Rheumatoid Arthritis

A Definitive Guide to Rheumatoid Arthritis

So many people suffer with Rheumatoid Arthritis across the globe but finding comprehensive information can be difficult. In this guide, we’re going to look at this serious condition holistically – covering everything you’ve ever wanted to know about RA.

What is Rheumatoid Arthritis?

Rheumatoid Arthritis is an auto-immune disorder that causes pain and swelling in your joints. Auto-immune conditions occur when your body’s immune system gets confused, believing that there’s a threat, which leads to the body attacking itself. In the case of RA, this means your healthy joint tissues suffer.

Rheumatoid Arthritis affects millions of people across the world, can strike at any age and is usually chronic, meaning it lasts a very long time. It can quickly get worse without early intervention. This information might seem bleak; however, most sufferers find effective treatment plans and live high quality and happy lives.

Symptoms

At first, the hands and feet will tend to show the initial signs of Rheumatoid Arthritis. Usually, but not always, the symptoms are symmetrical; meaning they affect both sides of your body equally.

Joint Pain

This is the most common symptom of Rheumatoid Arthritis, and it all leads back to your immune system. Attacking the healthy joint tissues leads to inflammation, making your joints swell. When the inflammation goes down, the tissue in your joints remains damaged and might have trouble maintaining its position.

Alongside this, you can also experience:

  • Joint Warmth & Redness
  • Stiffness – in the morning or after holding a position for a long time
  • Fatigue (tiredness)
  • Poor Appetite & Weight Loss
  • High Temperature / Fever / Sweating
  • Dry Eyes
  • Chest Pain
  • Loss or Reduction of Libido

Causes

As you might be aware, there’s no one, true cause of Rheumatoid Arthritis. However, there are many factors at play, including age, genetics and lifestyle choices.

Most people are diagnosed with RA between the ages of 40-60, but the reality is that Rheumatoid Arthritis can strike anyone at any age. Women are three times as likely to develop the condition, as are people who are classed as overweight.

Genetically, there’s little you can do about what you inherit from your parents. You are far more likely to have Rheumatoid Arthritis if a member of your family has it, but environmental factors can influence your chances too. As with most conditions, smoking and unhealthy diets can increase the risk so it’s worth looking at your lifestyle too.  Cigarette smoke has been proven to raise your chances of getting RA in countless studies, and a diet rich in red meat with a lack of vitamin C has also been blamed.  Smoking also reduces the chances of improving your arthritis if you’re diagnosed.

We hate to admit it, but a sedentary lifestyle with little to no exercise is another big factor. If you’re not active it becomes more difficult to stay healthy.

Diagnosis

Typically, your physician will refer you to a specialist, a Rheumatologist, for a definitive diagnosis. Expect to provide a medical history, including details of conditions that run in your family and your most recent symptoms.

Physical Examination

Be prepared to have a physical exam, where a physician will assess your joints for pain, swelling and movement. They will be looking for signs of fever, rheumatic nodules and movement issues, alongside changes to your joints – especially symmetrically.

Blood Tests

There are several blood tests which can be used to both diagnose Rheumatoid Arthritis and check the progression of the condition. Blood proteins or biomarkers will provide information on the inflammation levels in your body. Most commonly, your physician will be looking at the levels of ESR (Erythrocyte Sedimentation Rate) and C-RP (C Reactive Protein) in your blood. These combined with the presence of the antibodies RF (Rheumatoid Factor) and Anti- CCP (Anti-Cyclic Citrullinated Peptide) make a diagnosis of Rheumatoid Arthritis very likely.

Imaging Tests

You might be referred for an x-ray, an ultrasound or an MRI scan to look at joint damage, which will enable your specialist to know how fast the condition is progressing and what type of treatment will be the most beneficial for your case. If you have no visible joint changes that still does not rule out the possibility of an arthritis diagnosis.

The combination of these tests and assessments can provide a clear picture, not only of a diagnosis but on how the disease is affecting you and at what rate.

Treatment

The great news is that treatment options for Rheumatoid Arthritis are continually being updated, improved and added to. As with all conditions, everyone requires an individually-tailored plan to allow them to manage their symptoms, but the main goals of RA treatment are to stop inflammation, prevent joint and organ damage, reduce the risk of long-term complications and improve overall well-being.

Treatment Plans

After your diagnosis, your physician will want to embark on very thorough treatment as early as possible. The sooner your inflammation can be brought under control, the better the outcome. The term specialists use is “remission”, meaning achieving the halting or slowing of active inflammation, and maintaining that control over the condition.

Your physician will also be looking to get “tight control” of your arthritis, meaning to have power over the disease activity. By keeping how active your arthritis is to a minimum, you’ll have a better chance of avoiding further joint damage and maintaining a good quality of life.

Medications

Looking at a medication list for Rheumatoid Arthritis can be daunting, so let’s discuss the most common ones used, how they work and what that means for your symptoms.

