What You Need to Know About Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease that causes severe pain, joint swelling and damage. And RA doesn’t just affect your joints; it can also affect organs like your skin, heart and lungs.

The disease, which occurs when the immune system attacks healthy joint tissue, affects 1.5 million adults in the United States. And while the causes aren’t completely clear, there are some people who are at higher risk for RA like women.

The good news? Treatment advancements have greatly improved, especially for people who get diagnosed and treated early, says rheumatologist Stephen Gelfand, MD, of Grand Strand Medical Center in Myrtle Beach, South Carolina. Here are the most important facts about RA.

How RA is diagnosed  
Doctors use a combination of exams to diagnose RA. The disease can be hard to diagnose because other conditions like gout and psoriatic arthritis have similar symptoms like joint pain and stiffness.   

First, your rheumatologist—a doctor who diagnoses and treats rheumatic diseases—may perform a physical exam. Your doctor will check for symptoms such as joint warmth, stiffness swelling or pain, and whether or not the symptoms affect joints on both sides of the body. Other RA symptoms might include weight loss, fatigue, fever and joint pain that’s worse in the morning.

Your doctor can also order blood tests to check for RA, including:

• Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP), which look for certain antibodies, or proteins in your blood
• Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which measure inflammation in your blood

If you have swelling in three or more joints, or symptoms that last at least six weeks, you may have RA. A positive or abnormal RF or CCP test usually confirms  you have RA.

X-rays may be used after diagnosis to determine how the disease is progressing, and an MRI or ultrasound may show how severe the RA is

Risk factors for RA
While the exact cause of RA is unknown, certain things may increase your risk, including:

• Gender. Women are two to three more times likely to have RA than men.
• Age. RA can occur at any age, but people who are 60 and older are also more likely to have it.
• Other conditions. High cholesterol, high blood pressure, heart disease, kidney failure and diabetes, may also increase your risk, says Dr. Gelfand.
• Smoking. It can increase your risk, make symptoms of treatment more severe or even reduce the effectiveness of your treatments.

If you’re at risk, talk with your rheumatologist about your options.

How to treat RA
If you suspect you have RA, early treatment can help you manage symptoms, reduce joint damage and slow disease progression. Here are some of the most common medical treatments:

1. Steroids. Your rheumatologist may recommend a very low dose of glucocorticoids, or corticosteroids.
   “Steroids are very effective for reducing inflammation. They work as what we call bridge therapy, a therapy that will be effective until more specific drugs for rheumatoid arthritis take effect,” says Gelfand.
2. DMARDs. Non-biologic disease-modifying antirheumatic drugs, or DMARDs, are preferably prescribed within three months of diagnosis, says Gelfand. These drugs will slow down the inflammatory process and reduce pain. The most common DMARDs include methotrexate, leflunomide, hydroxychloroquine and sulfasalazine.
3. Biologics. For more severe cases of RA, your rheumatologist may prescribe biologic drugs that target the immune system and the specific signals that lead to inflammation, and joint and tissue damage. 
   “We have a whole group of drugs that have been developed over the last 20 years. These drugs have really revolutionized the treatment of rheumatoid arthritis because they are so effective in slowing down or stopping the inflammatory process in people who have progressive RA,” says Gelfand.
   The FDA has approved drugs like abatacept, anakinra and rituximab, among others.  

5 ways to manage RA on your own
In addition to the medical treatment options, you’ll want to manage your symptoms at home, too. Here are the ways Gelfand says you can improve your joint discomfort on your own:  

1. Exercise. Increase your range of motion and strengthen your joints with exercise. Low-impact workouts like walking, swimming and water aerobics are excellent choices for those with RA, says Gelfand.
2. Try hot and cold therapy. Both cold and hot pressure may reduce your pain and stiffness. Cold treatments include ice packs, ice massages and cryowraps. Heated treatments include paraffin or wax baths, and heating pads. Heat treatments are especially helpful for patients that have hand and wrist stiffness, says Gelfand.
3. Eat whole foods. People with joint conditions should eat a diet high in protein and low in fats and carbohydrates, says Gelfand. An anti-inflammatory diet can help, too.
4. Keep your weight under control. Being overweight and obese is not good for rheumatoid arthritis, says Gelfand. “In fact, recent studies have found that RA patients who are morbidly obese and have bariatric surgery, see improvements in their RA symptoms.”
5. Educate yourself. People with RA should be as educated as possible about their disease. It really helps as far as the compliance factor in taking their medication, says Gelfand.

Diagnosis is critical to managing RA
While treatment can ease symptoms and sometimes even stop them all together, avoiding treatment can cause more problems. Inflammation can eat away at the cartilage and bone on either side of the joint, which can cause significant limitation of motion and pain, says Gelfand.

People can prevent or relieve RA symptoms like pain through early diagnosis and treatments that help reduce or stop the inflammatory process, says Gelfand.