adivise him to seek a rheumatologist! to confirm the diagnosis and start the apropiate treatment.

Oral MTX, Monoclonal antibody etc.

I have heard that Emu oil is also helpful.  My company is working on some others as well but do not have one yet.

@Gustavo, Abdul and George: thank you for your advises. Best wishes

Dear Prof. Shahid Sheikh and Maximilian: thanks for your advise. Best wishes

Best is to see your rheumatologist, he/she will see the blood analysis and other test results. in this site, I will not recommend you should follow anyone's advise, since no one knows the details of RA extent in your friend.

Rheumatoid arthritis is a a chronic inflammatory arthritis. For initial response NSAIDS/ Steroids should be used but for long term control and remission of disease patient should be started on DMARDS(Disease modifying antirheumatic drugs ). For the samepatient should see a Rheumatologist

Your friend should seek out a rheumatologist to confirm the diagnosis and guide therapy.  Voltaren gel is not sufficient to suppress the inflammatory process if this is indeed RA.

Some have found relief using CBD that I have heard.

Hi

I second what Dr. Maximillian Konig has written. Firstly a diagnosis of Rheumatoid Arthritis needs to be confirmed. Proper treatment then leads to excellent results. Near cure like situation (called remission) may be obtained in majority of patients. Do contact a Rheumatologist for Proper treatment as per ACR guidelines. Do not indulge in hearsay treatments.

Best wishes

Siddharth Das

@Subhash, Sourabh, Aleksandra, George, and Siddharth: thank you for all your answers. Best wishes

I agree with Drs Konig and Das. Your friend needs to see a rheumatologist and confirm the diagnosis, document the severity and extent of damage. Remember, blood test aid in making the diagnosis and are NOT diagnostic by themselves. Once a diagnosis has been made, extent of damage documented and severity assessed, appropriate treatment can then be instituted. Non-steroidal anti-inflammatory drugs only provide short term symptomatic relief and have no effect on the progression of rheumatoid arthritis. Hope this helps you further.

Yes, have your friend see a reputable rheumatologist. If a RA factor test was found positive, and with joint aches and pains, infection with the hepatitis C virus, Parvovirus B19 infection, etc need all be excluded first,    

I agree with Drs Konig, Das and Maharaj. It is important to see a reputable rheumatologist to get a firm diagnosis - not all joint pains are due to rheumatoid arthritis (RA). If it is RA, treatment needs to be started early with disease modifying drugs (DMARDs) that will slow down the progression of joint damage that almost inevitably occurs. Other treatments such as Voltaren gel or Cataflam that you mentioned just give symptomatic relief and should not be just given on their own, as they do not prevent the joint damage in RA. Once joint damage occurs, it is irreversible, hence the importance of early accurate diagnosis of RA by a rheumatologist. 

@Ajesh, Emilio, Swan: thank you for all your answers. Best wishes

Thanks, Victor,

All the best to you and your friend as well and have a fabulous festive season. Warm Regards

Medications

Many drugs used to treat rheumatoid arthritis have potentially serious side effects. Doctors typically prescribe medications with the fewest side effects first. You may need stronger drugs or a combination of drugs if your disease progresses.

NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Side effects may include ringing in your ears, stomach irritation, heart problems, and liver and kidney damage.

Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, weight gain and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.

Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine).

Side effects vary but may include liver damage, bone marrow suppression and severe lung infections.

Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan) and tocilizumab (Actemra). Tofacitinib (Xeljanz), a new, synthetic DMARD, is also available in the U.S.

These drugs can target parts of the immune system that trigger inflammation that causes joint and tissue damage. These types of drugs also increase the risk of infections.

Biologic DMARDs are usually most effective when paired with a nonbiologic DMARD, such as methotrexate.

Therapy

Your doctor may send you to a therapist who can teach you exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks, which will be easier on your joints. For example, if your fingers are sore, you may want to pick up an object using your forearms.

