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This Is What Your Doctors Want You to Know About RA

Medically reviewed by Nancy Carteron, MD, FACR on February 13, 2017Written by Foram Mehta on February 13, 2017
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Rheumatoid arthritis (RA) is an autoimmune disease that affects about 1.5 million Americans. But not everyone’s symptoms, pain levels, or treatment will be the same. Here’s what an expert panel of healthcare specialists want you to know about RA and living your best life with the disease.

Protecting your joints is key

RA can take a serious toll on your joints, causing severe pain. The autoimmune disease can continue damaging your joints and cartilage to the point of permanent damage. For this reason, doctors recommend watching for early signs of joint pain.

“Protect your joints. It’s imperative to initiate treatment for RA as soon as possible. Early and appropriate treatment of RA helps prevent long-term joint damage,” says Dr. Abhishek Sharma, MD, neurosurgeon and spine surgeon. “The three primary bony targets for RA destruction include metacarpophalangeal joints in the hands, metatarsophalangeal joints in the feet, and the cervical spine. Therefore, early treatment may prevent long-term, irreversible joint degeneration in the above-mentioned areas.”

To get ahead of the damage, Dr. Sharma recommends the following: “Stay active, maintain an appropriate body weight, and monitor for signs of neck pain or new motor or sensory symptoms. Often patients will report difficulty with and loss of neck mobility prior to developing instability, and these signs often go unnoticed.”

There’s no single solution to pain relief

A number of medications are available both to slow the course of RA as well as ease the pain associated with the disease. With that said, experts advise exploring various methods of pain relief. Often, it’s a combination of treatments that will provide the optimal level of relief.

“[Think] pain pyramid, not ladder: RA is pain,” says Dr. Amy Baxter, MD, also CEO and founder of MMJ Labs, which manufactures personal pain control products. “We need to rethink treating pain as a pyramid, where the top is disease modifiers (time, autoimmune modulators, surgery); the slightly bigger pool of options is pharmacologic; but the base is nonpharmacologic — heat, cold, vibration, stretching, massage, meditation, in an almost infinite mix of timing and duration. Patients need to learn to advocate for their own pain relief and sometimes accept there will be pain, but commit to living fully anyway. Acceptance and commitment therapy has huge data support.”

Stress can worsen your condition

You’ve probably been told more than once by your doctors and close ones alike not to stress. You might shrug it off, but it’s one piece of advice that’s grounded in scientific fact. Research shows stress, chronic or short-term, can negatively impact your well-being, increasing risk for disease and other health problems.

This is especially true for RA. Numerous studies have found a relationship between psychological stress and RA, including disease flares. Research has also found a correlation between worrying and increased RA symptoms, which may cause the disease to worsen. As such, experts advise giving an equal amount of attention to stress-relieving therapies as to drug therapies.

“There’s a lot of interest in understanding the role of alternative therapies in RA, and a lot of progress has been made in the field,” says Dr. Anca Askanase, MD, MPH, director of rheumatology clinical trials at Columbia University Medical Center and clinical director of Columbia University Lupus Center. “While not fully understood, stress seems to play a big role in autoimmune diseases and RA in particular. Stress management should be included in all RA treatment strategies.”

Dr. Askanase recommends yoga and meditation as two effective stress relief methods if you’re someone with RA. She also advises having open conversations with your healthcare providers on your various treatment options. You can also try tai chi and acupuncture.

“Trust your doctor, review the information available with a critical eye, and talk to other people with arthritis that have had success in dealing with the disease,” she adds.

Being active is important for your mental health

Mild to moderate physical activity is not only beneficial for your physical health when managing RA, but also key for your mental and emotional well-being. Pain and the inability to participate in certain activities because of it can lead to additional stress and even depression, especially for younger people.

“The younger the person, the more challenging a diagnosis of RA can be. … Depression is often a result of what were once pleasurable activities no longer being possible. There can be a profound sense of loss and/or anger over no longer having the same quality of life,” says Dr. Cheryl Carmin, PhD, professor of psychology and director of clinical psychology training at Ohio State University Wexner Medical Center. “If [you] enjoyed sports, can a sport that is easier on the joints, like swimming, be a viable alternative? What other activities bring satisfaction to [your] life, or are [you] willing to experiment with new and different activities? Focusing on what you don’t have will only add to feeling worse.”

And once you find something that works, Dr. Carmin advises caution and not risking a physical and mental setback.

“If you take advantage of a good day and do way too much, the payback the next day is huge. Learning one’s limits and thinking in terms of doing a little more (versus a lot more) and having several good days is a far better strategy. This approach works in conjunction with ‘tight control’ of RA.”

Joining a support group can be extremely helpful

Being around people who are also living with RA can be another key way to stay positive, say doctors. On days when even your loved ones can’t help you feel better, support groups may offer you reassurance that you’re not alone.

“From what I’ve seen at my practice, the majority of my patients struggle the most with the fear of losing independence. They fear they will not be able to work, care for their families, dress and bathe themselves, or even just get around without assistance,” says Dr. Ellen Field, MD, rheumatologist. “They don’t want to be a burden to their family. … I have them interact with other experienced patients from my practice and share their concerns. Also, Joint Decisions offers similar interactions through its Facebook page and website. It’s important to help educate the patient families, and we encourage family members to accompany them to office visits.”

Try incorporating anti-inflammatory foods into your diet

In addition to staying active, what you eat has a direct impact on RA symptoms because weight gain can add more stress to your joints. It’s important to keep good nutrition in mind when treating RA and pay special attention to foods with anti-inflammatory properties, recommend experts.

“I usually recommend a Mediterranean-style diet that is high in vegetables, fruits, legumes, and healthy fats like extra virgin olive oil, safflower oil, avocados, and nuts, along with healthy protein like fish and lean poultry and low-fat dairy. Limiting sugar and highly processed foods is very important,” says Liz Weinandy, MPH, RD, LD, an outpatient dietitian at Ohio State University Medical Center Nutrition Services.

“I also recommend patients take in turmeric and ginger supplements or, better yet, try to get them in their food regularly. An easy way to do this is to buy ginger and turmeric root at the grocery store and make a daily cup of tea by steeping pieces of both in hot water. Both of these have both been shown to help reduce inflammation as well as have other health benefits.”

Before taking any supplements, always to check with your doctor to make sure they’re safe to take with any medications you take.

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