Things A Rheumatologist Wants You To Know About Rheumatoid Arthritis
Newly diagnosed with RA? A Cleveland Clinic rheumatologist explains some basics for you.
Before making treatment choices, a person newly diagnosed with rheumatoid arthritis and her doctor must determine how active the disease is.
If youve just been diagnosed with rheumatoid arthritis , you probably have a lot of questions about the condition and what it may mean for your future health and quality of life.
This inflammatory autoimmune disease affects many people: 1.5 million U.S. adults , according to the Arthritis Foundation.
The severity of rheumatoid arthritis varies from person to person and can be mild, moderate, or severe.
When you have rheumatoid arthritis, your immune system mistakenly attacks the linings of your joints , causing them to become inflamed and painful.
RA can begin at any age most commonly in the forties, fifties, and sixties and typically causes joint pain, fatigue, and stiffness lasting more than one hour, says Elaine Husni, MD, MPH, a rheumatologist at the Cleveland Clinic in Ohio and director of the Arthritis and Musculoskeletal Treatment Center there.
As with any condition, a number of important questions arise among the newly diagnosed, ranging from the nature of RA itself to treatment options.
Dr. Husni answers some of those questions and addresses queries she and other rheumatologists hear most often.
Here’s what she has to say:
How Do You Deal With Pain
The majority of people equate arthritis with discomfort. Its one of the diseases hallmark symptoms. A pain treatment such as acetaminophen or an NSAID such as ibuprofen or naproxen may be recommended by your doctor.
Other methods for pain relief include:
1. Using a heating pad, wrap, or patch to administer moist heat to the inflammatory joint
2. Applying ice to the affected area to relieve pain and swelling
3. altering ones activities to lessen joint strain
4. Supportive braces or splints for the joint
Although arthritis cannot be cured, it can be controlled. Call your doctor if you have arthritis and dont think your current treatment is helping. Its possible that youll need to attempt a new treatment. You can manage your arthritis and live a productive life with the correct kind of care.
Stage : Symptoms Are Visible
In this latter, more severe stage, blood tests and imaging are less relevant for diagnosis because you can actually see the effects of the disease. The joints start becoming bent and deformed, the fingers become crooked, Dr. Bhatt says. These misshapen joints can press on the nerves and can cause nerve pain as well, he says. In the older days we used to see more deformed joints when we did not have much treatment, but now we are seeing less and less, Dr. Bhatt says.
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What Determines Life Expectancy
RA is an autoimmune disease that makes patients more susceptible to developing other conditions. This can compromise the health of patients long-term. That being said, there are factors that can improve a patients life expectancy through mitigating the complications experienced during the disease course.
Stop Eating An Unhealthy Diet
Whats your diet got to do with arthritis? Eating well and maintaining your ideal weight is especially important if youve got arthritis. Excess pounds can put lots of stress on weight-bearing joints, which is likely to make arthritis pain worse. Even moderate weight gain can stress joints that are already burdened by arthritis.
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Exercise Doesnt Have To Hurt To Help
When it comes to all kinds of arthritis, exercise can feel like a catch-22. You need to stay active to help minimize stiffness and swelling, but thanks to RAs effects on your joints, the very exercises that can help you manage it can sometimes feel hard or even impossible to do.
But that doesnt mean you should give up on fitness. The trick, Dr. Levitan says, is to find a way to move your body that is manageable and, importantly, that makes you happy. No need to go hardcore but it is important to move every day.
With your doctors OK, you could start with 10-, 15- or 20-minute daily walks. Swimming or using an elliptical machine or recumbent bike at the gym are also easier on your joints. Gentle exercises like yoga can keep your joints limber and your muscles strong, he adds.
Stop Ignoring Your Physical Limitations
Just as there are people with arthritis who arent active at all, there are those who push beyond their limits. The trick is to pace your activities. Overdoing it is just as harmful as underdoing it.
Pushing your limits can increase pain and put you at higher risk of joint damage. Respect pain and choose activities with your physical limitations in mind.
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Articles On Is Remission Possible With Ra
The goal of your RA treatment is remission. It can make you feel like your RA has gone away — at least for a while.
Doctors define it several ways. Your doctor may use measures like:
- Less than 15 minutes of stiffness in the morning
- Little or no joint pain, based on your history
- Little or no joint tenderness
- Little or no joint swelling
- Blood tests that show low levels of inflammation
Remission might mean something different to you. Maybe it means you have no symptoms at all. Maybe it’s that you have just a little stiffness when you wake up. Perhaps your joints only swell once in a while.
