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Sandy, a 45 year-old woman, complained of bilateral hand and wrist pain on-and-off for many years. Rheumatoid Arthritis (RA) is a chronic, long-term disease that causes pain, stiffness, swelling and limited motion and function of many joints. Rheumatoid arthritis affects the wrist and the small joints of the hand, including the knuckles and the middle joints of the fingers.
Diagnosis of RA depends on the symptoms and results of a physical exam, such as warmth, swelling and pain in the joints.
Common DMARDs include methotrexate (brand names include Rheumatrex® and Folex®), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine). Patients with more serious disease may need medications called biologic response modifiers or “biologic agents.” They can target the parts of the immune system and the signals that lead to inflammation and joint and tissue damage. It is important to be physically active most of the time, but to sometimes scale back activities when the disease flares.
When you feel better, do low-impact aerobic exercises, such as walking, and exercises to boost muscle strength. AcupunctureBladder and Gallbladder ChannelsThe route which the sciatic nerve travels, in part, overlaps with two acupuncture channels. Recently for a month now, she felt both hands had constant pain and were tender, warm and swollen.  She woke up with morning stiffness that may last for hours and felt firm bumps of tissue under her both forearm accompanied with fatigue, mild fever and gradually weight loss. While RA can affect any joint, the small joints in the hands and feet tend to be involved most often. This means that certain cells of the immune system attack healthy tissues — the joints in RA, cause the inflammation in the synovium, the tissue that lines the joint. Periods of increased disease activity, called flares, alternate with periods of relative remission — when the swelling and pain fade or disappear. Thus, patients with a diagnosis of RA should begin their treatment with disease-modifying antirheumatic drugs — referred to as DMARDs.

Older DMARDs include gold, given as a pill — auranofin (Ridaura) — or more often as an injection into a muscle (such as Myochrysine). It has no side effects and can be combined with traditional western medicine to relieve your symptoms.
Feet: St 45 Li Dui, St 44 Neiting, Sp 1 Yin Bai, Sp 2 Da Du Sp3 Tai Bai, Sp 4 Gong SunUB 66 Zu Tong Gu, UB 65 Zhi Yin, UB 65 Shu Gu.
I first try to decrease her pain at the joints and body with the points of group 1 and 2 , then, I used the group 3 and 4 points to help her to improve her fatigue and depression, after about 2 month’s treatment, Sandy was put on maintenance treatment program once a week for 4 weeks, and she  felt much improved. Multiple Therapies are the best way to treat RA with combination of medicine, PT and Acupuncture. She visited her PCP and was given naproxen to reduce her inflammation and pain, however, she felt no improvement. Stiffness for a long time in the morning is a clue that you may have RA, since few other arthritic diseases behave this way. FDA-approved drugs of this type include abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi) infliximab (Remicade), rituximab (Rituxan) and tocilizumab (Actemra). Proper care requires the expertise of a team of providers, including rheumatologists, primary care physicians, physiatrist and physical and occupational therapists. A physical or occupational therapist can help you find which types of activities are best for you, and at what level or pace you should do them.
Expertise is vital to make an early diagnosis of RA and to rule out diseases that mimic RA, thus avoiding unneeded tests and treatments. Studies show that people who receive early treatment for RA feel better sooner and more often, and are more likely to lead an active life. You should encourage your patient perform exercise, which will keep your patients’ mobility of hands and other joints.
She was referred to a rheumatologist, who ordered x-ray images and rheumatoid factor test.  Both were positive for Rheumatoid Arthritis, therefore, the diagnosis was confirmed.

As the disease progresses, symptoms often spread to the knees, ankles, elbows, hips and shoulders. This can make cartilage (the tissue that cushions between joints) and bone erode, or wear away. These three drugs and gold are rarely prescribed for RA these days because other drugs work better or have fewer side effects. Most often, patients take these drugs with methotrexate, as the mix of medicines is more helpful. For most people with RA, early treatment can control joint pain and swelling, and lessen joint damage. A physiatrist who is an expert in RA also can design a customized treatment plan that is best suited for you. They also are less likely to have the type of joint damage that leads to joint replacement. The patient was given methotrexate and felt better for morning stiffness and swelling, however, she had many side effects, such as, nausea, vomiting, hair loss, etc.
DMARDs have greatly improved the symptoms, function and quality of life for nearly all patients with RA.
These checkups let your doctor track the course of your disease and check for any side effects of your medications.
Therefore, the rheumatologist, working with the primary care physician and other health care providers, should supervise the treatment of the patient with RA.
You likely also will need to repeat blood tests and X-rays or ultrasounds from time to time.

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