taking Enbrel. It’s normal to bleed a small amount in the area of the injection but if you notice other bleeding, bruising or if you look pale, talk to your rheumatologist right away.

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What are internal nerve stimulators?

Transcutaneous electrical nerve stimulation—or TENS—is a treatment that may help relieve rheumatoid arthritis (RA) pain. This treatment involves a small device that sends mild electric pulses to nerves in the painful area. The amount of pain relief varies from person to person.

During TENS treatment, electrodes are taped on the skin in painful areas. These electrodes are connected by a wire to a battery-operated device to stimulate the nerves. TENS doesn’t hurt, but it may cause some tingling. Usually, it feels like a vibrating or tapping sensation.

Talk to your rheumatologist or physical therapist to find out if TENS might help you. And remember to keep taking your RA medicines as instructed by your rheumatologist to help control your RA and prevent joint damage.

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My lower legs and ankles feel like rubber—numb and wobbly. Is this from my rheumatoid arthritis (RA)?

Although RA may not directly affect the nerves, inflammation (swelling) of tissues may press on the nerves. This can cause numbness, tingling and weakness in the body, including in the legs and ankles. RA can also damage joints that affect muscles and tendons in the damaged area, causing weakness. Share your symptoms with your rheumatologist since these symptoms could also be due to other health problems.

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I’ve lost my sex drive. Could this be due to my rheumatoid arthritis (RA) medicine?

Decreased sex drive can be a side effect of some RA medicines like methotrexate and prednisone. Living with RA can cause pain, fatigue and depression which can also affect your sex life. And when you feel like your daily activities are limited, it can affect your self-esteem and lower your sex drive.

Overcome sexual barriers by:

  • Planning ahead to reduce pain (for example, taking pain medicines as prescribed)
  • Getting enough rest and take breaks to save energy for your partner
  • Talking openly with your partner
  • Seeking help from a counselor for emotional and social support

Talk to your rheumatologist about your sex drive and RA. It might be a hard topic to bring up, but your doctor is there to listen and can help you find ways to improve intimacy with your partner.

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Where can I find out more about rheumatoid arthritis (RA) and treatments?

Visit these websites to learn about RA treatment, tips for managing daily life, help for caregivers and links to other news.

Arthritis Foundation
www.arthritis.org

American College of Rheumatology
www.rheumatology.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases
www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp

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This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2016 CVS Specialty. All rights reserved. 75-38753B 071416

DRUGS & CONDITIONS

OSTEOPOROSIS

Glucocorticoid-induced Osteoporosis

Preventing Fractures

 

Osteoporosis is a health condition that causes bone loss so they become weak, brittle and more likely to break. It can affect any bone in the body. But the bones most likely to break due to low bone mass are the hip, wrist and spine. People can get osteoporosis at any age. But osteoporosis is more common in older women.

People with rheumatoid arthritis (RA) are more likely to get osteoporosis. These are the reasons why:

  • RA can cause bone loss, too. Bone loss may be worse right around the joints.
  • Some people with RA do little or no exercise. And weight-bearing exercise is needed to rebuild bone.
  • Certain corticosteroid medicines used for the treatment of RA can lead to glucocorticoid-induced osteoporosis. Examples of corticosteroids include:
    • Prednisone
    • Prednisolone
    • Dexamethasone
    • Cortisone

 

Glucocorticoid-induced Osteoporosis

Anyone taking a corticosteroid medicine is at risk for glucocorticoid-induced osteoporosis. The rheumatologist will determine the right plan to either prevent or treat this condition. This plan includes:

  • Prevention of glucocorticoid-induced osteoporosis. The rheumatologist will try to find the lowest dose of corticosteroid and use it for the shortest time, while still keeping RA symptoms under control.

  • Bone Mineral Density Testing. A dual energy x-ray absorptiometry (DXA) test is used to measure bone mineral density of the bones in the body. A DXA T score of -2.5 or lower indicates that a person has osteoporosis.

  • Calcium and vitamin D. People taking these medicines need 1,200 mg to 1,500 mg of calcium every day. The body also needs 800 international units (IU) to 1,000 IU of vitamin D every day to help absorb the calcium. The best way to get enough of vitamin D and calcium is to take a supplement that has both. The body can only absorb 500 mg of calcium at a time. This means taking doses multiple times a day.

  • Exercise. Weight-bearing exercise strengthens the bones. Weight-bearing exercises include walking, running, dancing, skiing, weight lifting and stair climbing. Activities such as bike riding and swimming are good cardiovascular workouts, but they are not weight-bearing. They do not make the legs, hips and spine bear much weight. To strengthen bones, at least 30 minutes of weight-bearing exercise five times a week is needed. It’s important to talk to a doctor before starting any kind of exercise.

