Experts Answer Questions About Arthritis Treatment

Handling arthritis is tough enough, but women with the disease often have to juggle other conditions too. Fortunately, the earlier arthritis is treated, the less likely you are to develop other problems. In this interview with two top experts, you’ll learn about health conditions related to arthritis, how to juggle multiple medications – and what you can do to reduce your risk…

When you have osteoarthritis, you're dealing with joint pain. Rheumatoid arthritis (RA) sufferers are hit with additional symptoms, including fatigue, low appetite and fever. But arthritis can also result in other health conditions, from simple colds to osteoporosis and heart disease.

What are the best ways to deal with the one-two punch of arthritis and its secondary ailments? And how can you lower your risk of heart disease and other arthritis-related problems?

We asked two knowledgeable professionals for answers. Lianne Gensler, M.D., is assistant clinical professor of medicine in the division of rheumatology at the University of California-San Francisco; and Cynthia Crowson, M.S., is a biostatistician specializing in rheumatoid arthritis at the Mayo Clinic in Rochester, Minn.

In this exclusive Lifescript interview, Gensler and Crowson weigh in on conditions associated with arthritis and how you can manage them.

What’s the difference between osteoarthritis and inflammatory arthritis diseases such as RA?
Gensler: Osteoarthritis is the most common. It’s a degenerative joint disease that causes pain and loss of movement from bone rubbing against bone, but it isn’t inflammatory.

Autoimmune arthritis is the umbrella term for chronic, inflammatory conditions, including rheumatoid arthritis. It’s caused by abnormalities in the immune system, which make the body attack its own joints and connective tissue. These conditions also include psoriatic arthritis (associated with skin psoriasis) and ankylosing spondylitis (inflammation of the back joints).

What are the most common health conditions linked to RA and other forms of arthritis?
Gensler: Heart disease is very common. Inflammatory arthritis, such as RA, affects the vascular system, causing plaque build-up and an increase in levels of low-density lipoprotein (LDL), a type of cholesterol. Increases in inflammatory molecules also put blood vessels at risk.

Crowson: Rheumatoid arthritis patients have twice the risk of heart attacks and heart failure (when the heart doesn’t pump well) compared to people without the disease, because of plaque build-up. They have shorter life spans, mostly due to cardiovascular disease. It’s the most common co-condition with RA.

RA patients also risk osteoporosis, a condition in which the bones become thin, porous and fragile. Steroids – drugs commonly prescribed for RA – lessen body inflammation, but they also impair bone metabolism, resulting in fractures.

Gensler: On the other hand, osteoarthritis – the non-inflammatory form of arthritis – doesn’t predispose patients toward osteoporosis or increased risk of heart disease.

Are women with other immune-system issues at greater risk for RA?
Gensler: People with type 1 diabetes are more likely to get either RA or thyroid disease – they’re all autoimmune diseases.

And there’s a strong link between having RA and having thyroid diseases, but we don’t know the cause.

Some people are genetically predisposed to autoimmune conditions. The trigger in those patients may be environmental – it could be an infection, such as rheumatic fever.

Type 2 diabetics have a different problem. Due to their tendency to be obese, they’re at higher risk for osteoarthritis of the hip.

What other common health conditions are related to rheumatoid arthritis treatment or RA itself?
Crowson: The risk of cataracts is 1-1/2 times greater in RA patients than in the general population. This could mainly be due to steroids, but the connection isn’t entirely clear.

RA patients also have three times the rate of anemia than others [due to inflamed tissues, which secrete proteins that suppress red-blood-cell production].

People with RA are more likely to be smokers, and their incidence of lung cancer is 1-1/2 times higher than the normal population. They can also get rheumatoid lung disease – nodules or bumps like the ones on their joints that show up in the lungs.

Their risks of non-Hodgkins and Hodgkins lymphoma [types of blood cancer] are also greater, but we don’t know why.

