5 Things a Rheumatologist Wants You to Know About Rheumatoid Arthritis
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If you’ve just been diagnosed with rheumatoid arthritis (RA), you probably have a lot of questions about the condition and what it may mean for your future health and quality of life.
When you have rheumatoid arthritis, your immune system mistakenly attacks the lining of your joints (called the synovium), causing it to become inflamed and painful. This inflammatory autoimmune disease affects about 1.3 million people in the United States, according to the Cleveland Clinic.
The severity of rheumatoid arthritis varies from person to person and can be mild, moderate, or severe.
RA can begin at any age — most commonly in a person’s forties, fifties, and sixties — and typically causes joint pain and swelling, fatigue, and morning stiffness that lasts more than one hour, says the rheumatologist Elaine Husni, MD, MPH, the vice chair of the department of rheumatic and immunologic diseases at the Cleveland Clinic in Ohio and the director of the arthritis and musculoskeletal treatment center there.
As with any condition, a number of important questions arise among the newly diagnosed, ranging from the nature of RA itself to treatment options.
Below, Dr. Husni answers some of those questions and addresses queries she and other rheumatologists frequently hear.
1. It’s Not Your Fault That You Have Rheumatoid Arthritis
There’s a tendency among newly diagnosed patients to blame themselves, says Husni.
“One of the most common misconceptions about RA is that you did this to yourself,” she says. “We don’t really know the cause of autoimmune diseases, but many times patients will ask, ‘What did I do to get this?’”
The cause of rheumatoid arthritis itself also remains unclear, but like other autoimmune diseases, it’s triggered when the body’s immune system malfunctions and attacks healthy tissues and cells, according to the American College of Rheumatology.
Autoimmune diseases, which include RA, multiple sclerosis, and type 1 diabetes, among others, are fairly common; indeed, the U.S. Department of Health and Human Services reports that autoimmune disorders affect more than 23.5 million Americans.
2. You’ll Want to Educate Yourself About Rheumatoid Arthritis
Another important step when you’ve been diagnosed with RA is to become informed about the condition, says Husni.
The fears and ideas that newly diagnosed patients often have about RA usually come from the internet or somebody they know, says Husni, “so patients sometimes get misinformation. Also, I think autoimmune disease is a difficult concept to grasp.
“Patients often ask me, ‘What does autoimmune mean? I’ve never heard this before. I was healthy my whole life.’”
Understanding RA can be difficult, she adds, and patient knowledge about the condition tends to fall along a spectrum. “The first phase upon diagnosis is to give patients the correct information that they need,” Husni emphasizes.
RELATED: 8 Things I Didn’t Know About Rheumatoid Arthritis Until It Happened to Me
3. Ask Your Doctor How Active Your Rheumatoid Arthritis Is
Before you can make treatment choices, you have to determine how active your RA is, which includes your so-called disease burden, says Husni. “We now have many treatment choices in RA, and this allows us to personalize the process for each patient.
“Although we do not have a cure, we are better at controlling the signs and symptoms to allow patients to return to their normal lives. We still have patients who do not respond to treatments, but this is rare, and there is ongoing research to continue to improve RA treatment.”
“The three things rheumatologists normally do are a physical exam, some blood tests, and examine X-ray changes in the affected joint,” says Husni. “Those are the three pillars that we look at, and based on whatever they show, we can usually categorize you as having mild disease, mild to moderate disease, or moderate to advanced disease. We also want to know about the psychosocial aspects — how else does the disease affect you? This could be disturbing your sleep or mood or ability to work. We weigh all these aspects when treating an RA patient.”
RELATED: Early Rheumatoid Arthritis Treatment: Why Is It So Important?
How active the disease is will affect your RA treatment plan. “One of the first things we do is try to figure out where you are on that spectrum, because treatment and advice will change for somebody with mild RA versus somebody with severe RA,” she adds.
4. Other Health Conditions May Affect Your Rheumatoid Arthritis Treatment
Research shows that among RA patients, there’s a high prevalence of other conditions, such as depression and cardiovascular disease, referred to by doctors as comorbidities.
So another crucial step in treating RA is to determine if you have any comorbidities. “It’s very important to see if you have any associated diseases or disorders that your rheumatologist needs to take into account,” says Husni.
If you have depression, for example, your rheumatologist may not want to prescribe certain RA medications, because they could make your depression worse.
“Another example is if you have a family history of multiple sclerosis. In that case, there are some other medications that can’t be prescribed [for RA],” Husni notes.
It’s important to have a primary care physician who oversees all aspects of your health, and who can work with the rheumatologist to treat any comorbid conditions you have.
RELATED: Rheumatoid Arthritis Disease Progression and Symptoms
5. Eat Well, Stop Smoking, and Do What You Can to Stay Healthy
Adopting healthier habits may make life with RA easier, says Husni, adding that you’ll want to keep up with and even improve the healthy habits you already do have.
“For instance, now is not a good time to increase your smoking,” she says, and if you do smoke, you should really make an effort to quit. Smoking is a modifiable risk factor for RA, according to the Centers for Disease Control and Prevention; the habit also interferes with the effectiveness of some RA medications, notes the Mayo Clinic.
“If you are overweight, this might be the time to lose some weight, because it may contribute to excess stress on your joints in addition to the RA,” she notes.
Diet is another modifiable risk factor. “Healthy eating can’t necessarily stop or cure RA,” but it can help you live better with it, says Husni.
A number of studies connecting what you eat and how well you feel with RA have been based on small numbers of people or haven’t produce definitive conclusions on what to eat long-term. Still, your physician may advise you to follow a Mediterranean diet, which is high in vegetables, fruit, and seafood, according to a study published in Rheumatology International, and you may find some relief this way. Research has also shown that higher adherence to the Mediterranean Diet is associated with lower disease activity.
As research into the ways diet specifically helps RA symptoms continues, Husni believes “there will probably be a lot more information about nutrition in the years to come. I think it’s already happening, and I do believe that it will probably play a bigger role in RA treatment.”
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