  • Medicines. Medicines are used to prevent and/or treat glucocorticoid-induced osteoporosis. Risendronate and zoledronic acid are approved for both the treatment and prevention of glucocorticoid-induced osteoporosis. Teriparatide is approved for the treatment of glucocorticoid-induced osteoporosis.

For some women who no longer have periods, hormone replacement may also help.

 

Preventing Fractures

The main goal of treating glucocorticoid-induced osteoporosis is to prevent fractures. The tips below can help prevent bone loss and can decrease the chance of a fracture. 

Lifestyle changes 

  • Quit smoking
  • Limit alcohol
  • Eat a well balanced diet high in calcium and vitamin D
  • Lose weight
  • Exercise more

Preventing falls

Everyone needs a safe home environment that guards against falls. Here are some tips for preventing falls at home:

  • Wear good support shoes (for example, low heels with rubber soles) 
  • Use nightlights in the bathrooms and hallways
  • Keep outdoor walkways well lit
  • Keep a flashlight with fresh batteries handy
  • Install railings on both sides of all stairs
  • Install grab bars in bathrooms
  • Keep home and floor clear of clutter
  • Remove all scatter rugs, bath mats or other nonattached carpeting that might be tripped on
  • Use a wheelchair, walker, cane or other aids such as handholds if needed
  • Use a chair with a lift for trouble getting into or out of a chair
  • Change positions slowly to prevent dizziness and/or fainting
  • Don’t rush
  • Place items within easy reach
  • Get help carrying or lifting heavy items
  • Establish an exercise routine. This will improve both muscle and bone strength and help reduce the likelihood of injury

 


This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

This document contains registered trademarks of entities not affiliated with CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. 75-36601B 122215

This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty.

DRUGS & CONDITIONS

JUVENILE IDIOPATHIC ARTHRITIS

Subtypes

Diagnosis

Treatment

Learn More

 

Anyone can have arthritis. The term used to describe arthritis in children is juvenile idiopathic arthritis, or JIA. JIA is the most common type of arthritis in children under the age of 17.  

The most common symptoms of JIA involve the joints and may include:

  • Pain
  • Swelling
  • Tenderness
  • Warmth
  • Stiffness (usually in the morning or after a nap)

Subtypes

Juvenile idiopathic arthritis (JIA) is divided into subtypes. Each subtype is different and is based on symptoms or the number of joints involved.

JIA Subtypes

Systemic Arthritis

Possible Symptoms

Other Findings

  • High fever
  • Salmon-colored rash (most often on arms, legs and trunk)
  • Low red blood cell count
  • High white blood cell count
  • Occurs in up to 2 out of 10 children with JIA
  • Affects boys and girls equally
  • Can affect the heart, liver, spleen and lymph nodes
  • Rarely affects eyes

Oligoarthritis

Possible Symptoms

Other Findings

  • Involves fewer than five joints (most often the knee, wrist and ankle)
  • Eye inflammation
  • Half of all JIA patients have this subtype
  • More common in girls than boys
  • Some children may outgrow this subtype by the time they become adults

Polyarthritis

Possible Symptoms

Other Findings

  • Involves five or more joints (often the same joints on both sides of the body)
  • Can affect neck and jaw joints as well as joints in the hands and feet
  • More common in girls than boys

Psoriatic Arthritis

Possible Symptoms

Other Findings

  • Child has both arthritis and psoriasis (a skin condition)
  • Skin rash
  • Nail changes
  • Swelling of a finger or toe
  • Family history of psoriasis may play a role in helping diagnosis

Enthesitis-Related Arthritis

Possible Symptoms

Other Findings

  • Joint pain without obvious swelling
  • Can affect the spine, hips, and enthesis (the attachment point of tendons to bones [for example: knee or Achilles tendon on the back of the ankle])
  • Sometimes called spondyloarthropathy
  • Can affect eyes

 

Diagnosis

There isn’t one test to diagnose juvenile idiopathic arthritis (JIA). If JIA is suspected, a person will usually see a doctor who specializes in arthritis. These doctors are called rheumatologists. Then to confirm or diagnose JIA, a rheumatologist may:

  • Perform a medical and family history.
    The rheumatologist will ask questions that may include:
    • When did symptoms begin?
    • Do symptoms come and go?
    • What makes symptoms feel better? What makes them feel worse?
    • Which joints are involved?
    • History of previous or current autoimmune conditions?
    • Do any family members have JIA, RA, psoriasis or other autoimmune conditions?
       