What is it about RA that predisposes patients to these other conditions?
Gensler: Blame inflammation and drugs. Prednisone, an anti-inflammatory corticosteroid that’s commonly prescribed for rheumatoid arthritis patients, promotes bone loss and accelerates osteoporosis.

Though we prefer that patients avoid steroids, we do use them in the early stages of RA because they act quickly.

What else should patients watch out for right after an RA diagnosis?
Crowson: “Normal-weight obesity” – when a person looks normal-sized but has extra body fat and less muscle than people of the same weight – sometimes occurs when people first get RA. They’re hurting, less active and may delay seeking medical help. And they lose muscle and increase fat without gaining weight.

Even with medication, the inability to exercise makes recovery difficult and increases their risk of heart disease.

Not exercising also increases the risk of type 2 diabetes. What can women with RA do to lower that risk?
Gensler: Avoid smoking. Exercise, and eat a healthy diet to avoid high cholesterol.

If a rheumatoid arthritis patient has a severe case of the disease and can’t walk, medication can control the inflammation so she can exercise.

If inflammation can’t be controlled, we recommend non-weight-bearing exercises, such as water exercise in a pool. It’s good aerobically and the resistance builds strength. Any exercise is better than none.

Are arthritis patients at greater risk of infection?
Crowson: Yes, due primarily to immunosuppressant medications such as prednisone. With these prescriptions, RA patients have more colds, serious bacterial infections, fungal infections, tuberculosis and viral infections.

They’re more likely to be hospitalized with infections, especially rare ones, than the general population. If 1% of the population has a rare infection, then 2% of RA patients have it.

Gensler: I encourage patients on immunosuppressant drugs to get vaccinated against flu and other illnesses [such as pneumonia].

When do patients typically develop arthritis co-conditions?
Gensler: That depends on a patient’s age and other risk factors. A 50-year-old diagnosed with RA is more likely to develop osteoporosis and heart disease sooner than a younger woman. Add steroids, and the risk goes up. (Not all patients develop osteoporosis, though.)

Also, the longer you have RA, the more likely you are to develop other conditions, especially if it goes untreated. That’s because you’re not controlling the inflammation.

Do RA medications other than steroids raise the risk of other health conditions? How can you avoid them?
Crowson: Doctors have to weigh the risks and benefits of medications they give RA patients, and monitor them regularly. For instance, disease-modifying anti-rheumatic drugs (DMARDs) can cause liver damage, so we have patients come back every 2-4 months to have their livers checked.

Doctors also caution patients to be careful with non-steroidal anti-inflammatory drugs such as ibuprofen. They help relieve pain but can also increase the risk of gastrointestinal ulcers. And because they’re available over the counter, users choose their own doses.

How does having multiple health conditions affect rheumatoid arthritis treatment?
Crowson: It complicates treatment decisions. Steroids might be good for RA but bad for other conditions, such as osteoporosis, cataracts and heart disease.

Women with multiple conditions should coordinate their care with their physician. They need to be proactive and get the best preventive care, which includes Pap smears, mammograms and having their cholesterol checked.

Is there any way to prevent RA in the first place?
Crowson: Some studies show that oral contraceptives cut the risk of RA by half. But since we don’t have really strong risk factors for RA, we don’t know if a patient will get it or not – so there’s currently not enough evidence to recommend them as a preventive measure.

Once a woman has RA, the contraceptives provide less benefit.

Gensler: There’s no miracle pill when it comes to inflammatory arthritis conditions. The most effective way to control the disease is to modify the risk factors: Don’t smoke; keep cholesterol controlled; exercise; eat a healthy diet.

Work on factors you can modify, because you can’t control family history, age and gender.

What’s Your Inflammation IQ?
Inflammation has become a hot topic over the last few years. The latest scientific research indicates that inflammation is behind more than 80% of the conditions we suffer from – everything from arthritis to heart disease. Dr. Mark Hyman, author of The UltraSimple Diet, agrees that inflammation leads to a host of health problems. Fighting it can get you on track to a healthier, happier life.