When people hear arthritis, they typically think of swollen, painful joints and often associate the condition with aging or old injuries. While that is frequently the case with a condition called oseoarthritis – the most common form of arthritis that results from wear and tear on the joints and is most common in elderly people — rheumatoid arthritis is quite different.
At a recent Via Christ 50+ Lunch & Learn, Praveena Gorantla, MD, a Ascension Medical Group rheumatologist who sees patients at the E. Murdock and W. 21st Street clinics, educated more than 120 attendees about rheumatoid arthritis (RA) and what can be done to treat it.
Rheumatoid arthritis is a systemic autoimmune inflammatory disease. It affects 21 million people in worldwide, approximately one percent of the population. It can occur at any age to both genders, but its peak onset is between the ages of 35 to 50 and it affects three to four times as many women as men.
For those who have the disease and go without proper treatment, rheumatoid arthritis can be extremely painful, debilitating or even cause severe deformity. Fortunately there are treatment options and the earlier RA is diagnosed, the more successful the treatment is.
The exact cause is unknown but RA seems to be the result of a combination of genetics, abnormal immunity, environmental conditions and hormonal factors. The immune system confuses its own makeup with a foreign invader and makes antibodies directed against self. It causes inflammation of lining of the joints called synovium, and, if untreated, invades bone and cartilage. It most commonly affects wrists, small joints of the hands and feet but it can affect shoulders, elbows, hips, knees and ankles.
Know the symptoms:
- Joint pain
- Joint swelling, redness and heat
- Decreased range of motion
- Morning stiffness for 1 hour or more
- Stiffness after long periods of sitting or inactivity (gel phenomenon)
- Lack of appetite
- Weight loss
- RA affects joints symmetrically
- Does not affect spine except neck (not common)
- Untreated RA results in irreversible joint damage, chronic pain, deformity and loss of function
- Can impact patients physically, emotionally and economically
RA can affect other organs, resulting in:
- Skin nodules
- Blood vessels
Because it is an autoimmune disease, it can also increase the risk of other medical conditions, including:
- Cardiovascular disease
- Anxiety and depression
- GI bleeding
- Decreased life expectancy by seven years in men and three years in women
No single exam or test can diagnose RA. It is typically determine through a series of tests and questions such as:
- Medical history
- Physical exam
- One or more laboratory tests (inflammation testing, blood counts, kidney tests, liver tests and/or X-rays
- X-rays, MRI or ultrasound
- No single lab test can rule in or rule out diagnosis of RA
There is no cure for RA but the progression can be slowed and the pain, inflammation and stiffness can be successfully managed through the use of several effective medications and physical therapy. Treatment should be individualized. No single drug works for all cases.
Damage typically occurs within the first two years after onset so early intervention can make a difference:
- Reduces joint damage
- Slows disease progression
- Reduces disability and mortality risk
- Improves quality of life
Medications may include:
- NSAIDs (nonsteroidal anti-inflammatory drugs)
- DMARDs (disease-modifying antirheumatic drugs – work by curbing the underlying processes that cause the disease to progress
- TNF blockers – Inhibits tumor necrosis factor (TNF), a key molecule causing inflammation and joint damage in RA
- Biologics – genetically engineered proteins derived from human genes. They are designed to inhibit specific components of the immune system that play pivotal roles in fueling inflammation, which is a central feature of rheumatoid arthritis.
Medications are very effective in controlling symptoms and joint damage. If the joint is severely damage, joint replacement may be an option.
Dr. Gorantla provided some suggestions for RA sufferers to help minimize their pain and symptoms:
- Rest during flare-up of joint
- Stop smoking
- Control blood pressure, cholesterol and diabetes
- Regular exercise
- Maintain ideal body weight
- Eat healthy
- Take Calcium, vitamin D if you are on steroids
- Get vaccinated
- Follow up with your rheumatologist regularly for ongoing care and monitoring