What do I need to know about rheumatoid arthritis?
Rheumatoid arthritis is an autoimmune disease that causes stiffness in the joints and is commonly diagnosed between ages 45 and 50. In this video, Sanjay Gupta, MD, and leading expert Sanford Hartman, MD, discuss these and other essential RA facts.
Transcript
SANJAY GUPTA: Well, thank you again for your time, Dr. Hartman. You are a member of the Georgia Society of Rheumatology and a member of the American College of Rheumatology
as well. What is rheumatoid arthritis? It's an autoimmune disease. You're immune to yourself. The problem with rheumatoid arthritis
is synovial damage, the capsule around the joint. [MUSIC PLAYING]
The typical rheumatoid patient will-- they will present with small joints, initially, hands, feet,
fingers, toes, wrists, almost always symmetrical, so symmetrical that frequently if it's
your right pinky middle joint, it will be your left pinky middle joint as well.
If you stick the patient and tell them you have to tell me what this feels like with one word, you know, is this pain, is this stiffness,
is this aching, whatever, they will say stiffness and then quickly say, but it's not a stiffness like I've ever had before.
How common is rheumatoid arthritis, at least in this country? The statistics are that there are about 5 million people
in the country with rheumatoid arthritis, maybe a little bit more in a country that has 320 million people.
Is there a typical rheumatoid patient age-wise, gender-wise? SANFORD HARTMAN: Gender-wise, yes.
2/3 of the patients are women and some-- between 2/3 and 70%. It's a pretty narrow range.
And the rest are men. So it's much more likely going to be women. The one thing that's not uncommon is after pregnancy.
And we think that what happened is they developed it during pregnancy. But we know that pregnancy frequently
mitigates against it. Age-wise, usually the patients can be as young as 15 or 20.
The most common age is probably between 45 and 50. And, occasionally, you'll get somebody 70, 75 years old,
80 years old who develops rheumatoid. If you use one of these disease-modifying drugs, how quickly can it work?
How quickly have you seen it work in patients in terms of relieving their symptoms of stiffness or whatever unease they have?
SANFORD HARTMAN: Two weeks. SANJAY GUPTA: Really. SANFORD HARTMAN: Yes. SANJAY GUPTA: It's pretty, pretty fast. SANFORD HARTMAN: That's not the common. So I usually tell them it's-- to expect something in six
to eight weeks. But it isn't surprising for somebody to come back in two weeks and say, man, this is fantastic. No, I'm not perfect yet, but I can already
see an unquestionable improvement. What else do you counsel the patient in terms of their life, their diet, anything else?
In general, there is no diet that seems to make a difference. Exercise-wise is a whole different question.
It's a stiffening disease so that the more you exercise, the better off you are.
The caveat in there is as a general rule, an acutely inflamed joint should be rested.
You know, they tell you to splint it when you do something bad to your elbow or whatever. But a chronically inflamed joint should be exercised.
And frequently for patients who have difficulty, you recommend water aerobics where the water bears most of the weight. When you have that first conversation with the patient
who's come in, and, you know, they-- presumably they've been suffering for some time with this, what do you tell them the goals are?
If I get a patient where I think there is no significant damage, meaning I haven't-- I have an X-ray, I don't see damage yet there,
yes, they have swelling, yes, they have stiffness, yes, they have these abnormal tests, I tell them the goal is that you should be back how you were
before you got this disease. Given the number of options now, you've-- you're more optimistic? Your tone, your-- the way you characterize this to patients,
you're more optimistic nowadays than 20, 30 years ago? Oh, I am gigantically more optimistic because I see how well the patients do,
how little surgery is required now. And it's not an unreasonable thing nowadays to tell a patient that if you catch them early enough,
you are hoping that they will be clinically, symptomatically back to how they were before they got the disease.
rheumatoid arthritis
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