Rheumatoid Arthritis: What to Expect
By Sarah Sebetka, Physicians’ Clinic of Iowa, Linn County LIVING WELL Magazine
Rheumatoid arthritis (RA) is an autoimmune disease, in which the body’s immune system mistakenly attacks healthy tissue, specifically synovium—the thin membrane that lines the joints. When attacked, fluid builds up in the joints causing inflammation and pain. It most commonly starts by affecting the hands and feet, and may continue to other joints such as the hips, knees, neck, cervical spine, and elbows. Left untreated, this disease may be disabling. “Untreated, maybe 50% of people who have RA will be unable to do their normal jobs in three to four years,” says Dr. Eyanson, rheumatologist at Physicians’ Clinic of Iowa. “The sooner we treat it, the better.”
Those at risk
According to the Arthritis Foundation, RA is most common in women ages 30-50 and affects about 1.3 million adults. Nearly three times as many women have this disease than males; however men are often affected later in life.
This disease is not (knowingly) determined by genetics or hormones, but the large number of women affected suggests a covert link. Eyanson suspects a genetic predisposition in some families. “They’d probably have to have the right genes and the right situation, whatever that is.”
Unlike other types of arthritis, such as osteoarthritis, the prior conditions of joints and tissue also have no discovered connection to the disease.
RA symptoms vary between sufferers and may change day-to-day. The disease often starts slowly with minor joint pain and stiffness. As mentioned, it typically begins in the hands and feet, and is symmetrical, meaning both sides are affected equally. Joints will likely feel warm, tender, and stiff and may be reddish colored. A general fatigued and ill feeling should be expected, similar to the flu but longer lasting.
Other symptoms include rheumatoid nodules, which are firm lumps under the skin. They affect about 35% of patients and appear close to the affected joint. Moderate to severe RA sufferers may see the effects in the lungs, eyes, or voice box, but such effects can be avoided through early treatment.
Because RA is a progressive and incurable disease, early diagnosis and treatment is crucial to avoid irreversible damage. “That first couple of years is the window that we can do the most for the course of the disease over a lifetime,” says Eyanson. Methotrexate is a disease-modifying antirheumatic drug (DMARD) typically used in early RA stages. It reduces inflammation and prevents disease progression, which in turn saves joints from permanent destruction and disability if used early. Biologics are biologically derived treatments that have advanced in the past decade. They are designed to control specific components of the immune system that fuel RA symptoms, specifically inflammation. Biologics are most commonly used in conjunction with methotrexate or another DMARD.
Eyanson believes that combination therapy, including biologics, has made the biggest positive difference in managing this disease. “The outlook is much more optimistic than it was even 15 to 20 years ago, largely because of our use of methotrexate and biologic drugs.”
Physical therapy, joint analysis, exercise, and a balanced diet he also describes as important practices for all RA patients at PCI.
The fine line between too much and too little exercise can be crucial if crossed. Both extremes may worsen symptoms in the long term. “Keep moving, rest things when they’re really inflamed, exercise them when they’re not, keep the bones strong. Exercise is very important, as is joint protection,” says Eyanson. Strengthening muscles helps preserve range of motion and improves overall mood and health. The saying “To rest is to rust” definitely applies here.
For more information, visit www.pcofiowa.com.
Individuals interested in learning more about rheumatoid arthritis and potential treatments should contact the Rheumatology Department at Physicians’ Clinic of Iowa by calling 319-398-1546.
“Individuals interested in learning more about rheumatoid arthritis and potential treatments should contact Physicians’ Clinic of Iowa—Rheumatology by calling 319-398-1546.”