  • Conduct a physical exam.
    The rheumatologist will examine the body, including each joint, and check for swelling, redness, warmth, pain and range of motion.
     
  • Order blood tests
    Several blood tests can be given to help a rheumatologist diagnose JIA or to rule out other conditions. However, for many children with JIA, no changes will be found in the blood tests. Tests may include:
    • Erythrocyte sedimentation rate (ESR) or "sed rate" measures how fast red blood cells (erythrocytes) fall to the bottom of a tube of blood. The faster the cells drop, the greater the level inflammation happening in the body. 
    • Rheumatoid factor is an antibody––a protein the immune system uses to fight off foreign substances. This antibody is commonly found in children with JIA.
    • C-reactive protein (CRP) is made by the liver. It increases or decreases in response to inflammation. 
    • Cyclic citrullinated peptide (CCP) antibody test is a test to help diagnose JIA. The CCP antibody may be found in children with JIA.
    • Order imaging tests.

Treatment

Based on the subtype of juvenile idiopathic arthritis (JIA) and severity of symptoms, the rheumatologist will determine the best medicine to treat the condition. Children with JIA will usually need a combination of medicine and physical therapy to achieve the best outcome possible.

Goals of JIA Treatment

  • Relieve pain
  • Reduce swelling
  • Increase joint movement
  • Increase joint strength
  • Prevent joint damage
  • Maintain a good quality of life

Medicines used for JIA may include:

  • Nonsteroidal anti-inflammatory drugs, or NSAIDS, can be used for treating JIA symptoms like pain and joint inflammation. Examples include ibuprofen and naproxen sodium. However, they can cause serious side effects, can’t always be used for extended periods of time and are not appropriate for everyone. NSAID side effects can include heart and blood vessel disease, stomach upset and bleeding in the stomach or intestines. 

    Some NSAIDs are available over-the-counter. Others are only available with a prescription. The doctor will determine if an NSAID is appropriate and which one is best. People should not self-treat with over-the-counter NSAIDs or other products, including supplements, without talking to their doctor first.

  • Corticosteroids can be used to help manage the pain and inflammation caused by JIA. Some examples include prednisone, prednisolone, methylprednisolone and cortisone. Corticosteroids can have serious side effects, especially when given in high doses for a long time. Corticosteroids can interfere with a child’s growth and bone development. When a corticosteroid is necessary, the rheumatologist will find the lowest dose of corticosteroid and use it for the shortest period.

  • Disease-modifying antirheumatic drugs (DMARDs) can reduce or prevent joint damage, preserve function and help maintain quality of life. DMARDs stop the body’s immune system from attacking healthy joint tissue that leads to damage. DMARDs are used when a child does not respond to an NSAID. DMARDs work slowly, can cause serious side effects and, sometimes can take three to four months before any results appear.

  • Physical therapy and exercise are also important. In most cases, medicine alone is not enough to treat JIA. A physical therapist can suggest exercises that help increase muscle tone, increase joint motion, reduce pain and improve overall quality of life.

Learn More

Growing up with arthritis can be challenging. But, arthritis in children is treatable. Children with arthritis should live as normal a life as possible. Visit these websites to learn more about juvenile arthritis.

Arthritis Foundation: Kids Get Arthritis, Too
www.kidsgetarthritistoo.org

The American College of Rheumatology
www.rheumatology.org/

National Institute of Arthritis and Musculoskeletal and Skin 
www.niams.nih.gov/

Juvenile Arthritis Foundation
www.juvenilearthritis.org/

 


This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

This document contains registered trademarks of entities not affiliated with CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. 75-36601B 122215

This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty.

DRUGS & CONDITIONS

SUPPORT

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Please call CVS Specialty toll-free at 1-800-237-2767 to start filling your RA prescriptions with us. We can help you get the best possible outcomes for a better quality of life. And help is always available―365 days a year. 

Already Enjoying Our Services?

Contact your CVS Specialty CareTeam toll-free at 1-800-237-2767, if you have questions or concerns about your health or treatment. A pharmacist, nurse or counselor is ready to help.

Resources 

Learning about RA gives people more tools to help manage their health and live better. Visit these websites to learn about RA medication, tips for managing daily life and links to other RA news.

Arthritis Foundation
www.arthritis.org/

The American College of Rheumatology
www.rheumatology.org/

National Institute of Arthritis and Musculoskeletal and Skin 
www.niams.nih.gov/

 


This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

This document contains registered trademarks of entities not affiliated with CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. 75-36601B 122215

This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty.