Your Doctor Can’t Fully Appreciate Potential New Symptoms Via Telemedicine
In the COVID-19 pandemic era, people with rheumatoid arthritis cant always make it into the doctors office for a physical visit. But a telemedicine, or telehealth, appointment, which is unquestionably better than not checking in with health professionals at all, may not detect that the disease is progressing as well as an in-person visit.
Domingues says that rheumatologists should definitely notice if joints are swollen and warm to the touch in an office consultation signs of active inflammation but they may not catch the severity of those symptoms on a computer screen. If were not physically examining them, the communication between doctors and patients needs to be even better, Domingues says. He says to make sure that you mention how your joints feel when you wake up, how much stiffness you experience in the morning and for how long, if youre able to make a full fist early in the day, and if you see red, warm, or swollen joints. Those are the pivotal signs of worsening RA, he says.
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Ra Symptoms: How Do You Diagnose Rheumatoid Arthritis
Rheumatoid arthritis symptoms range from obvious physical symptoms of joint damage and joint deterioration to less obvious signs and symptoms that mimic other illnesses. This is what makes rheumatoid arthritis so difficult for healthcare providers when it comes to diagnosing and prescribing treatment, especially in its early stages.
Your Lifestyle Is More Sedentary And You’re Moving Less
Regular physical activity is necessary for everyone but especially for people with RA. Research has shown that regular cardiovascular exercise and weight training can substantially improve daily function without exacerbating rheumatoid arthritis disease activity. There are numerous health benefits associated with regular physical activity like improved muscle strength and better bone and joint health which all help your aches and pains feel better. But rest is also needed to restore the body from the bouts of intense pain and fatigue that are characteristic of rheumatoid arthritis. But you cant let taking it easy become a way of life. A sedentary lifestyle may eventually lead to increased pain, fatigue, and weakness, and a lower quality of life.
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Regular exercise also has another life-enhancing benefit: It helps reduce your odds of developing cardiovascular disease. Taking good care of your ticker is essential for people with rheumatoid arthritis, because heart problems are more prevalent in people who have RA compared with the general population. Its heart disease that kills you, not the RA, says Domingues. Its very important to talk to your primary care doctor or a cardiologist if you have RA to control your risk factors, such as high cholesterol, obesity, and diabetes.
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Ra Symptoms In Your Joints
RA almost always affects your joints. It may take a few weeks or months for the first signs to show. The inflammation it causes often leads to these three hallmark symptoms:
- Pain.Inflammation inside a joint makes it hurt whether youâre moving it or not. Over time, it causes damage and pain.
- Swelling. Fluid in the joint makes it puffy and tender.
- Tenderness. It hurts when you move or push on a joint.
Other RA symptoms include:
- Stiffness. The joint is harder to use and doesn’t move as well as it should. Itâs especially common in the morning. Although many people with other forms of arthritis have stiff joints in the morning, it takes people with rheumatoid arthritis more than an hour before their joints feel loose.
- Redness and warmth. The joints may be warmer and have color changes related to the inflammation.
They Ask About Other Symptoms
Although symmetrical joint pain and swelling are the hallmarks of rheumatoid arthritis, its a full-body disease that can cause full-body symptoms. Sometimes, people experience loss of appetite, exhaustion, low-grade fever, and even nerve damage, says Dr. Cohen. Neuropathymuscle weakness, numbness, or a pins-and-needles sensationmay be another clue RA is the culprit. Osteoarthritis, on the other hand, is much more of a localized condition.
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Ra Blood Tests: What Lab Tests Show Rheumatoid Arthritis
To diagnose rheumatoid arthritis there is no one test that can on its own reach a diagnosis. Instead, there are a number of criteria that must be established in order to reach a rheumatoid arthritis diagnosis.
As part of the criteria for diagnosing rheumatoid arthritis, doctors will order multiple blood tests. These blood tests look for specific indicators that support the possibility that the patient could have rheumatoid arthritis.
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Problems With Old Assessments
After diagnosis, the level and progression of RA need to be monitored and tracked. Prior to RASS, doctors combined results from a physical examination with factors reported by the patient, such as pain level, and inflammatory blood markers, to estimate RA severity.
Doctors also used the Health Assessment Questionnaire , in which patients rated their own level of pain. Of course, everyone has a different threshold for pain, which can make these assessment models inaccurate. These assessment methods were also complicated by a close relationship between pain and depression.
Depression can be a significant component of RA. But there are challenges with using it to measure disease severity, including:
- some patients may be more depressed than others
- some patients may feel particularly depressed at the time of examination
- some patients may not acknowledge they are depressed
While depression can be an element of RA, measuring it is not helpful for disease activity assessment. The RASS is completed by your doctor and based on the visible signs of the disease. Its not based on your individual emotional assessment.