Not only do your symptoms ease while you’re in remission, but your disease stops progressing. That halts lasting damage to your joints.
When To Get Medical Advice
See a GP if you think you have symptoms of rheumatoid arthritis, so they can try to identify the underlying cause.
Diagnosing rheumatoid arthritis quickly is important, because early treatment can prevent it getting worse and reduce the risk of joint damage.
Find out more about diagnosing rheumatoid arthritis.
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Not Sticking To Treatment
After you are diagnosed with RA, your doctor will recommend a course of treatment to help manage RA symptoms and disease activity. If you fail to follow the treatment regimen by not filling prescriptions, not taking medication as directed, not exercising, or skipping appointments there is an increased risk of worsening symptoms and disease activity. Thats the case even when its unintentional, such as when you forget.
While your reasons for not following your treatment plan may be entirely valid, it is your responsibility to discuss those reasons with your doctor before you make changes to the prescribed regimen. You could benefit from a medication change or the addition of a treatment. Be sure to have that conversation with your doctor and decide on your next move together.
Importance Of Treating Psoriatic Arthritis
Although psoriatic arthritis may range from mild to severe, it is important to treat no matter the severity. If left untreated, psoriatic arthritis can cause permanent joint damage, which may be disabling. In addition to preventing irreversible joint damage, treating your PsA may also help reduce inflammation in your body that could lead to other diseases. These other diseases are often referred to as comorbidities.
A comorbidity is a disease or condition that occurs because of or is related to a health condition you have, such as PsA. Some common comorbidities of PsA include cardiovascular disease, obesity and depression.
There may be other reasons that you choose to treat. You may want to reduce joint pain that often prevents you from sleeping well or engaging in daily activities. You may want to protect your joints and range of motion so you are able to move comfortably as you age. These are all valid reasons to treat your PsA.
Whatever your motivation for treating, know that there are more options available now than ever before. Discuss with your rheumatologist how to effectively treat your PsA and meet your treatment goals. Since your treatment may also affect your overall health, continue to see your primary care provider for regular check-ups.
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Juvenile Rheumatoid Arthritis : Does Jra Ever Go Away
Children can develop many of the same types of arthritis that adults do. Around 300,000 minors have been diagnosed with an arthritic disease. However, unlike adults with similar diagnoses, children with appropropriate treatment can live long and active lives. Like adult rheumatoid arthritis , Juvenile Rheumatoid Arthritis is caused by the bodys immune system attacking its own healthy tissue. Researchers believe that children, just like adults, have the same genetic tendencies that can be triggered to develop arthritic diseases. Research has not provided any conclusive solution to preventing arthritic diseases in children because the cause of the initiation of immune malfunction is still widely unknown.
In the United States, JRA is the most common term to encompass all of the types of arthritic diseases that children can be diagnosed with, but there are several other terms that exist. Juvenile chronic arthritis and juvenile idiopathic arthritis are terms that are interchangeable with JRA.
The symptoms of JRA are similar to those of adult RA:
- Persistent joint pain
- Rashes that appear with fevers
Ask Your Doctor How Active Your Rheumatoid Arthritis Is
Before you can make treatment choices, you have to determine how active your RA is, which includes your disease burden, says Husni. We now have many treatment choices in RA, and this allows us to personalize the process for each patient.
Although we do not have a cure, we are better at controlling the signs and symptoms to allow patients to return to their normal lives. We still have patients who do not respond to treatments, but this is rare and there is ongoing research to continue to improve RA treatment.
The three things rheumatologists normally do are a physical exam, some blood tests, and examine X-ray changes in the affected joint,” says Husni. “Those are the three pillars that we look at, and based on whatever they show, we can usually categorize you as having mild disease, mild to moderate disease, or moderate to advanced disease. We also want to know about the psychosocial aspects how else does the disease affect you? This could be disturbing your sleep or mood or ability to work. We weigh all these aspects when treating an RA patient.
How active the disease is will affect your RA treatment plan. One of the first things we do is try to figure out where you are on that spectrum, because treatment and advice will change for somebody with mild RA versus somebody with severe RA, she adds.
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Pregnancy May Give You A Reprieve
RA is primarily diagnosed in women during their childbearing years, so its natural to have many questions and concerns about how the disease will affect your fertility, pregnancy, and postpartum health.
The good news is that for many patients with inflammatory arthritis, pregnancy temporarily suppresses the immune system. This causes an overall decrease in inflammation throughout the body, giving many patients a nine-month window of some relief. On the other hand, some women may still experience flares during pregnancy, so its important to work together with both your ob-gyn and rheumatologist closely to manage all your arthritis and pregnancy symptoms.