Assistive devices can make it easier to avoid stressing your painful joints. For instance, a kitchen knife equipped with a saw handle helps protect your finger and wrist joints. Certain tools, such as buttonhooks, can make it easier to get dressed. Catalogs and medical supply stores are good places to look for ideas.

Surgery

If medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and correct deformities.

Rheumatoid arthritis surgery may involve one or more of the following procedures:

Total joint replacement. During joint replacement surgery, your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic.

Tendon repair. Inflammation and joint damage may cause tendons around your joint to loosen or rupture. Your surgeon may be able to repair the tendons around your joint.

Joint fusion. Surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief when a joint replacement isn't an option.

This is a link to the Rheumatología Clínica paper about Update of the Mexican College of Rheumatology Guidelines for the Pharmacologic Treatment of Rheumatoid Arthritis (Actualización de la Guía Mexicana para el Tratamiento Farmacológico de la Artritis Reumatoide del Colegio Mexicano de Reumatología)

You can find it in Spanish and English

http://www.reumatologiaclinica.org/es/update-of-the-mexican-college/articulo/90332775/

Although this topic have now 3 years old, It also worries me, because my mother have been diagnosed and is suffering of Rheumatoid arthritis, and I'm on the search of alternatives to calm her pain and her joint inflammation. Does anyone know anything about the CBD treatment or any other treatment (better if is biological), because the Arava have been damaging her body, and also her mind because the side effect of depression.

Thank you for your help, and is good to know that there are good professionals working on this field.

Dear Juan

Rheumatoid Arthritis is generally a very well treated Arthritis. Only about 10-15% patients are very aggressive and do not show good response. 

From whatever you have written she seems to have aggressive disease. Besides it seems that she is not responding to Arava. She is also suffering from Depression.

Where are you based (country)? What does CBD stand for? What medications has she taken? What are her current medications? These information will help in letting me advice further.

Siddharth Das

Professor of Rheumatology

K G Medical University, Lucknow, India

First, confirm that your friend has bona fide RA, excluding other autoimmune disorders like lupus, and also viral infections such as hepatitis C, for example. If he indeed has seropositive RA, then he needs to see a rheumatologist. The treatment of RA is not just topical creams or even just NSAIDS but with the use of the so-called DMARDS, including methotrexate (MTX), Plaquenil, biologic agents, etc. 

Dear Dr. Das.

Thank you for your quick answer.

We are from Colombia, and we are right now living on Bogotá. The question about the CBD, is because my partner and me are interested about making research about the desinflamatory and painkiller effect with the CBD/THC treatment/consumption and, of course, how the endocannabinoid system could be related with this kind of autoimmune illnesses.

About the clinical condition of my mother, she has been suffering of seropositive erosive RA from 7 years, with a global qualification of the illness of 80/100 in the last report.

The medications that she have been taken are arava, as I told you, but also methotrexate (that I suggest her about 1 year to begin to leave the consumption from min - 1 pill each tree days - to 0, taking them for approx. 5 months, because the several side effects), also she tried ozone therapy on cuba with ontake of biomodulin plus compvit.

Likewise, she's taking as current medications an endovenous of Abatacept each month of 250 mg, a powder of biocalcium D daily and turmeric with ginger tea.

Thank you for your concern in this matter.

Sincerely,

Juan Sebastián Mora A.

Biology and Environmental Engineering student

University of La salle, Colombia. 

What would be the full form of CBD and THC. Try to lookup a Rheumatologist in Colombia. Methotrexate can be given in doses UpTo 30 mg per week. It needs to be given with Folic Acid tablets. One has to be careful with high doses of MTX. There are other medications also. Dr. Emilio has suggested plaquenil . It is good drug with not many side effects. Others are Sulphasalazine, Infliximab and other Biologicals. Depression needs to be treated with medications for depression. I strongly suggest that 1. Do not treat your mother yourself. 2. Look for a Rheumatologist.3. if rheumatologist not available seek help from a good physician.

Best Wishes

Siddharth Das

Thanks for you answer, Dr. Siddharth Das.

