How Can Rheumatoid Arthritis Be Prevented

Arthritis Risks And Complications That May Develop

In most cases, arthritis cannot be cured and the disease will continue to progress. Even with the best of treatment, arthritis of the foot and ankle may continue to cause you pain or require you to limit your activities.

Severe disability from arthritis is rare, however, and usually seen in persons with rheumatoid arthritis.

Frequent use of anti-inflammatory medications is known to cause gastrointestinal upset. People with rheumatoid arthritis are at higher risk for complications, such as peripheral neuropathy, infection, and skin or muscle problems.

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Maintain A Healthy Weight

A healthy diet can be beneficial when it comes to preventing RA. Obesity has been linked to the condition, and maintaining a healthy weight may reduce your risk of RA. Additionally, a number of vitamins and mineralsâlike vitamin D and calciumâcan help keep RA and osteoporosis from progressing.

There is also some evidence that anti-inflammatory diets can help fight RA and other inflammatory diseases. These diets typically rely on elements of vegetarian, gluten-free, and Mediterranean diets.

While these diets don’t have a significant effect on disease development or progression, eating or avoiding certain foods seems to help some patients with RA when combined with other therapies.

Key aspects of these diets include:

• Fishâmostly salmonâthree to four times each week
• Vegetarian meals with legumes one to two times each week
• Potatoes
• Five or more servings of fruit and vegetables each day
• Probiotics

• Biking
• Strength training

When you have RA, it’s important to listen to your body. Be mindful of pain, and don’t push yourself to discomfort.

The right equipment, like supportive shoes, can help you stay safe and get the greatest benefit from your efforts.

Causes And Risk Factors

Doctors donât know exactly what causes this disease. But they know these things could be risk factors for RA:

Age. RA can affect you at any age, but itâs most common between 40 and 60. It isnât a normal part of aging.

Family history. If someone in your family has it, you may be more likely to get it.

Environment. A toxic chemical or infection in your environment can up your odds.

Gender. RA is more common in women than men. Itâs more likely in women who’ve never been pregnant and those who’ve recently given birth.

Obesity. Extra weight, especially if youâre under 55.

Smoking. If your genes already make you more likely to get RA, lighting up can raise your odds even higher. And if you do get the disease, smoking can make it worse.

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Tips To Prevent Rheumatoid Arthritis

Now lets see what habits you can incorporate into your daily life to reduce your chances of developing the disease. Generally speaking, leading a healthy life is a positive thing to avoid any type of disease. In the specific case of this autoimmune disease, we recommend that you follow the following tips.

1. Stop smoking

The research associate tobacco smoke with an increased risk of developing rheumatoid arthritis. Although the association is strongest in active smokers, passive smokers are also at risk. Oxidative stress, autoantibody formation, internal inflammatory processes and epigenetic changes influence the development of the disease.

Therefore, if you want to prevent rheumatoid arthritis, you must quit smoking. Try to reduce the number of cigarettes you smoke per day to gradually get rid of the habit. Diagnosed patients should also follow this advice, as reducing tobacco consumption positively affects symptoms of the disease.

2. Reduce alcohol consumption

The researchers also found a link between excessive alcohol consumption and rheumatoid arthritis. However, other experts suggest that low and even moderate consumption has a positive effect. Despite this ambivalence in the results, the general recommendation is to reduce alcohol consumption.

3. Reduce episodes of stress

4. Maintain a healthy weight

5. Get some physical exercise

6. Avoid bone loss

7. Control infections and allergies

An Overall Model Of Ra Development

Based on available data it is likely that RA develops as described in Fig. 1 , where initially genetic, environmental and perhaps stochastic factors combine to initiate autoimmunity. Once an initial break in tolerance has occurred, over time, and influenced by ongoing factors that include the same or perhaps additional genetic and environmental factors, autoimmunity evolves to a more pathogenic stage. This state is manifested by expansion of autoreactive T and B cells, epitope spreading, increases in inflammation, up-regulation of signalling molecules, increases in autoantibody levels and alterations of autoantibodies pathogenicity such as changes in glycosylation rendering them more capable of inducing disease. Ultimately, tissue injury occurs to a sufficient degree that the clinical symptoms and signs of RA develop.

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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.

Reduce Exposure To Environmental Pollutants

Environmental pollutants like chemicals used in cleaning and manufacturing have been shown to trigger a host of health problemsâespecially in people with certain genes.

The HLA gene has been tied to the development of RA, and studies have found that pollutants like dioxin and cigarette smoke are associated with disease development in people with this gene. New medications are being investigated to block these actions, but avoidance of harmful chemicals is best when possible.

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What Are The Early Signs Of Rheumatoid Arthritis

Early signs of rheumatoid arthritis include tenderness or pain in small joints like those in your fingers or toes. Or you might notice pain in a larger joint like your knee or shoulder. These early signs of RA are like an alarm clock set to vibrate. It might not always been enough to get your attention. But the early signs are important because the sooner youre diagnosed with RA, the sooner your treatment can begin. And prompt treatment may mean you are less likely to have permanent, painful joint damage.

I Avoid Alcohol And Tobacco

There are more than 100 types of arthritis and joint-related conditions. Some risk factors are not modifiable , but there are a few things you can do to lessen your risk. Not smoking reduces the risk of developing rheumatoid arthritis while eating a low-purine diet and avoiding alcohol reduces the risk of developing gouttwo of the most common types of arthritis. Don R. Martin, MD, a rheumatologist with Sentara RMH Rheumatology, Harrisonburg, Virginia

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Whats The Normal Sed Rate For Rheumatoid Arthritis

Sed rate is a blood test that helps detect inflammation in your body. Your healthcare provider may also use this test to watch how your RA progresses. Normal sed rates are as follows:

In rheumatoid arthritis, your sed rate is likely higher than normal. To take part in clinical trials related to rheumatoid arthritis, you usually need an ESR of 28 mm/hr. With treatment, your sed rate may decrease. If you reach the normal ranges listed above, you may be in remission.

Recent News About Ra Treatment Guidelines

Due to ongoing developments since the last update in 2016 for the treatment of RA, including approval of novel therapies and efficacy and safety data from clinical trials, EULAR updated some guidelines in 2019.12,34 These updates can be found at https://ard.bmj.com/content/79/6/685.full.

In a November 2020 press release, ACR announced that it would preview the updated draft guidelines for RA management at its ACR Convergence 2020 annual meeting.36,37 These guidelines update previous guidelines based upon the latest clinical data available. A summary of the clinical recommendations for pharmacologic treatment of RA includes critical updates to the previous guideline released in 201536:

Recommendations highlight initiating patients on methotrexate and continuing with the treatment in place of promptly changing to another DMARD.

A conditional recommendation based on the ADRs associated with corticosteroids is aimed at reducing the use of steroids to treat RA inflammation, due to the serious ADRs associated with this class of drugs. The panel indicated that this recommendation is meant to encourage rheumatologists to limit use of steroids as much as possible.36

There is a shift from past recommendations to expand to triple therapy before beginning a biologic. Now, it is recommended that rheumatologists add a biologic or a targeted synthetic DMARD instead of changing patients to triple therapy, the ACR stated.36

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What Types Of Lifestyle Changes Can Help With Rheumatoid Arthritis

Having a lifelong illness like rheumatoid arthritis may make you feel like you dont have much control over your quality of life. While there are aspects of RA that you cant control, there are things you can do to help you feel the best that you can.

Such lifestyle changes include:

Rest

When your joints are inflamed, the risk of injury to your joints and nearby soft tissue structures is high. This is why you need to rest your inflamed joints. But its still important for you to exercise. Maintaining a good range of motion in your joints and good fitness overall are important in coping with RA.

Exercise

Pain and stiffness can slow you down. Some people with rheumatoid arthritis become inactive. But inactivity can lead to a loss of joint motion and loss of muscle strength. These, in turn, decrease joint stability and increase pain and fatigue.

Regular exercise can help prevent and reverse these effects. You might want to start by seeing a physical or occupational therapist for advice about how to exercise safely. Beneficial workouts include:

• Range-of-motion exercises to preserve and restore joint motion.
• Exercises to increase strength.
• Exercises to increase endurance .

Ra Progression Isnt Inevitable

Thanks to the newer treatments available and more on the horizon RA doesnt have to mean a life of eventual disability or even limited mobility. Its not an inevitable thing nowadays, says Dr. Bhatt. People can have a normal life.

But patients do have to be sure to follow their treatment plan and doctors recommendations. Routine follow-up with a rheumatologist who performs joint exams, follows levels of systemic inflammation in the blood and can assess function is the best way to ensure RA is being controlled and is not progressing, Dr. Lally says.

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What Are The Diagnostic Criteria For Rheumatoid Arthritis

Diagnostic criteria are a set of signs, symptoms and test results your provider looks for before telling you that youve got rheumatoid arthritis. Theyre based on years of research and clinical practice. Some people with RA dont have all the criteria. Generally, though, the diagnostic criteria for rheumatoid arthritis include:

• Inflammatory arthritis in two or more large joints .
• Inflammatory arthritis in smaller joints.
• Positive biomarker tests like rheumatoid factor or CCP antibodies.
• Elevated levels of CRP or an elevated sed rate.
• Your symptoms have lasted more than six weeks.

How Your Ra Treatment Plan Prevents Disease Progression

Perhaps the biggest factor that affects how RA progresses is if youre in treatment with a specialist who can put you on medications to slow the disease. Being on a DMARD or biologic therapy for RA is the best way to prevent progression, Dr. Lally says.

Disease-modifying anti-rheumatic drugs are usually the first line in medication. Methotrexate is the anchor drug for rheumatoid arthritis, Dr. Bhatt says. Some patients are scared because methotrexate is also used for cancer chemotherapy so they dont want to take a chemo pill, but those we use for RA are a very small dose with lesser chance of side effects. Your doctor will reassess in a month or so and see if its necessary to add in other drugs.

If after three to six months they have still not responded then we progress to medications called biologics, Dr. Bhatt says. These genetically engineered drugs target the inflammation process specifically, and are usually self-injected or infused via IV in your doctors office or a medical center. There are sub-classes and different types, Dr. Bhatt says. Your doctor will try various medications to see which you respond best to.

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What Are The Risk Factors For Ra

Researchers have studied a number of genetic and environmental factors to determine if they change persons risk of developing RA.

Characteristics that increase risk

• Age. RA can begin at any age, but the likelihood increases with age. The onset of RA is highest among adults in their sixties.
• Sex. New cases of RA are typically two-to-three times higher in women than men.
• Genetics/inherited traits. People born with specific genes are more likely to develop RA. These genes, called HLA class II genotypes, can also make your arthritis worse. The risk of RA may be highest when people with these genes are exposed to environmental factors like smoking or when a person is obese.
• Smoking. Multiple studies show that cigarette smoking increases a persons risk of developing RA and can make the disease worse.
• History of live births. Women who have never given birth may be at greater risk of developing RA.
• Early Life Exposures. Some early life exposures may increase risk of developing RA in adulthood. For example, one study found that children whose mothers smoked had double the risk of developing RA as adults. Children of lower income parents are at increased risk of developing RA as adults.
• Obesity. Being obese can increase the risk of developing RA. Studies examining the role of obesity also found that the more overweight a person was, the higher his or her risk of developing RA became.

Characteristics that can decrease risk

Practice Good Posture And Proper Body Mechanics

Like Mom always said: Sit up straight. Why? Good posture helps decrease strain and stress on your joints, ligaments, and tendons.

