Our Approach To Rheumatoid Arthritis
UCSF provides comprehensive evaluations and advanced, personalized care for rheumatoid arthritis. Because rheumatoid arthritis often involves different systems in the body, our team includes several types of doctors, such as rheumatologists, plastic surgeons who specialize in correcting hand deformities, and orthopedic surgeons who specialize in joint deformities and joint replacement.
Highly effective medications are available to control pain and slow the progression of rheumatoid arthritis. These include common pain relief medications, corticosteroids and a class of drugs called disease-modifying anti-rheumatic drugs. We also prescribe physical therapy to gently strengthen the joints and may recommend support devices, such as splints or crutches, to take stress off the joints. Surgery, including joint replacement, is also available to patients with severe joint damage.
In addition to caring for patients, our providers conduct clinical trials to evaluate potential new treatments for rheumatoid arthritis. Interested patients may have the option to receive investigational treatments through a clinical trial.
What Are The Signs And Symptoms Of Ra
With RA, there are times when symptoms get worse, known as flares, and times when symptoms get better, known as remission.
Signs and symptoms of RA include:
- Pain or aching in more than one joint
- Stiffness in more than one joint
- Tenderness and swelling in more than one joint
- The same symptoms on both sides of the body
- Weight loss
What Can Happen To A Person With Ra Without Proper Treatment
The natural history of RA is progressive damage and deformity to the joints. As cartilage and bone are progressively lost, the fingers also angle to the side in what is called ulnar deviation. It becomes difficult and painful to use the joints and doing such routine activities such as bathing, grooming, and cooking becomes progressively more difficult. Below is an example of joint damage that can be seen in RA. This picture shows the ulnar deviated and subluxed joints of long-standing RA. The same thing can happen to the feet. In the feet the toes become fibular deviated and also subluxed. Other joints areas such the cervical spine, shoulders, elbows, wrists, hips, knees, and ankles can also be affected.
We also know that undertreated people with RA can also have a shorted life span. Data from the 1980s found that women with active RA that never came under control lost 10 years off of their lives primarily due to early heart disease. Research has found that chronic inflammation leads to early atherosclerosis that leads to heart attacks. Men in this same data set lost 5 years off of their lives for the same reason. Early effective treatment though can avoid all of the issues described above and the treatment of RA has become one of the great success stories in medicine in the last 30 years. Currently the life expectancy of someone with well treated RA is almost the same as the general population.
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What Are The Risk Factors For Rheumatoid Arthritis
Genetics can predispose some people to rheumatoid arthritis. But researchers also say that an environmental triggersuch as an infection or some other type of physical traumamay be necessary for someone to actually develop rheumatoid arthritis.
However, the science behind this argument is not fully understood, and doctors dont know exactly what causes rheumatoid arthritis or who is most at risk.
Besides genetics, these factors may make a person more likely to develop rheumatoid arthritis.
Sex: Seventy percent of people with rheumatoid arthritis are women.Age: Rheumatoid arthritis symptoms can start at any age, but they most commonly begin in people between 40 years old and 60.Tobacco use: For people who are genetically predisposed, cigarette smoking raises their risk of developing rheumatoid arthritis or having more severe disease.Obesity: Being overweight or obese also seems to raise a persons risk of developing rheumatoid arthritis.
How Does This Relate To The Sensation Of Dizziness
When the bones of the neck begin to degenerate, the body tries to manage what has been lost. Like our hard-working, and well-meaning brick builders, this can eventually cause bone to form in places it shouldnt. The additional bone can place pressure on nerve roots and blood vessels that pass between the vertebrae of the spine. Additionally, the degeneration can cause the spaces between the vertebrae to become smaller, also placing pressure on these structures. The weakness in the bones and joint spaces can also make the individual more prone to injury, including strains and sprains.
The vertigo is thought to be caused by neurological and vascular concerns. When certain nerve roots are compressed, this affects the signals going toward the brain, including those for your sense of vestibular tone leading to dizziness and vertigo. The vascular portion of this symptom is due to compression of the vertebral artery, one of the main highways of blood to the brain. As this artery is compressed, blood flow to the vestibulocochlear organ, the one responsible for balance, is reduced.
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How Does Rheumatoid Arthritis Affect The Entire Body
Like many autoimmune diseases, rheumatoid arthritis typically waxes and wanes. Most people with rheumatoid arthritis experience periods when their symptoms worsen separated by periods in which the symptoms improve. With successful treatment, symptoms may even go away completely .
Although rheumatoid arthritis can have many different symptoms, joints are always affected. Rheumatoid arthritis almost always affects the joints of the hands , wrists, elbows, knees, ankles, and/or feet. The larger joints, such as the shoulders, hips, and jaw, may be affected. The vertebrae of the neck are sometimes involved in people who have had the disease for many years. Usually at least two or three different joints are involved on both sides of the body, often in a symmetrical pattern. The usual joint symptoms include the following:
These symptoms may keep someone from being able to carry out normal activities. General symptoms include the following:
- Malaise
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.