Actually I don't know how to treat efficiently with the CBD or THC, and that's why I'm asking for this option, because I have read and seen the studies made by Dr. Raphael Mechoulam, Dr. Manuel Guzmán and Dr. Ethan Russo, about the medical use of the CBD and THC, and they have found that the CBD could help on the pain treatment, as well in the inflammatory treatment, but I haven't found info related to the RA, so that's what I'm looking for .

In fact all the info that I wrote was the medical history made by an Rheumatologist. The thing is that the arava was the medication that was giving her depression, thing that stopped with the stop of the consumption of it, and the Methotrexate was damaging her digestive system,so the recommendations, not only given by my researches, was to stop consuming them.

I also Will look and ask the Rheumatologist, (that, in fact, tomorrow we're gonna see her again) for the use of Plaquenil and the others recommended.

Hope this information help better.

Sincerely,

Juan Sebastián Mora A.

Biology and Environmental Engineering student

University of La salle, Colombia

Dear Juan Sebastian,

If your mother's RA is not responding to the standard medications for RA, it may be worthwhile to seek the advice of a physician specializing in environmental medicine. Sometimes removal of one or more person-specific environmental triggers can help calm recalcitrant RA disease activity.  The causes of RA flares have not been well described, and probably not well studied.  The physician of environmental medicine can be added as a team member for the mother's care.

The following article may be helpful to develop insights and a different perspective for treatment of a recalcitrant RA disease:  " Each type of cause that initiates rheumatoid arthritis or RA flares differentially affects response to therapy."  Med. Hypoth. 78:123-129 (2012) by Molnar-Kimber and Kimber.   One of the potential types of listed causes was bone or joint trauma.  A recent article, Koyama et al (Mod Rheumatol 26:1-5, (2016)) has shown in a case report and retrospective study that a bone fracture induced a flare in most of their RA patients (57%) .

Hope these suggestions help. 

Sincerely,

Kathy

Look into the Neuroviral Pathogenesis.

Five balances in the management of  rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is the most common chronic autoimmune joint disease. The etiology of RA is complex, then it is impossible to cure completely today and it should be individualized treatment. Immune system is complex. Existing statistical techniques based on reductionism cannot discover many relevant disease risk factors and complex interaction relationship. The disease network model based on complex network is important for the analysis and treatment of RA disease. In this Review, we have found five important layers of RA complex network and presented five balances regulating strategy in the management of RA. We have followed up one RA patient (wife of the author) for one year using this strategy, and the management effect is good. This Review argues RA is self-limiting to some extent, good management with five balances regulating strategy would have positive significance, among which the balance between neuroendocrine system and immune system is the most important. During the day, glucocorticoid plays an important role in controlling inflammation, and human growth hormone plays an important role in eliminating inflammation during the slow-wave sleep at night. Five balances core concepts can shed light on the management of other causes of arthritis.

Keywords

Rheumatoid arthritis, Autoimmune diseases, Complex network, Balance, Network medicine

My new Book:

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Use of DMARD's early in the disease reduces the destruction of joints over a period of time. Use of biologics if DMARD's not sufficient. Advise Rheumatologist is mandatory.

Case Report Glob J Intellect Dev Disabil Breakthrough Treatment of Rheumatoid Arthritis In the Light of Nucleopathy Global Journal of Intellectual & Developmental Disabilities

• July 2018
• Journal of Intellectual & Developmental Disability 4(5):01-02
• DOI:
• 10.19080/GJIDD.2018.04.555650

I agree with Dr. Reddappa,

Good luck.

These are all add on therapies for temporary pain relief and would work at various degrees. You definitely need non biologic DEMARDs or biologic ones guided by a rheumatologist

Thank you all to take time trying to help us on this difficult times.

Right now things aren't getting better, mainly because the psychological effects that some of those drugs have (even that when I convince her to try some CBD extracts, and showed good results, but then she just didn't wanted to continue).

Thus, the health system often change the rheumatologist, and Isn't a same professional always, it's hard to maintain continuity.

Hope to find some good pathway.