These can be split into two simple groups; those that slow the disease activity and those that ease your symptoms.

Slowing Disease Activity

Corticosteroids

Corticosteroid is the full name of a drug you might have heard before – steroids. They have names such as prednisone or prednisolone, but there are many more available. This medication can come in the form of a tablet or an injection into your joint. They reduce pain, stiffness and inflammation and can do it very fast. The most important thing to know about steroids is that they are a short-term medication. Long-term use causes a whole range of nasty side-effects such as weight gain and osteoporosis. You also shouldn’t stop using steroids suddenly, so make sure your physician provides a withdrawal plan and you stick to it strictly.

DMARDs

This odd-looking acronym stands for Disease Modifying Anti-Rheumatic drugs. This slow-acting treatment may be started immediately following a diagnosis but won’t bring relief for a few months. Prescribed under names such as methotrexate, sulfasalazine and azathioprine they can modify the course of your disease and help reduce and slow the damage to your joints. Your physician might prescribe these in tablet form or with an injection but be prepared to undergo regular blood tests as they can affect your liver. Coming in three forms; conventional synthetic DMARDs, biological therapy DMARDs or targeted synthetic DMARDs, your physician will be able to explain what type and for how long you need treatment with this medication.

Biologics

Technically, biologics are a sub-type of DMARDs but they act much faster and are given solely via injection or infusion by your physician. By targeting specific elements of the inflammatory process, they can leave a lot of your immune system untouched which is beneficial to your health. Recent research has found that biologics are good at stopping, slowing or modifying the disease in people who have had problems with other treatments.

JAK Inhibitors

An even newer form of DMARD that can be taken as a tablet. This medication blocks the Janus Kinase (JAK) pathways of the immune response only, making them even better at targeting the specific issues of Rheumatoid Arthritis than their traditional ancestors.

Easing Symptoms

NSAIDs

Non-Steroidal Anti-Inflammatory Drugs can be purchased over the counter or via a prescription from your physician. You might have heard of Ibuprofen, Ketoprofen or Naproxen Sodium, but there are so many more, including those for weaker stomachs. These drugs help to reduce pain and inflammation caused by many disorders, including Arthritis, and can be taken in tablet form, as a capsule, suppository or as a cream applied directly to the affected area.

Painkillers

Most people are familiar with painkillers. If you’ve ever had a headache you have probably reached from the acetaminophen (paracetamol). Painkillers do exactly as they say, they reduce pain and fevers and can be bought from most stores. However, if you are experiencing stronger pain than store-bought painkillers can tackle, your physician might prescribe stronger medication which should only be taken under their advice. Prescribed painkillers tend to be addictive, which is something to bear in mind.

Surgery

It will hopefully never come to it, but surgery is still an option for those suffering with Rheumatoid Arthritis. If the damage done to the joints is too great, joint replacement surgery can take away severe pain and restore your mobility. Hip and knee replacements are commonplace these days, this is where the joint is replaced by metal and plastic parts – and with an excellent prognosis. As our scientific knowledge continues to expand, many other joints are becoming available for replacement too. Your physician will be able to recommend this avenue should it become necessary.

Other surgeries might include Arthroscopy, which is the removal of inflamed joint tissues. A small incision will be made close to the joint and an arthroscope will be inserted to remove your damaged tissue in a procedure that doesn’t require an overnight stay.

You can also have surgery to straighten your toes or fingers, fix your joints or have carpal tunnel or tendon release, all of which are designed to improve joint condition and reduce your symptoms.

Managing Symptoms

As with a lot of chronic diseases, your symptoms will fluctuate. When they’re at their worst, this is known as a “flare-up”.  Stress and recent infections or sickness can contribute to causing a flare-up, as can the progression of Rheumatoid Arthritis.

As you learn to live with your condition, you’ll start noticing the early warning signs of your flare-ups, however these can be completely different from person to person. Any regular flare-ups should be reported to your physician so they can re-evaluate your treatment plan.

But how can you help yourself during a flare-up? The most important aspect is to continue to take your medication. You might find the pain and swelling has increased, alongside a low-grade fever and a general feeling of being unwell, so reach out to your loved ones to give you extra support during this time.

Heat & Ice

Hot and cold compresses are also great when applied to your joints for relief. Hot water bottles, electric blankets or even hot baths and showers can provide respite from your symptoms but remember to use heat carefully not to cause burns. Cold items, particularly ice-packs are recommended too but again caution must be taken. Wrap ice packs in a cold, wet towel and apply oil to the joint beforehand. Check the colour of your skin after 5-10 minutes and if it is red or pink, stop using the pack.

Gentle Exercise

Flare-up or not, gentle exercise can help to reduce your symptoms in the long-term. A lack of exercise will cause you more problems, and more stress on your joints. Being overweight and having stiff joints does not help with Rheumatoid Arthritis.