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When To Speak With A Doctor
Anyone experiencing symptoms of RA should seek medical attention. It is important to receive an accurate diagnosis quickly, as appropriate, timely treatment can limit the effects of RA and their impact on someones life.
Rheumatologists are doctors who specialize in RA, and they are the most suitable healthcare professionals to diagnose the condition accurately. They will take the individuals medical history, perform a physical exam, and request laboratory tests and imaging studies to make a diagnosis.
RA can develop in people of any age, from children to older adults. The disease appears most commonly in females aged 2545 years, but it can also affect people at an older age.
Some defining differences between RA and EORA include:
- distribution between sexes
The Bottom Line On The Importance Of Hydration
While drinking more water wont cure RA, adequate hydration may help improve joint health and keep joints lubricated.
When youre hydrated, your entire body functions better, and youre likely to have more energy and improved mood.
But dont overdo it. Drinking too much water can cause hyponatremia a condition thats characterized by low sodium levels in the blood.
Talk to your doctor if youre concerned that youre not consuming enough liquids.
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Heart And Blood Vessels
People with RA are more prone to atherosclerosis, and risk of myocardial infarction and stroke is markedly increased.Other possible complications that may arise include: pericarditis, endocarditis, left ventricular failure, valvulitis and fibrosis. Many people with RA do not experience the same chest pain that others feel when they have angina or myocardial infarction. To reduce cardiovascular risk, it is crucial to maintain optimal control of the inflammation caused by RA , and to use exercise and medications appropriately to reduce other cardiovascular risk factors such as blood lipids and blood pressure. Doctors who treat people with RA should be sensitive to cardiovascular risk when prescribing anti-inflammatory medications, and may want to consider prescribing routine use of low doses of aspirin if the gastrointestinal effects are tolerable.
When To Seek Medical Advice
You should see your GP if you think you have symptoms of rheumatoid arthritis, so your GP can try to identify the underlying cause.
Diagnosing rheumatoid arthritis quickly is important because early treatment can help stop the condition getting worse and reduce the risk of further problems such as joint damage.
Read more about diagnosing rheumatoid arthritis.
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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.
Blood Tests For Rheumatoid Arthritis
There are several types of blood tests that help your healthcare provider or rheumatologist determine whether you have RA. These tests include:
- Rheumatoid factor test. The RF blood test checks for a protein called rheumatoid factor. High levels of rheumatoid factor are associated with autoimmune diseases, especially RA.
- Anticitrullinated peptide antibody test . This test looks for an antibody thats associated with RA. People who have this antibody usually have the disease. However, not everyone with RA tests positive for this antibody. The anti-CCP test is more specific for RA than the RF blood test, and often is positive before the RF test.
- Antinuclear antibody test. The antinuclear antibody panel tests your immune system to see if its producing antibodies to the nucleus of cells. Your body often makes ANA antibodies as a response to many different types of autoimmune conditions, including RA.
- Erythrocyte sedimentation rate. The ESR test helps determine the degree of inflammation in your body. The result tells your doctor whether inflammation is present. However, it doesnt indicate the cause or site of the inflammation.
- C-reactive protein test. A severe infection or significant inflammation anywhere in your body can trigger your liver to make C-reactive protein. High levels of this inflammatory marker are associated with RA.
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Do Infections Play A Role In Rheumatoid Arthritis
A number of RA cases begin within a few weeks of a viral or bacterial infection. Thats because when your body senses danger from an infection, it switches on the immune response to fight off the invader. In some people, this immune response may fail to switch off as it should, leading to autoimmune diseases like RA.
Weight Management May Reduce Symptoms And Disease Progression
According to the , obesity may increase the risk of experiencing RA progression. If needed, losing weight may help decrease RA progression and lessen your symptoms.
Weight loss can also help alleviate pain in certain joints, particularly your:
- back
Talk with your doctor about how a gradual weight loss plan may help.
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How Does Dehydration Affect Someone With Ra
Dehydration results when your body doesnt have enough fluids to perform normal functions because you use or lose more liquids than you consume, according to the Mayo Clinic.
Studies have suggested more than 500,000 people in the United States are hospitalized for dehydration every year.
Although research on the exact relationship between dehydration and RA is limited, scientists do know water consumption can affect the processes that keep joints working.
To my knowledge, there are no studies showing the effects of dehydration with people with RA, but there is evidence that hydration might help maintain joint health, says Betty Hsiao, MD, a rheumatologist at Yale School of Medicine in New Haven, Connecticut.
According to the Arthritis Foundation, staying hydrated is important for flushing toxins from your body, which may lessen inflammation.
How Is Rheumatoid Arthritis Different From Other Types Of Arthritis
People often confuse rheumatoid arthritis with other types of arthritis or other inflammatory diseases. In fact, there are several different types of inflammatory diseases that accompany arthritis that may or may not be rheumatoid arthritis.
