The Facts About Rheumatoid Arthritis
Rheumatoid Arthritis (RA) is a disease that affects men and women most commonly between 40 and 60 years of age. It is more common in women and rarely seen in men under 45 years of age. It is a chronic disease characterized by periods when the disease may be relatively inactive, or when it flares, when there is joint pain, stiffness and swelling.
Risk factors of RA include:
- Gender: Women are about three times as likely to develop the disease.
- Genetics: If a first-degree relative has RA, a family member may inherit a predisposition to the disease.
- Smoking: This increases the risk for RA.
Symptoms of RA:
RA typically affects the small joints in the hands and feet, but it can also affect larger joints such as the knee, hip and shoulder. RA is usually symmetrical, involving the same joints on both sides of the body. Symptoms include pain, swelling and tenderness of the affected joints. Morning stiffness is a common symptom and can last for hours. The stiffness may ease with movement. Other non-specific symptoms include fever and weight loss.
There is no single test that will diagnose RA. The diagnosis is based on a person’s symptoms, joint examination, blood tests and X-rays. X-rays may help determine the severity of the disease. Periodic X-rays may help track progression of the disease.
Treatment of RA:
The focus of treatment of RA is to decrease pain and swelling, prevent further progression of the disease and ideally induce a remission.
- Pain medications: There are non-steroidal anti-inflammatory medications (such as Ibuprofen, Naproxen, Aleve, Advil and other prescription NSAID’s) that may help control pain. And steroids such as prednisone or methylprednisolone may be prescribed for severe flare-ups.
- To prevent disease progression: There are disease-modifying anti-rheumatic drugs such as Hydroxychloroquine, Sulfasalazine, Methotrexate and Leflunomide that can help slow further progression of RA and prevent joint damage. These drugs are commonly referred to as DMARD’s. The choice of DMARD is tailored to the individual patient based on disease activity and other coexisting medical conditions.
- Biologics: In the last ten years a new category of medications has emerged. These medications are commonly referred to as Biologics or Biologic Response Modifiers. They are used alone or in combination with other medications. They have been proven to be effective in reducing the inflammation and pain associated with RA. Biologics are self-administered as an injection or are given in a clinic setting in the form of an intravenous infusion. The single biggest risk of this category of medications is infection. Because of the way these medications affect the immune system, they can predispose the patient to significant infections and may also reactivate a dormant tuberculosis infection. As these biologic medications are relatively new and have only been around only for about 12 years, we don’t yet know the long-term safety, and data is still being collected.
- Patient education: This an important part of the treatment plan for RA. Understanding the disease allows patients to cope better with their disease. Self-management programs are offered through the Arthritis Foundation at www.arthritis.org. These kinds of programs give those affected by RA the tools to cope better with their disease so they can lead active, productive lives.
- Diet: There is no specific diet for RA. It’s important to eat a healthy, balanced diet with the appropriate amount of calories and proportions of protein, carbohydrate and fat.
- Exercise: Regular exercise is important to help preserve joint range of motion and maintain flexibility. Any exercise program has to be tailored to the individual’s specific physical limitations. Physical therapists and occupational therapists can help devise a plan for a home exercise program.
- Supplements: There has been a lot of interest lately in omega-3 fatty acids (those found in fatty fish such as salmon, herring and sardines) and their ability to modify inflammation. There have been some studies on the benefits of fish oil in RA patients. A few have shown favorable results. There are still questions about safety and optimum dosing and thus far fish oil supplementation has not been part of standard RA treatment. In addition, fish oil supplements can interfere with anti-coagulants (blood-thinning medications such as coumadin), increasing the risk for bleeding. They may also cause nausea, bloating and diarrhea.
Prognosis For RA:
RA was once thought to be a disease that progressed very slowly. In recent years we have learned that it can progress rapidly. Most of the joint damage that occurs with RA occurs within the first two to three years of diagnosis. With rapidly progressive disease, joint damage may occur as early as six months after onset. Frequent monitoring with joint assessment, laboratory testing, X-ray or MRI may help identify those with rapidly progressive disease who need aggressive treatment.
In the last two decades many advances have been made in the treatment of RA. In addition there has been much research interest in the disease which has been applied to clinical practice, allowing doctors to diagnose the disease earlier and institute treatment.
While there is no cure for RA, the treatments have improved considerably in the last twenty years, particularly with the development of the Biologics. With early diagnosis and adequate treatment, those affected with the disease can lead active and productive lives.
Dr. Nimali Mendis is a board-certified rheumatologist at Pacific Medical Centers Canyon Park clinic location. Dr. Mendis did her residency training at the University of Medicine and Dentistry of New Jersey and her fellowship at the University of Washington. Click here for more information about Dr. Mendis.