Every Day with RA

Rheumatoid arthritis (RA) is a chronic disease that affects multiple joints, causing pain, inflammation, stiffness, and in some cases joint damage. RA can ultimately restrict one’s ability to perform daily activities.

Approximately 1.3 million people in the United States have RA. RA can develop at any age, but is most common in adults 30-50 years old and is two to three times more prevalent in women than in men.

Though the exact cause of RA is unknown, it is believed that RA occurs when the immune system responds abnormally. RA is the result of white blood cells leaving the blood stream and collecting within the joints’ lining (synovium). The white blood cells cause the lining to become inflamed, resulting in the release of proteins, such as tumor necrosis factor (TNF). Such proteins can then cause the lining to thicken around the joint over time, which gradually results in the joints losing their alignment and shape.

The body’s production of excess TNF, a type of protein, contributes to the inflammation and joint damage associated with RA.

People with the genetic marker HLA-DR4 may have a higher risk of developing RA than people without the marker.

Factors that may contribute to the development of RA include:

• Gender – Women are two to three times more likely than men to develop RA.
• Genetics – Patients with the genetic marker HLA-DR4 may have an increased risk for RA.
• Environment – In people genetically susceptible to RA, it may be triggered by a bacterial or viral agent, but the exact agent is not known.

Both the symptoms and severity of the disease – mild, moderate, or severe – vary depending on the individual. RA can begin with pain or stiffness in any joint, but it is most commonly found in the wrists, fingers, ankles, and feet. In most cases, pain is symmetrical, occurring in both hands or limbs in the same place on both sides of the body; however, this can vary by individual. Other symptoms include:

• Fatigue
• Stiffness, primarily in the morning or during long periods of inactivity
• Flu-like symptoms such as low-grade fever
• Rheumatoid nodules – small bumps of tissue that can be felt under the skin
• Loss of appetite
• Depression

Long-term RA has been associated with cardiovascular disease and, rarely, with problems with lung function. Research also shows that the risk of lymphoma may be increased in patients with RA.

RA is a progressive disease. If left untreated or inadequately treated, the inflamed joint lining can destroy the cartilage and bone of the joint. The muscles, ligaments, and tendons that support the joint may get weaker and stop working normally. These changes lead to pain and joint damage, which can become debilitating over time, and result in a lack of joint function or mobility.

Most people living with RA experience some level of depression, anxiety, or feelings of helplessness as a result of their condition.

Studies have shown that the disability associated with RA can make it difficult for some people to maintain employment. Over time, people living with RA who continue to work may need to switch jobs to decrease work load because of physical limitations related to their disease.

A physician or a rheumatologist, a doctor who specializes in the diagnosis and treatment of rheumatologic diseases, can identify RA through a physical exam, a complete medical history, blood tests, and x-rays to determine the severity of the disease and if it is progressing.

There are many treatment options available for RA ranging from over-the-counter pain relievers to prescription biologic treatments. However, because each patient's medical history and disease is unique, physicians weigh and consider these factors when determining a treatment plan. Previously it was common practice to begin patients on the lowest strength of medication; today many doctors have changed their approach, especially for patients with moderate to severe, progressing disease. Studies show that early treatment with more powerful drugs and the use of drug combinations instead of one medication alone may be more effective in treating symptoms and reducing the progression of joint damage.

Common medications used to treat RA include:

Non-steroidal anti-inflammatory drugs (NSAIDs) are used to relieve inflammation and alleviate pain and are available either over the counter or as prescriptions. NSAIDs are associated with increased risk for side effects when used at high dosages over an extended period of time. A cyclooxygenase-2 (COX-2) inhibitor is a specific type of prescription NSAID that is used to relieve inflammation and discomfort around the joints and may be less damaging to the stomach.

Corticosteroids also reduce pain and inflammation and, additionally, may slow joint damage. Due to serious side effects, physicians aim to treat a patient for a minimal amount of time with the goal of relieving acute symptoms and eventually tapering off the medication completely.

Disease-modifying anti-rheumatic drugs (DMARDs) are typically prescribed in the early stages of the disease to slow joint damage. DMARDs relieve joint pain and produce results over a matter of weeks or months. This particular category of drugs works by suppressing the immune system; patients should be watchful for any signs of infection such as fever, sore throat, or cough.

Other advanced treatments include biologic agents. Such treatments include anti-tumor necrosis factor (TNF) therapies, which work by absorbing excess TNF, a protein in the immune system that plays a role in inflammation. Some anti-TNF therapies have been widely used by physicians for nearly a decade in the treatment of RA and have been shown to significantly inhibit the progression of joint damage associated with RA. Interleukin-1 receptor antagonists, another kind of biologic, block the protein interleukin 1 (IL-1) that is found in excess in patients with RA. Other biologic therapies with different mechanisms of action target certain types of white blood cells; they may be appropriate for patients who have not been helped by DMARDs or anti-TNF therapies.

Researchers continue to study new drug and biologic therapies, which may play a role in the future of disease management by providing additional treatment options for patients living with RA.

Studies have shown that people who receive treatment soon after they begin to experience the pain, inflammation, and discomfort of RA are more likely to continue an active lifestyle and are less likely to experience additional joint damage and possible disability. Studies have shown that early and aggressive treatment may help slow the joint damage caused by RA.

Surgery may be necessary for some people who do not respond to medications. Joint replacement, tendon repair, or joint lining removal are types of surgeries that a rheumatologist may consider.

A doctor may suggest that people with RA find a balance between rest and activity because exercise can play an important role in strengthening muscles and preserving joint movement. Reducing stress may also be useful. While no scientific data prove that diet can improve symptoms of RA, nutrition that balances caloric intake, fats, and protein may aid in the overall management of the disease.