Types of inflammatory arthritis include:
- Rheumatoid arthritis: The most common form of inflammatory arthritis in which the bodys immune system attacks its own joints.
- Psoriatic arthritis: An inflammatory arthritis that usually develops in a person with psoriasis.
- Ankylosing spondylitis: A type of inflammatory arthritis that primarily affects the spine and sacroiliac joints located in the back of the pelvis.
- Juvenile idiopathic arthritis: The most common type of arthritis in children.
- Systemic lupus erythematous: A chronic autoimmune disease that can cause joint pain, skin rash and damage to internal organs.
The most common type of arthritis, osteoarthritis, does not usually cause the degree of inflammation found in rheumatoid arthritis and is a different disease with different treatments.
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What Are The Different Types Of Rheumatoid Arthritis
Symptoms of rheumatoid arthritis usually begin gradually in several joints. Sometimes the symptoms begin only in one joint, and sometimes the symptoms begin initially in the whole body, with generalized stiffness and aching, and then localize to the joints.
- Typical “classic” rheumatoid arthritis is the most common type of rheumatoid arthritis. Classic rheumatoid arthritis involves three or more joints. Usually, people have a gradual onset of joint pain, stiffness, and joint swelling, usually in the fingers, wrists, and forefeet. Elbows, shoulders, hips, ankles and knees are also commonly affected.
- About 80% of people with rheumatoid arthritis are classified as “seropositive,” which simply means the rheumatoid factor blood test is abnormal. Some people with an abnormal rheumatoid factor also have an abnormal anti-CCP blood test. This is another blood test for rheumatoid arthritis.
- Approximately 20% of people with rheumatoid arthritis are classified as “seronegative,” which means the rheumatoid factor blood test is negative, or normal. In this case, the anti-CCP blood test may be abnormal or normal. Other blood tests, such as the ESR measure of inflammation, may be abnormal.
Palindromic rheumatism
Atypical presentations of RA
- Persistent arthritis of just one joint may be the first symptoms of rheumatoid arthritis in some people.
- Some people experience generalized aching, stiffness, weight loss, and fatigue as their initial symptoms of rheumatoid arthritis.
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What Is The Prognosis Of Rheumatoid Arthritis
As a rule, the severity of rheumatoid arthritis waxes and wanes. Periods of active inflammation and tissue damage marked by worsening of symptoms are interspersed with periods of little or no activity, in which symptoms get better or go away altogether . The duration of these cycles varies widely among individuals.
Outcomes are also highly variable. Some people have a relatively mild condition, with little disability or loss of function. Others at the opposite end of the spectrum experience severe disability due to pain and loss of function. Disease that remains persistently active for more than a year is likely to lead to joint deformities and disability. Approximately 40% of people have some degree of disability 10 years after their diagnosis. For most, rheumatoid arthritis is a chronic progressive illness, but about 5%-10% of people experience remission without treatment. This is uncommon, however, after the first three to six months.
Rheumatoid arthritis is not fatal, but complications of the disease shorten life span by a few years in some individuals. Although generally rheumatoid arthritis cannot be cured, the disease gradually becomes less aggressive and symptoms may even improve. However, any damage to joints and ligaments and any deformities that have occurred are permanent. Rheumatoid arthritis can affect parts of the body other than the joints.
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Who Treats Rheumatoid Arthritis
Diagnosing and treating rheumatoid arthritis requires a team effort involving you and several types of health care professionals. These may include:
- Rheumatologists, who specialize in arthritis and other diseases of the bones, joints, and muscles.
- Primary care providers, such as internists, who specialize in the diagnosis and medical treatment of adults.
- Orthopaedists, who specialize in the treatment of and surgery for bone and joint diseases or injuries.
- Physical therapists, who help to improve joint function.
- Occupational therapists, who teach ways to protect joints, minimize pain, perform activities of daily living, and conserve energy.
- Dietitians, who teach ways to eat a good diet to improve health and maintain a healthy weight.
- Nurse educators, who specialize in helping people understand their overall condition and set up their treatment plans.
- Mental health professionals, who help people cope with difficulties in the home and workplace that may result from their medical conditions.
Points To Remember About Rheumatoid Arthritis
- Rheumatoid arthritis is a chronic disease that mostly causes pain, swelling, stiffness, and loss of function in joints.
- RA may cause you to feel unusually tired, to have occasional fevers, and to have a loss of appetite.
- Treatments can include medications, ongoing care from a doctor, and surgery.
- The goals of treatment are to help relieve pain and swelling, prevent, slow, or stop joint and organ damage, and help you take part in daily activities.
- You can do many things to help you cope with RA, including finding a balance between rest and exercise, keeping a healthy weight, taking care of your joints, talking with your doctors, family, and friends, and managing your stress.
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