Maybe it starts when you wake up: your feet hurt, making it difficult to walk across the floor. Buttoning your shirt takes longer to do, and your ring doesn’t fit over your swollen finger. You’re sorer than usual after your daily walk. You think perhaps you’re just getting older, but after a few months, you check with your doctor. A set of blood tests and a thorough exam reveals that it’s rheumatoid arthritis (RA). Now what?
RA is a chronic inflammatory disease that causes small joints to swell up and hurt. It affects an estimated 1.3 million Americans by attacking the hands, feet, and wrists. It may progress to the knees, elbows, hips, and shoulders. In severe cases, RA inflammation can form in critical body organs like the eyes, blood vessels, heart, and lungs, and may increase risk of anemia and heart attack.
RA symptoms range from slightly problematic to disabling, and can make even simple daily tasks more difficult.
A properly functioning immune system protects the body’s tissues from viruses and bacteria. However, immune cells mistakenly attack the body’s own tissues—namely, the smooth lining of the joints, called the synovium—in individuals with RA.
The synovium produces the fluid that lubricates and nourishes cartilage in the joint. When the immune cells attack, they cause inflammation, which gradually destroys cartilage and erodes bone. Over time, joints become deformed and permanently damaged.
Symptoms of rheumatoid arthritis can be painful and frustrating. Joints feel swollen, stiff, and sore. During a flare-up, they ache more than usual, making it difficult to open a jar, spread butter on toast, or type on a keyboard.
RA can also cause morning stiffness, fatigue, insomnia, and flu-like symptoms. Some people don’t feel like eating and may lose weight. About 20 percent of people with RA will develop lumps or nodules under the skin.
Though RA can affect anyone at any time, it’s more likely to attack women than men. The Centers for Disease Control and Prevention (CDC) estimates that about 60 percent of people with RA are women. Risk increases with age and is highest for those between 40 and 60 years old. Scientists also believe there may be a genetic factor. People with family members who suffer from RA or another autoimmune disease may be at a higher risk for RA themselves.
You can’t do anything about your gender, age, or genetic makeup. You can, however, avoid cigarettes, or quit smoking. According to a 2011 study published in the Annals of Rheumatic Disease, smoking was associated with an increased risk of RA. The more cigarettes participants smoked per day, the more their risk increased.
A 2012 study published in Rheumatology confirmed that smoking increased the risk of RA, and noted that obesity may be a risk factor as well.
Doctors use a variety of tests to diagnosis RA. No one test is definitive, but several tests can provide an accurate picture. Blood tests will look for specific antibodies related to the disease, as well as for markers that indicate inflammation. An ultrasound, X-ray, or magnetic resonance imaging (MRI) allows the doctor to check for damage in the joint. A sample of the synovial fluid from the joint may also show irregularities that indicate the presence of the disease.
Sed rate is one way to assess inflammation. Short for erythrocyte sedimentation rate (ESR), this test measures how fast red blood cells settle in a test tube. Inflammation can make blood cells lump together, causing them to settle more quickly. A high sed rate means greater inflammation.
However, it isn’t the only test to measure inflammation, and a high sed rate doesn’t mean you have RA. But the test can signal an inflammatory disease like RA, and your doctor may use it to help diagnose and monitor the disease.
Unfortunately, there is no cure for RA. Treatments include a number of different approaches to help reduce symptoms, slow joint damage, support flexibility, and help individuals to maintain their independence.
Various medications, including anti-inflammatories, corticosteroids, immunosuppressants, and antirheumatic drugs can help relieve pain, reduce inflammation, and slow joint damage. Physical therapy can help maintain flexibility, while devices like gripping and grabbing tools can prolong independent living. Surgery is a last result to help repair damaged joints.
In addition to traditional treatments, alternative methods for treating RA are also available. For example, applying heat to inflamed joints can help relieve pain, as can taking a hot bath or shower. Alternating hot packs with cold packs may also ease symptoms.
All types of low-impact exercise such as swimming, biking, walking, yoga, and tai chi have been shown to relieve pain and improve mobility. Fish oil supplements and acupuncture may be effective. Mind-body therapies like meditation, hypnosis, and biofeedback may help reduce stress, which may reduce perception of pain.
Living with RA can present many challenges. Fortunately, research is ongoing, and the future of treatment looks promising. Find out as much as you can about your condition and don’t be afraid to talk with your doctor. Ask for help when you need it and try different treatment techniques to maintain your confidence, independence, and optimism.