Conquering the Pain Of Rheumatoid Arthritis

Health Topics Jun 16, 2021

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Rheumatoid arthritis (RA) is an autoimmune disease, which means that your own immune system attacks your body and causes inflammation. RA is an ongoing condition that mostly affects joints, but it also can damage other body systems. For example, RA may cause inflammation in your lungs, heart muscle, blood vessels, and eyes.

Rheumatologist Sanford M. Wolfe, DO, says if it is not well-controlled over years, it puts you at greater risk of hardening of the arteries, stroke, and cancer. It also increases your risk of getting cancers and lymphomas. An estimated 1.3 million Americans have RA, according to the Arthritis Foundation.

RA is not the same as osteoarthritis, although both cause joint pain. These two types of arthritis have different causes and effects throughout a person’s life.

Causes And Risk Factors

There is no known cause or risk factor for RA. Some doctors think it may be triggered by infection, but that hasn’t been proven, Dr. Wolfe says.

What doctors and scientists have observed is that RA:

Occurs most often in people during their 20s through 50s
Is 1.5 times more likely in women than in men
Tends to be the same in women as in men
Generally doesn’t occur (or flare up) in women who are pregnant

Symptoms

“The most debilitating effects of RA are joint pain and swelling,” Dr. Wolfe says. “The hands and wrists are commonly affected, and usually on both sides. Joint pain may also occur in the knees, ankles, feet, shoulders, and neck. Many people develop significant joint damage that can’t be reversed.”

He notes these common symptoms of RA:

Joint pain
Stiffness that lasts for several hours, requiring you to get up earlier than usual to ease into movement
Fatigue, which can lead to inactivity and deconditioning of muscles
Inability to bend or straighten some joints as the disease progresses
Weight loss from loss of appetite, or weight gain from inactivity
Difficulty sleeping if in pain
Dry mouth
Eye discharge, dryness, itching

Later signs of the disease are chest pain when you breathe, and hard, unsightly lumps of tissue beneath the skin that typically show up on the hands and elbows.

Diagnosis

Dr. Wolfe encourages anyone who has persistent joint pain and swelling to see a doctor for evaluation. To diagnose RA, you doctor will typically:

Ask you about symptoms
Perform a physical exam, including looking at your joints for signs of swelling or tenderness
Order X-rays to help confirm RA or rule out other causes of joint pain
Order blood tests to rule out other conditions or identify antibodies that can precede onset of RA symptoms

Treatment

Treatment options for RA have improved dramatically in recent years.

“Years ago, we didn’t have that much. Everything changed for the better when biologics such as Enbrel^® (1998), Remicade^®(1993), and Humira^® (2003) became available,” Dr. Wolfe says.

He adds that an early diagnosis helps you to get appropriate treatment as early as possible. This limits permanent damage to joints and organs. Biologics target specific parts of the immune system that drive inflammation. One limitation is that, currently, there are no markers in the blood that allow doctors to match the correct drug to what’s driving the inflammation.

Dr. Wolfe explains, “Even though treatment has advanced, it’s still trial and error. Most of the time something will work. We typically start with TNF inhibitors (e.g. Enbrel, Humira) to calm inflammation.”

He further notes that people sometimes think they are doing well enough to stop their medications. “This isn’t a good idea without medical advice. By the time people come back, sometimes they’ve had worsening joint damage. If you need or want to taper off, ask your doctor for advice.”

Outlook

“We have about 15 to 20 medication options, and we can generally get people feeling better. Most people will respond to something and will be much better off than when they started,” Dr. Wolfe says. He is optimistic about ongoing research to develop new drugs and treatments.

Currently, RA cannot be cured. If RA is poorly controlled over years, it can shorten a person’s lifespan by six or seven years.

Dr. Wolfe advocates improving your odds by taking the right medicine for you and staying physically active. Walking, swimming, and biking are good examples. Maintaining a healthy weight that doesn’t put stress on your joints is also advisable.

Additionally, “if we treat this aggressively, sometimes we can keep people on the job,” Dr. Wolfe says. “I want to provide people with hope and encouragement that they will have the ability to stay active, work, enjoy their lives, and have a better quality of life.”