Aching, dull, and grinding pain and stiffness in your hips, fingers, or knees is one patient’s description of what rheumatoid arthritis (RA) feels like. For some, the burning pain of RA can come on suddenly.
You might not know why your joints are aching, but you realize you must see a doctor.
RA is an autoimmune disease in which your immune system mistakenly attacks your joints, causing damaging inflammation. Approximately 1.5 million U.S. adults over age 18 have RA, according to the Centers for Disease Control and Prevention (CDC) — a disease that primarily strikes women during their childbearing years. Although genetics can increase your RA risk, most people with rheumatoid arthritis don’t have a family history. Early aggressive treatment and lifestyle changes can help you manage RA symptoms and minimize long-term joint damage.
If you believe you might have RA, take these 10 questions with you to your next doctor’s appointment.
1. Do my symptoms indicate that I could have RA?
Alane Miles, a minister in Richmond, Viriginia, was in her early twenties when she began having trouble opening her hands and standing up in the morning. “I had horrible pain,” she says. “In the evening, I couldn’t stand up straight all the way, and [doing so] hurt my knees, hips, hands, and wrists.”
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Miles experienced the classic RA symptoms of joint pain and stiffness, especially in the morning. If you have RA, you may also experience fatigue, weight loss, and a low-grade fever. This type of arthritis generally affects the symmetric small joints.
2. If I have rheumatoid arthritis, what will it do to my joints in the long term?
Over time, the lining of the joint, called the synovium, becomes inflamed and can ultimately destroy the joint. Medication and lifestyle changes can improve mobility and even prevent deformity. RA-related joint damage is irreversible.
3. How will you determine if I have RA?
Physicians diagnose rheumatoid arthritis through a patient evaluation that includes a health history and physical, X-rays, and lab tests. There’s no single, definitive diagnostic tool, which, as Miles learned firsthand, can delay an accurate diagnosis.
4. What’s the difference between rheumatoid arthritis and osteoarthritis?
Osteoarthritis is a slow, degenerative joint disease, says Jonathan Samuels, MD, associate professor of medicine in the division of rheumatology at NYU Langone Medical Center in New York City. “Rheumatoid arthritis is much more inflammatory and acts on other organ systems [in addition to the joints].” The incidence of osteoarthritis increases with age, while rheumatoid arthritis usually affects young women.
5. If I have RA, will it cause other health problems?
Rheumatoid arthritis is a systemic inflammatory disease (meaning it affects the whole body), says Brian D. Golden, MD, a clinical associate professor of medicine in the division of rheumatology at NYU Langone. And yes, it’s associated with other conditions, including osteoporosis (loss of bone density) and cardiovascular disease.
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In fact, about 40 percent of all deaths in people with rheumatoid arthritis are attributable to heart disease. Because RA is systemic, it can also affect otherorgans, such as the eyes, lungs, and skin. RA is also associated with Sjögren’s syndrome, an autoimmune disease that causes dryness in the mouth and eyes, among other symptoms.
People with RA are also more likely to get infections, such as tuberculosis, which can be caused by some medications and the disease itself. Anxiety and depressionare also more likely to develop in people with RA. Aggressive rheumatoid arthritis treatment reduces the risk of these complications, says Dr. Golden.
Miles wishes she’d understood early on how vulnerable RA would render her immune system. “I got sick a lot. I didn’t realize how dangerous grocery stores can be, for example, or how susceptible I was to other people’s germs,” she says.
6. What treatments are available for my rheumatoid arthritis?
There are many highly effective and well-tolerated treatments for RA, says Stacy Ardoin, MD, associate professor of rheumatology and immunology at the Ohio State University Wexner Medical Center in Columbus. Disease-modifying anti-rheumatic drugs, or DMARDs, reduce disease activity and prevent joint deformity. Early and aggressive treatment is critical in preventing long-term damage, says Dr. Ardoin.
Your doctor may also prescribe short-term treatments for relief of RA symptoms, including over-the-counter NSAIDs, such as Motrin or Advil (ibuprofen) and Aleve (naproxen sodium); prescription NSAIDs, such as Clinoril (sulindac) and tolmetin; and corticosteroids, such as prednisone and prednisolone. But corticosteroids might have a number of side effects that limit their use over a long period of time.
7. Will my treatment plan change over time?
The course of treatment can change for some patients. “DMARDs have varying degrees of potency to suppress the immune system, and varying degrees of toxicity,” says Golden. “It’s important to ask your doctor about the benefits and risks of each medication.”
“There are so many new therapies,” Ardoin says. “We don’t know up front which is going to be most effective [for each patient]. Sometimes it’s trial and error to find the right fit.” She adds that it’s pretty common to change RA treatment over time as one medication loses effectiveness or causes side effects, and new therapies become available.
8. What lifestyle changes can I make to help manage RA symptoms?
Miles says she started a program early in her disease that combined meditation, gentle exercise, and relaxation techniques. It helped her respond to flare-ups (periods of intense disease activity) and reduced her need for pain medications, such as narcotics. Miles encourages others with arthritis to find ways to pair natural pain reduction with pharmaceutical treatments.
“The [hard] thing is ramping up anti-RA meds when what you need to be doing is learning to deal with pain,” she says. “I’ve learned ways to relax around the pain so I don’t need as much medication.” Golden recommends losing weight if you need to, and getting exercise to prevent damage and increase strength around your joints. Ardoin encourages her patients to get adequate dietary calcium and vitamin D, to avoid smoking cigarettes and drinking alcohol, and to try to limit intake of steroid medications.
You may have to modify activities that cause pain. “You have to change what you do,” says Miles. “You do not have a choice. You have to change your habits.”
Miles also recommends learning proper sleep positions. “You spend eight hours a day sleeping — if you do it wrong, it makes you miserable. You need the right bed and the right pillow.”
9. Will complementary or alternative therapies help me?
Physical therapy is one alternative to medication that really helps Miles learn new techniques for strengthening the muscles around her joints. Ardoin says physical therapy is valuable and underused in people with RA. In addition, massage therapyand acupuncture are low risk and may also help relieve symptoms.
Although there is no specific diet for RA, some people with RA might find that an anti-inflammatory diet similar to the Mediterranean diet might help with some symptoms.
10. Where can I get additional help or support?
The Arthritis Foundation and the American College of Rheumatology both offer educational materials, tools, and other resources for rheumatoid arthritis patients and caregivers. Creaky Joints is an arthritis resource community that provides helpful information and support for people with arthritis and their families.