Where possible, you should also try to use proper body mechanics. Spare your small joints by using larger ones like the palm of your hand instead of your fingers to press buttons, and a hip instead of your hands to close a door. You may also consider using splints for your hands and wrists, and orthotics in your shoes.

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Nutritional Supplements And Dietary Changes

There’s no strong evidence to suggest that specific dietary changes can improve rheumatoid arthritis, although some people with rheumatoid arthritis feel their symptoms get worse after they have eaten certain foods.

If you think this may be the case for you, it may be useful to try avoiding problematic foods for a few weeks to see if your symptoms improve.

But it’s important to ensure your overall diet is still healthy and balanced. A Mediterranean-style diet, which is based on vegetables, fruits, legumes, nuts, beans, cereals, grains, fish and unsaturated fats such as olive oil, is recommended.

There’s also little evidence supporting the use of supplements in rheumatoid arthritis, although some can be useful in preventing side effects of medicines you may be taking.

For example, calcium and vitamin D supplements may help prevent osteoporosis if you’re taking steroids, and folic acid supplements may help prevent some of the side effects of methotrexate.

There’s some evidence to suggest that taking fish oil supplements may help reduce joint pain and stiffness caused by rheumatoid arthritis.

Further information

• National Rheumatoid Arthritis Society : diet and rheumatoid arthritis

Page last reviewed: 28 August 2019 Next review due: 28 August 2022

Heres Why The Disease Progresses What To Expect And How To Stop It

Rheumatoid arthritis is a chronic condition for which there is no cure. But even though the disease is progressive, newer disease-modifying drugs may actually be able to slow or even halt it getting worse. We have many effective treatments for RA that help control the symptoms of joint pain and stiffness, but also prevent progression of the disease and the development of permanent damage, says Lindsay Lally, MD, a rheumatologist at Hospital for Special Surgery in New York City.

Early treatment for RA is key, because whatever joint damage has already occurred cant be reversed. Find out how to recognize the symptoms at each stage of RA, and what can be done to treat it.

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What Medications Treat Rheumatoid Arthritis

Early treatment with certain drugs can improve your long-term outcome. Combinations of drugs may be more effective than, and appear to be as safe as, single-drug therapy.

There are many medications to decrease joint pain, swelling and inflammation, and to prevent or slow down the disease. Medications that treat rheumatoid arthritis include:

Non-steroidal anti-inflammatory drugs

• Golimumab .
• Tocilizumab .

Biologics tend to work rapidly within two to six weeks. Your provider may prescribe them alone or in combination with a DMARD like methotrexate.

Prevention Of Progression From Undifferentiated Ia To Classifiable Ra

The progression of undifferentiated IA to classifiable RA is highly related to the definitions of disease states that are used. Specifically, it may take months for someone to progress from undifferentiated IA to classifiable RA if classifiable RA is defined by the 1987 ACR criteria. However, with the 2010 ACR/EULAR criteria, an individual with IA and high-titer RA-related autoantibody positivity may transition relatively quickly to classifiable RA because it may be only a matter of having 3 swollen small joints evolve to 4 swollen small joints.

With these issues in mind, several studies have evaluated the efficacy of interventions to prevent progression of undifferentiated IA to classifiable RA. In the PRObable rheumatoid arthritis: Methotrexate versus Placebo Treatment study, 110 patients with undifferentiated IA of < 2 years duration were randomized to receive MTX versus placebo. They were followed for 18 months for the primary outcome of fulfillment of the 1987 ACR RA classification criteria. In this trial, 40% of the MTX-treated patients developed RA compared to 53% in the placebo group, although importantly the majority of benefit of MTX in delaying or preventing development of classifiable RA was seen in the anti-CCP positive subgroup of patients. Furthermore, the onset of classifiable RA was later in the MTX-treated group, and radiographic joint damage was also less in MTX-treated subjects.

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