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Rheumatoid arthritis

5 Things a Rheumatologist Wants You to Know About Rheumatoid Arthritis

If you’ve just been diagnosed with rheumatoid arthritis (RA), 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 (or 1 percent of the adult population), according to the Centers for Disease Control and Prevention (CDC).

The severity of RA 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 (called synovium), causing them to become inflamed and painful.

RA can begin at any age — most commonly in the twenties and thirties — and typically causes joint pain, fatigue, and prolonged stiffness after rest, says the CDC.

As with any condition, a number of important questions arise among the newly diagnosed, ranging from the nature of RA itself to treatment options.

Elaine Husni, MD, MPH, a rheumatologist at the Cleveland Clinic in Ohio and director of the Arthritis and Musculoskeletal Treatment Center there, answers some of those questions and addresses queries she and other rheumatologists hear most often.

Here’s what she had to say.

1. It’s Not Your Fault That You Have Rheumatoid Arthritis

There’s a tendency among newly diagnosed patients to blame themselves, says Dr. Husni.

“One of the most common misconceptions about RA is that you did this to yourself,” she says. “We don’t really know the cause of autoimmune diseases, but many times patients will ask, ‘What did I do to get this?’”

The cause of rheumatoid arthritis itself also remains unclear, but like other autoimmune diseases, it’s triggered when the body’s immune system malfunctions and attacks healthy tissues and cells, according to the American College of Rheumatology.

Autoimmune diseases, which range from RA to multiple sclerosis and type 1 diabetes, are fairly common; in fact, the U.S. Department of Health and Human Services reports that autoimmune disorders affect more than 23.5 million Americans.

2. You’ll Want to Educate Yourself About Rheumatoid Arthritis

Another important step when you’ve been diagnosed with RA is to become informed about the condition, says Husni.

The fears and ideas that newly diagnosed patients often have about RA usually come from the internet or somebody they know, says Husni, “so patients sometimes get misinformation. Also, I think autoimmune disease is a harder concept to grasp.

Patients often ask me, ‘What does autoimmune mean? I’ve never had this before. I was healthy my whole life.’”

Understanding RA can be a bit difficult, she adds, and patient knowledge about the condition tends to fall along a spectrum. “The first phase upon diagnosis is giving patients the correct information that they need,” Husni emphasizes.

3. Ask Your Doctor How Active Your Rheumatoid Arthritis Is

Before you can make treatment choices, you have to determine how active your RA is.

“The three things rheumatologists normally do are an exam, some blood tests, and look for any 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.”

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.

4. Other Health Conditions May Affect Your RA Treatment

The CDC reports that about 47 percent of U.S. adults with arthritis also have at least one other condition, referred to by doctors as a comorbid condition.

So another crucial step in treating RA is to find out if you have any comorbidities. “It’s very important to see if you have any associated diseases or disorders that your rheumatologist needs to take into account,”says Husni.

If you have depression, for example, your rheumatologist may not want to prescribe certain RA medications, because they could make your depression worse.

“Another example is if you have a family history of multiple sclerosis. In that case, there are some other medications that can’t be prescribed [for RA],” Husni notes.

It’s also important to have a primary care physician who oversees all aspects of your health, and who can help treat any comorbid conditions you may have.

5. Eat Well, Stop Smoking, and Do What You Can to Stay Healthy 

Adopting healthier habits may make living with RA easier, says Husni, adding that you’ll want to keep up with and even improve the healthy habits you already do have.

“For instance, now is not a good time to increase your smoking,” she says, and if you do smoke, you should really make an effort to quit smoking. Smoking is the strongest modifiable risk factor for RA, according to the CDC, increasing your risk by 1.3 to 2.4 times; the habit also interferes with the effectiveness of some RA medications.

“If you are overweight, this might be the time to lose some weight, because it’s stressing your joints on top of the RA,” she notes.

Diet is another modifiable risk factor. “Healthy eating can’t necessarily stop or cure RA,” but it can help you live better with it, says Husni.

Although there’s not a lot of evidence right now that diet specifically helps RA symptoms, she says, “I think there will probably be a lot more information about nutrition in the years to come. I think it’s already happening, and I do believe that it will probably play a role in treating RA.”