Its important to know what type of RA you have to get an accurate assessment of disease activity. There are three types of RA:
- rheumatoid factor positive
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Ditch The Screen And Unwind With A Board Game
Old-school games like checkers, jigsaw puzzles, and Scrabble may seem like indoor activities particularly after two years of a pandemic that kept us all inside far more than we ever wanted to be. But you can bring them out to your patio or picnic table while you safely soak up a little vitamin D. The pieces with checkers and Scrabble are small and light, and theres no reason for people with joint pain not to play games like that, says Dodge.
Classic games are also a good reminder that stepping away from our computers and phones is a great way to connect with friends and family and avoid further discomfort thats associated with too much screen time.
What Should Be Done If Rheumatoid Arthritis Is Suspected
Any person who is suspected of having RA should be referred to a specialist rheumatologist. Early referral is important so that disease modifying anti-rheumatic drugs may be prescribed as soon as possible so as to slow or halt the disease process. Delay in referral or receiving a definitive diagnosis and treatment can result in significant costs to the individual, particularly those who are employed. This is because joint damage occurs most rapidly in the early stages of the disease, and often the treatment drugs can take several months to work.
Many areas now offer Early Arthritis Clinics where a rapid assessment is performed by specialists/specialist nurses in order to limit any delays. An ultrasound of the affected joints may be performed during this assessment.
If your symptoms are particularly severe when you first see your GP, then they may refer you urgently but also ring to speak to one of the local rheumatologists to ask for assistance in how to best help you in the meantime. Sometimes people are started on treatments other than those mentioned above, e.g. steroid tablets or a steroid injection, prior to being seen, in order to improve their condition. This though can affect what the specialists see and find at the first appointment, which can potentially delay their making a diagnosis or there may be increased uncertainty of the diagnosis.
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How Is Ra Diagnosed
RA is diagnosed by reviewing symptoms, conducting a physical examination, and doing X-rays and lab tests. Its best to diagnose RA earlywithin 6 months of the onset of symptomsso that people with the disease can begin treatment to slow or stop disease progression . Diagnosis and effective treatments, particularly treatment to suppress or control inflammation, can help reduce the damaging effects of RA.
Human Leukocyte Antigen Tissue Typing
This test checks for a genetic marker called human leukocyte antigen .
Some studies suggest that around 60% of RA cases may be inherited. If a person has specific antigens, it could mean that they have a higher likelihood of developing RA. However, other factors, such as tobacco use, can also trigger the condition.
HLA markers in the blood can help indicate the likelihood of developing an immune-related condition such as RA. These markers may also be a sign of another condition, such as ankylosing spondylitis or reactive arthritis.
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Questions For Your 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?
What Are The Symptoms
The main symptoms of rheumatoid arthritis are pain, stiffness, and swelling in the joints of the hands, wrists, elbows, feet, ankles, knees, or neck. The disease usually affects both sides of the body at the same time. In rare but severe cases, it may affect the eyes, lungs, heart, nerves, or blood vessels.
Sometimes the disease can cause bumps called nodules to form over the elbows, knuckles, spine, and lower leg bones.
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How Ra Affects Feet
Rheumatoid arthritis is an autoimmune condition. When you have RA, your immune system tries to destroy the lining of your joints, called synovium. It also attacks the fluid in your joints, called synovial fluid. It does this because it mistakes these parts of your body for disease-causing invaders.
RA causes damage and inflammation that makes your joints swell and feel warm. The small joints, like those in the feet, are the most common targets of these attacks.
Eventually, long-term inflammation thickens the synovium. This causes cartilage and bone to wear away. In the feet and toes, the joints may become deformed. This leads to poor range of motion and considerable pain. Walking, standing, and even wearing shoes can become difficult.
Proper treatment may help reduce the damage and inflammation to your foot joints. It may also prevent or delay deformities and other problems.
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Is This Topic For You
There are many types of arthritis . This topic is about rheumatoid arthritis. If you are looking for information about how juvenile idiopathic arthritis affects young children, see the topic Juvenile Idiopathic Arthritis. If you are looking for information on the most common form of arthritis in older adults, see the topic Osteoarthritis.
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You Notice Issues With Your Eyes
People with RA are also at risk for Sjogrens syndrome, an autoimmune disorder that can cause dryness of the eyes, mouth, nose, throat, or skin due to inflammation that stops glands from releasing moisture, says Dr. Mandl.
This can happen even in the early stages of RA, but its unlikely to be the only symptom.
Most people with dry eyes head to an eye doctor to find out the cause, but Dr. Mandl recommends telling your doctoreven an eye doctor or other specialistabout additional symptoms youre having in any part of the body.
Early Rheumatoid Arthritis Symptoms
In the early stages of rheumatoid arthritis, it is common to feel characteristic symptoms of pain and stiffness. The specific symptoms, their severity, and timing differ in each patient and may be related to how aggressively the immune system is attacking the bodys healthy tissues.