What Causes Rheumatoid Nodules
Currently, research doesnt clearly indicate a specific cause of rheumatoid nodules and why exactly they develop in some patients and not in others. Given that they generally form on extensor joints, rheumatoid nodules could be the result of repeated pressure on the affected joints over time. Some patients even report a decrease in size or disappearance over time.
Patients who are bedridden, sometimes form rheumatoid nodules on the backs of their elbows, legs, hips and sacrum. There are even reported cases of these nodules on the posterior scalp. These are all the pressure points of bedridden patients and possibly the catalyst to the formation of rheumatoid nodules.
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How To Stop Reactive Arthritis Coming Back
There is a risk you could develop reactive arthritis again if you get another infection. The best way to avoid this is by protecting yourself against STIs and bowel infections.
The most effective way of preventing STIs is to always use a barrier method of contraception, such as a condom, during sex with a new partner.
Page last reviewed: 09 February 2021 Next review due: 09 February 2024
Is Remission Possible
Early and more aggressive treatment raise your chances of remission. But itâs more likely if you have low or good scores on these RA assessments when youâre diagnosed:
- Disease activity score or other measures of disease activity: It uses joint tenderness, signs of inflammation in your blood, and pain levels to rate disease activity.
- Health assessment questionnaire : It gauges how well you can do activities in eight daily life categories.
- C-reactive protein levels: Youâll get a blood test to look for these signs of inflammation in your blood.
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Should I See A Doctor
Its common to have aches and pains in your muscles and joints from time to time. This may especially be true if you take part in unusual or strenuous physical activities.
So, how can you tell the difference between the early signs of arthritis and normal pain and stiffness? And, how do you know when you should see a doctor about your symptoms?
If you have swelling or stiffness that you cant explain and that doesnt go away in a few days, or if it becomes painful to touch your joints, you should see a doctor. The earlier you get a diagnosis and start the right type of treatment, the better the outcome will be.
Here are some other things to think about that might help you decide whether you need to see a doctor:
- How do I know if my joint pain is caused by rheumatoid arthritis?
- Does RA run in families?
- What medicines would work best for me, and what are the side effects?
- Is there anything I can do to prevent flare-ups of RA?
- What are the pros and cons of surgery to treat RA?
- Does RA affect my life expectancy?
The Pain You Feel Isnt From Your Bones Grinding Together
A popular myth about RA is that the characteristic joint pain is caused by your bones rubbing together at the joint. Not so, says Ed Levitan, MD, of Five Journeys, a functional medicine practice in Newton, Massachusetts. Studies have shown that even if an X-ray shows bone on bone that does not equal pain the pain comes from inflammation of the joint, he explains. So while its important to protect your joints from further damage, with RA its equally important to work on reducing inflammation in your body, he says.
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How Reactive Arthritis Is Treated
There is currently no cure for reactive arthritis, but most people get better in around six months. Meanwhile, treatment can help to relieve symptoms such as pain and stiffness.
Severe symptoms may require more powerful steroid medication or disease-modifying anti-rheumatic drugs .
Read more about treating reactive arthritis.
What Makes Ra Get Worse
Different factors affect the pace and progression of individual patients RA. Some things you cant control, like whether you have a family history of the disease. In addition, although women are more likely to get RA, when men get rheumatoid arthritis, their prognosis is generally worse, Dr. Bhatt says.
But there are factors you can control and change. We know smoking makes RA more aggressive, so smoking cessation is key, Dr. Lally says. Also, people with heavy manual occupations might stress the joints further and might have quicker progression, Dr. Bhatt says. If your workplace can make accommodations for your disease, that will help. Read more about how to make working with arthritis easier.
Exercise and maintaining a healthy weight can also help reduce stress on the joints, Dr. Bhatt says. But talk to your doctor before starting a workout regimen. A physical therapist can advise patients on the right type of exercise, he says. If patients do exercises wrong it could stress the joints even further. In addition, getting enough sleep, starting an anti-inflammatory diet, eating less red meat, and possibly using herbal remedies like turmeric may help control RA, Dr. Bhatt says. Here are more healthy habits to adopt if you have RA.
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How Is Ra Treated
RA can be effectively treated and managed with medication and self-management strategies. Treatment for RA usually includes the use of medications that slow disease and prevent joint deformity, called disease-modifying antirheumatic drugs biological response modifiers are medications that are an effective second-line treatment. In addition to medications, people can manage their RA with self-management strategies proven to reduce pain and disability, allowing them to pursue the activities important to them. People with RA can relieve pain and improve joint function by learning to use five simple and effective arthritis management strategies.