 

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Rheumatoid arthritis

Rheumatoid arthritis – Diagnosis and treatment

Diagnosis

Rheumatoid arthritis can be difficult to diagnose in its early stages because the early signs and symptoms mimic those of many other diseases. There is no one blood test or physical finding to confirm the diagnosis.

During the physical exam, your doctor will check your joints for swelling, redness and warmth. He or she may also check your reflexes and muscle strength.

Blood tests

People with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate (ESR, or sed rate) or C-reactive protein (CRP), which may indicate the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies.

Imaging tests

Your doctor may recommend X-rays to help track the progression of rheumatoid arthritis in your joints over time. MRI and ultrasound tests can help your doctor judge the severity of the disease in your body.

Treatment

There is no cure for rheumatoid arthritis. But clinical studies indicate that remission of symptoms is more likely when treatment begins early with medications known as disease-modifying antirheumatic drugs (DMARDs).

Medications

The types of medications recommended by your doctor will depend on the severity of your symptoms and how long you’ve had rheumatoid arthritis.

  • NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Side effects may include stomach irritation, heart problems and kidney damage.
  • Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, weight gain and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.
  • Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall, Otrexup, others), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine).

    Side effects vary but may include liver damage, bone marrow suppression and severe lung infections.

  • Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), baricitinib (Olumiant), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), sarilumab (Kevzara), tocilizumab (Actemra) and tofacitinib (Xeljanz).

    These drugs can target parts of the immune system that trigger inflammation that causes joint and tissue damage. These types of drugs also increase the risk of infections. In people with rheumatoid arthritis, higher doses of tofacitinib can increase the risk of blood clots in the lungs. Biologic DMARDs are usually most effective when paired with a nonbiologic DMARD, such as methotrexate.

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Rheumatoid arthritis

Rheumatoid Arthritis: 17 Warning Signs of Serious Complications

Call a doctor immediately if you have rheumatoid arthritis and experience these symptoms

Doctors themselves, or with “call partners,” cover urgent medical concerns for their patients when the office is closed.

People with rheumatoid arthritis can develop certain symptoms that are really warning signs of something occurring in their bodies that is not what the doctor expects to happen. These are signs that can also sometimes represent a significant danger. These “rheumatoid warning signs” are reasons to call the doctor so that they can be interpreted in light of the patient’s overall condition. When the doctor who is aware of your condition hears of these symptoms, he/she can determine whether or not they are serious and if any action should be taken immediately or in the near future.

Rheumatoid warning signs can represent a worsening or complications of the rheumatoid disease, side effects of medications, or a new illness that is complicating the condition of patients with rheumatoid arthritis. Patients with rheumatoid arthritis should be aware of these rheumatoid warning signs so that they can contact their health care professional before their health is jeopardized.

Here are some warning signs that I like my patients to call me about.

Worsening of joint symptoms

This includes more pain, more swelling, additional joint involvement, redness, stiffness, or limitation of function. The doctor will determine whether or not these are significant, not the patient. Sometimes, patients have just begun a medication and some minor increase in joint problems might be occurring while the medication is taking effect. However, worsening symptoms can also mean that the medications are not working and that they require adjustments in dosing or a change in the medications.

Lack of improvement of joint symptoms

One major purpose of seeing the doctor is to get better. The doctor knows this. If a patient with rheumatoid arthritis has seen the doctor and is started on a treatment program and is not showing improvement but is worsening, notification of the doctor is appropriate. After starting a new treatment program, it sometimes takes time for the medications, physical therapy, etc., to control the inflammation. It is up to the doctor to decide if things are on course.

Fever

A mildly elevated temperature is not unusual in a person with active inflammation from rheumatoid arthritis. However, a true fever (temperature is above 100.4 F or 38 C) is not expected and can represent an infection. People with rheumatoid arthritis are at increased risk for infection because of their disease and frequently because of their medications. Many of the medications used to treat rheumatoid disease suppress the immune system of the body that is responsible for defending against infectious microbes. Furthermore, these medications can increase the risk of a more serious infection when a bacterium or virus strikes. It is important for people with rheumatoid arthritis to notify the doctor as soon as a fever occurs so that infections are treated at the earliest time possible. This can minimize the chances for many serious complications of infections.