Some of the most common RA signs and symptoms include:
- Pain and tenderness in joints for at least six consecutive weeks
- Stiffness and loss of range of motion in the joints
- Stiffness in the morning lasting at least 30 minutes and up to several hours
- Pain and soreness in one or multiple joints
- Involvement of joints on both sides of the body
- Pain and soreness in small joints like knuckles and toes
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When To Call A Doctor
if you have:
- Sudden, unexplained swelling and pain in any joint or joints.
- Joint pain associated with a fever or rash.
- Pain that is so severe that you cannot use the joint.
- Back or neck pain along with weakness in your arms or legs.
- Loss of bowel or bladder control.
- Joint pain that continues and has not improved for over 6 weeks.
- Side effects that occur with large doses of non-steroidal anti-inflammatory drugs or other medicine used to treat your arthritis. NSAIDs include ibuprofen and naproxen .
Effective Treatments For Ra Are Available
But the good news is that in 2021, the treatments for rheumatoid arthritis are better than ever. There are phenomenal therapies for RA, and most patients will have a completely normal life, provided they take their medications, says Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida, and a medical advisor to CreakyJoints, a support, education, advocacy, and research organization for people living with arthritis and rheumatic disease. Here are five important things to note about disease progression:
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Signs And Symptoms Of Rheumatoid Arthritis
The main joint symptoms are related to the inflammation and include pain, swelling, redness, warmth, weakness and limitation in range of motion of the affected joints. These joints will be tender to pressure and can occasionally appear red. Inside the joints, the immune system has been activated, and many cells proliferate in the joints producing fluid, and mediators of pain. If left untreated, this process can lead to joint damage.
The joint pains in RA behave in a specific manner and affect multiple joints on both sides of the body in what is called a symmetric pattern. That is, if your left knee is affected, your right knee will likely also be affected.
The joints most likely to be affected are the:
- small joints of the hands and feet
- elbows
- knees
- ankles.
The external signs of inflammation reflect a potentially damaging disease process that can lead to injury to bone, cartilage, and soft tissues such as tendons. If left untreated, this can cause deformities and limitation in function. Fortunately, today we have excellent treatments that can stop this inflammation and avoid further damage.
When the disease is very active, one may also experience weight loss, loss of muscle mass and immune response effects on other organs.
Then Theyll Run More Tests
Doctors will also likely measure your overall level of inflammation using two common tests: C-reactive protein and the erythrocyte sedimentation rate . Not everyone with rheumatoid arthritis has elevated levels, but when the numbers are high, the findings can help confirm the diagnosis. If a patient has elevated ESR and/or CRP levels, it would imply they have an inflammatory kind of arthritis, versus osteoarthritis, Dr. Cohen says. Your doctor may continue to use these tests to monitor your disease and inflammation levels over time.
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Joint Stiffness & Loss Of Range Of Motion
Stiffness in the joints occurs when this disease is in an active state of inflammation, or when your immune system is actively attacking healthy tissue. Oftentimes, the greatest amount of stiffness occurs in the mornings, but it can continue throughout the day as well.
Dealing with this type of stiffness, as well as overall joint swelling, can result in the loss of range of motion if rheumatoid arthritis treatment is not sought early or if the disease is too advanced. In more advanced RA, the range of motion can be permanently lost in certain joints.
Working with a qualified physical therapist may help preserve or extend the range of motion for RA patients. Other treatment methods, such as taking nonsteroidal anti-inflammatory drugs, can help as well.
What Exactly Is Rheumatoid Arthritisand How Do You Know If You Have It
Rheumatoid arthritis is an autoimmune and inflammatory disease that mainly affects the bodys joints, according to the Centers for Disease Control and Prevention .
The condition, per the CDC, commonly affects the joints in the hands, wrists, and kneesand occurs when the lining of those joints becomes inflamed, damaging the joint tissue. That damage can eventually lead to long-lasting or chronic pain, unsteadiness, and deformity.
The symptoms of RAwhich can include pain, stiffness, tenderness, and swellingcan go through phases where theyre worse and better . But some symptoms of RA can mimic those of other conditionsheres what to look out for, and how to know if its due to RA or something else.
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What Are The Treatments For Rheumatoid Arthritis
RA is usually treated with a combination of medications to relieve swelling and pain while regulating the immune system. Joint surgery to relieve pain and disability, including joint replacement, may also be considered when these nonsurgical methods have failed to provide lasting benefit.
With early detection and intervention, RA and other forms of inflammatory arthritis can be treated very effectively. The connects patients quickly and efficiently with a rheumatologist who can evaluate their joint pain and get each patient started on an appropriate course of treatment. HSS also offers specialized for people with RA.
Today, we are blessed with a deeper understanding of the pathogenesis and characteristics of RA and the availability of safe and effective medications that can alter the natural history of RA and improve function. We start with the premise that RA is eminently controllable, and the goal of our therapies is “no evidence of disease.” That means no signs of redness, warmth, swelling or tenderness and normal function. Since we would not accept uncontrolled illness in angina, chronic obstructive lung disease, hypertension or diabetes, we should similarly not accept it in RA. Luckily, today, we have the therapeutic tools to make this happen.