Find an activity you enjoy doing and get in touch with a physiotherapist for expert advice on what might be suitable for you. Maybe you’d like to join a walking club or a fitness group. If your hobbies include strenuous activities, speak to your physician about how to keep doing them while protecting your joints.

Being in water is great support for your joints, so activities like swimming or water aerobics might be very suitable for you. Hydrotherapy is a new form of treatment, providing physiotherapy exercises in a specialised pool. Check with your physician for registered hydrotherapy specialists in your area.

Yoga and other gentle stretching classes have also been shown to improve flexibility and joint stiffness. Whatever you do is better than a sedentary lifestyle.

Resting

Yes, this might go against the recommendation to do exercise, but there is a fine balance between overexertion and light activity. As you become used to your symptoms and how your body recovers from exercise, this will become easier to navigate. Take regular breaks throughout the day, talk to your workplace about what you need to help manage your symptoms and don’t be afraid to tap-out when you’re tired. Being exhausted with RA means you’ll take a lot longer to recover than the average person.

Complementary Therapies

As with all aspects of healthcare, complementary therapies can work for some people but should never replace the treatment plan your physician has constructed with you. It is hard to know the efficacy of alternative therapies and it’s always a good idea to talk through your plans with your primary medical practitioner. Complementary therapies might include mindfulness, relaxation techniques, massage, acupuncture or acupressure.

Positive Support Networks

Being sick can bring you down, and the ability to have resilience is of key importance to our wellbeing. It is so important to have a support network that can pick you up when you fall on hard times, so ensure you nurture your friendships and partnerships and be honest with them about how you feel. Aside from your personal connections, your physician, physiotherapist and even occupational therapist are there to help you remain confident, meet challenges head on and strive for the best quality of life you can achieve – so lean on them.

Living with RA

Aids & Adaptions

Making everyday life easier is a key factor with rheumatoid arthritis. If you’re experiencing difficulties getting around and doing the tasks you need to, aids and adaptions around the house can be fitted to help you out. These might be shower seats if you’re too tired to stand for a shower or handrails to help you navigate stairs. Something as simple as a shoehorn can help you put your shoes on without putting too much stress on your joints. Further adaptions such as wheelchairs or bath mechanics can be discussed with your treatment team as needed.

Diet & Nutrition

You are what you eat, as the saying goes, and a healthy, balanced diet is recommended for everyone, regardless of condition. For rheumatoid arthritis, diet is becoming a big area of research. No single diet is beneficial to everyone, as we are all individuals with our own gut biome and needs.

A diet high in Omega 3 fish oils, a good dairy intake and a reduction in the amount of junk food and alcohol will do no harm. Getting a regular source of all the vitamins and minerals your body needs is important. In the UAE, Vitamin D deficiency has become a big problem, with the food industry being asked to fortify certain foods with the vitamin to increase intake. Supplements have never been guaranteed to assist with RA however some of the medication you are taking might require a boost of folic acid, Vitamin D or calcium.

Your physician will be able to recommend good nutrition or refer you to a nutritionist who can help you with meal plans, dietary changes and further advice.

Foot Care

Most rheumatology departments have podiatrists to help you with your feet. Rheumatoid Arthritis sufferers often struggle with foot care and can experience pain, swelling and infections such as athletes foot. You may find it difficult to walk or have problems with your shoes fitting comfortably.

Foot care is vitally important as it’s such a big part of your overall mobility. A podiatrist can monitor your feet, provide guidance on footwear and foot care that you can do at home.

Sleep

Getting enough restorative sleep is necessary to our health. So, when our joints are aching, painful and swollen or stiff, sleeping can seem like a big challenge. Up to 80% of people with rheumatoid arthritis complain of sleeping problems, and the dangerous cycle is that lack of sleep can make your symptoms even worse. Aside from establishing a good, regular bedtime routine, practicing relaxation techniques before you lie down and making sure you have enough time to rest fully, your physician can help you with other treatments such as medication. Getting sleep is vital to maintaining your quality of life, so if you’re suffering in this area it’s important to be seen as soon as possible.

Relationships

It’s important to have a good support network when you’re living with a chronic illness, and this can sometimes make your relationships more stressful than average. But communication is key. Being able to talk to your friends, family and significant other will help you get the support you need.

When it comes to a healthy intimate relationships, most couples go through times when their intimacy isn’t as exciting or pleasurable as it once was. But again, communication is the one element that can help. Emotional problems and stress can play a big part, but with RA pain and fatigue can have an even greater effect on all the activities you like to do with your partner. Your significant other will also be more concerned about how the condition is affecting you.

Talking these issues through with a specialist might be uncomfortable at first, but they are trained to assist in all areas that arthritis might be affecting your life.

Summary

Whilst we are still learning, through tireless research, so much about Rheumatoid Arthritis, the journey is not over. New and improved diagnostic tools and treatment plans are being formulated all the time. If you’re someone who has just received a diagnosis, or have been suffering for years, it’s time to take back control of your quality of life and we hope this guide will help.

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