Numbness or tingling

When a joint swells, it can pinch the nerves of sensation that pass next to it. If the swelling irritates the nerve, either because of the inflammation or simply because of pressure, the nerve can send sensations of pain, numbness, and/or tingling to the brain. This is called nerve entrapment. Nerve entrapment most frequently occurs at the wrist (carpal tunnel syndrome) and elbow (ulnar nerve entrapment). It is important to have nerve entrapment treated early for best results. A rare form of nerve disease in patients with rheumatoid arthritis that causes numbness and/or tingling is neuropathy. Neuropathy is nerve damage that in people with rheumatoid arthritis can result from inflammation of blood vessels (vasculitis). Vasculitis is not common, but it is very dangerous. Therefore, it is important to notify the doctor if numbness and/or tingling occurs.

Rash

Rashes can occur for many reasons in anybody. However, in people with rheumatoid arthritis, the medications or, rarely, the disease can cause rashes. Medications that commonly cause rashes as side effects include gold (Solganal, Myochrysine), methotrexate (Rheumatrex, Trexall), leflunomide (Arava), and hydroxychloroquine (Plaquenil). A rare, and serious, complication of rheumatoid arthritis is inflammation of blood vessels (vasculitis), which can cause rash that most commonly appears in the fingertips, toes, or legs.

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Rheumatoid arthritis

7 Things You Didn’t Know About Arthritis

Most people understand that arthritis has to do with swollen and painful joints. But beyond that, there are a lot of misconceptions about the condition. Television commercials would have you believe that only the elderly experience arthritis, and that a miracle pill can get them back out on the tennis court or playing on the beach with their grandkids.

In reality, arthritis is an incurable, progressive disease that can eventually steal a person’s ability to care for themselves.

There is a lot that can be done to manage the disease and slow its progression, but it is more than just a minor nuisance that will have you rubbing your wrists with a rueful expression.

And not only that, but there are actually a staggering number of forms of arthritis, many that you may not have realized qualify. Chronic fatigue syndrome, Fifth disease, Lyme disease, and spinal stenosis are just a few examples. Stick with us to bust 7 common myths about arthritis – #1 and #5 are total game-changers.

1. Anyone Can Have Arthritis

Age can be a factor is arthritis, but it’s not true that it only affects the elderly. In fact, almost 300,000 babies and children have been diagnosed with arthritis or a rheumatic condition. And approximately 2/3 of adult arthritis patients in the U.S. are of working age, between 18-64 years old.

Arthritis also hits the genders differently. Official diagnoses are more common in women (26% of total cases) than in men (18% of total cases). Women also experience rheumatoid arthritis in much higher numbers than men do. On the other hand, men tend to experience gout and ankylosing spondylitis more often.

2. There Are Over 100 Different Forms Of Arthritis

As you may have guessed from point #1, despite being grouped under the single heading of “arthritis”, there are many different types of the disease. In fact, there are literally hundreds of kinds. The three most common forms are rheumatoid, osteoarthritis, and psoriatic arthritis.

Other fairly common types include gout, in which sharp uric acid crystals form in the joints, and fibromyalgia, which causes chronic pain anywhere in the body, fatigue, memory problems, and mood swings. Even lupus, carpal tunnel syndrome, and inflammatory bowel disease may be considered forms of arthritis because they cause chronic inflammation.

3. Rheumatoid Arthritis Is An Autoimmune Disease

It’s easy to think of joint pain and swelling as something that occurs due to stress on the area. That assumption has led to the linking of obesity and arthritis, and also plays into the assumption that it is something that happens mostly to older people who have been using their joints the longest. But rheumatoid arthritis, one of the most common types, is actually an autoimmune disease.

This means that the body’s immune system wrongly believes that its own joint tissue is diseased and must be attacked. The cells within the joint capsules are then bombarded constantly and the cartilage, bone, and ligaments become deformed. Untreated, not only will the sufferer lose mobility, he or she may also experience systemic damage to their organs.

4. There Is No Cure For Arthritis

Unfortunately, there is currently no known cure for almost all types of arthritis. There are, however, various treatment regimens that can slow the progression of the disease and minimize the associated pain and loss of mobility. Therefore, early detection is critical.

Your doctor may talk to you about an anti-inflammatory diet, medication, exercise, and coping techniques. The prognosis for each different type of arthritis varies, but you can still have good quality of life with proper management.

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