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Rheumatoid arthritis is an autoimmune inflammatory arthritis. The word "auto" means self, so these are diseases in which the immune system attacks itself. Normally your immune system is not supposed to do that. It's supposed to attack viruses, bacteria, fight off infections, but in some people for whatever reason their immune system gets confused and attacks its own tissues. In the case of rheumatoid arthritis the immune system makes inflammation, the inflammation runs through the body and settles into certain areas, especially into the joints, and if it settles into those joints it can cause pain, swelling, stiffness, and over time that swelling has chemicals, which can cause destruction of bone underneath it, leading to deformity and disability.

Once a diagnosis of rheumatoid arthritis is made, depending on the severity we decide on the treatment path. Traditionally we use two groups of medications, the disease modifying medications referred to as DMARDS, and the biologic medications. Traditionally we start with a DMARD if the symptoms are relatively mild. If on the other hand the symptoms are more severe, we may start with a biologic medication. Oftentimes we find ourselves combining various combinations of these medications to get adequate control of the disease.

Disease modifying medications or DMARDS have been on the market for many years. They're oral medications that act on the immune system in a more general way. They act on overactive immune processes, whereas biologic medications, this newer group of medications, is much more specific targeted therapy.

One of the most important properties of our immune system is to make inflammation. Say for example you get a cut or a wound. It's your immune system that detects the danger and makes inflammation. Inflammation is made by a group of proteins referred to as cytokines. These are signaling proteins.They tell cells to make inflammation.

Some of the newer treatments referred to as biologic medications target specific pro-inflammatory cytokines. By preventing or inhibiting these inflammatory cytokines, inflammation is prevented from being made.

The majority of our patients actually are on various combinations of medications and to adequately control our patients oftentimes we combine these medications. Occasionally we get lucky. We find a patient that may be in the early stages or has very mild disease or has a great response to just an oral disease modifying medication. This happens in about a third of our patients, however two-thirds of our patients require various combinations of disease modifying medications or disease modifying medications plus a biologic.

Oftentimes we will often cycle through various biologics. If one biologic doesn't work, we may swap it out for another one to achieve better control of the disease.

If a patient has persistent joint pain, stiffness, or swelling, then they are most likely failing their current therapy. On the other hand, at times patients feel that their symptoms are adequately controlled, however there are certain objective measures that the rheumatologist monitors, and if those objective measures such as blood work, ultrasound, x-rays are showing persistent disease activity, then also we consider that the patient is failing current therapy. In either situation we try to dose adjust these patients or change medications to get better control of their disease process.

Rheumatoid arthritis is a painful and debilitating chronic disorder. It affects approximately 1.5 million Americans according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. This inflammatory condition has no cure. However, even the most severe forms of RA can be managed more effectively by working closely with your healthcare provider.

Your doctor will help you cope with your symptoms and create the best possible treatment plan. According to The Arthritis Society, patients who make the effort to learn more about their treatment and discuss their treatment in depth with their doctor report less pain and symptoms. They may also experience better mobility.

Below are some important points to discuss with your doctor if you have RA. Discussing these matters with your doctor can help you better manage your condition.

Your Symptoms

For the best possible RA treatment plan, you need to explain your symptoms to your doctor in specific detail. Understanding exactly what you’re feeling will help your doctor make any necessary changes to your treatment plan.

When you talk to your doctor about your symptoms, you may want to bring up the following:

  • how often you are experiencing symptoms such as pain, stiffness, and swelling
  • specify the joints where you are experiencing the symptoms
  • the intensity of your pain on a scale from one to 10
  • any new or unusual symptoms such as increased pain, fatigue, or nodules under the skin


Describe to your doctor the effects that RA has on your lifestyle. These effects offer a good indicator of how well your treatment is working. Think about how your condition affects your ability to go about your daily activities. Pay attention to the emotional distress that your condition is causing. Dealing with chronic pain can be very upsetting and stressful, as well as emotionally draining. Ask yourself the following questions and discuss the answers with your doctor:

  • Does the pain and stiffness make it difficult or impossible to perform simple activities such as getting dressed, cooking, or driving?
  • What activities are causing you the most pain?
  • What do you have difficulty doing (or can no longer do) since your diagnosis?
  • Is your condition causing you to feel depressed or anxious?


RA can be managed far better today than even a few years ago thanks to the numerous treatment options available.

Nathan Wei, MD is a board-certified rheumatologist with more than 30 years of practice and clinical research experience and Director of the Arthritis Treatment Center in Frederick, Maryland. When asked for advice to patients who need to discuss RA treatment with their doctor, he said, “First and foremost, patients should be reassured that their prognosis is a good one. Most patients can be put into remission with the meds we use today.” According to Wei, “patients should also ask questions about the type of meds that will be used, when they will be used, potential side effects and what they can expect as far as benefits.”

Managing your RA isn’t just about finding the right medication. Though prescription medications may go a long way to alleviate symptoms even in those with severe RA, adding simple natural remedies to your treatment plan can also be beneficial, according to Carolyn Dean, MD, ND, a Medical Advisory Board Member of the non-profit Nutritional Magnesium Association.

“What’s often missing from an RA protocol [are] simple remedies to help with pain and inflammation and the toxicity of medications,” says Dean. “In my experience I find that magnesium in its many forms is very useful. Drugs used for RA drain magnesium from the body. Magnesium is a very powerful anti-inflammatory.” She recommends asking your doctor for a simple blood test to check to see if more magnesium is needed in your diet, adding that “oral magnesium in the form of powdered magnesium citrate dissolved in water and sipped through the day can be very helpful.” Dean also recommends soaking your feet or hands in Epsom salts (magnesium sulfate). She alternately recommends adding two or three cups of it to a bath and soaking for 30 minutes (if you are able to navigate a bathtub).

Ask your doctor whether or not you should be referred to a physiotherapist or occupational therapist. It has been found that adding physiotherapy and rehabilitation applications to a patient’s RA treatment plan can greatly improve symptoms and mobility. Improvements in these areas allow a patient to more easily carry out day-to-day activities.