Think only older people get arthritis? Think again. Rheumatoid arthritis (RA) usually strikes between ages 30 and 45 – and women are four times more likely than men to get it. We asked RA expert Robert G. Lahita, M.D., Ph.D., for the facts on this painful inflammatory disease. Plus, test your osteoarthritis IQ with our quiz...
Most of us have aches from time to time. But if you find yourself – suddenly or gradually – with swollen, stiff, painful joints, you may have rheumatoid arthritis (RA), a serious autoimmune disease in which your immune system attacks the joints.
The bulk of those affected are women, although no one knows why, says rheumatologist Robert G. Lahita, M.D., Ph.D., professor of medicine at University of Medicine and Dentistry of New Jersey and vice president and chairman of medicine at Newark Beth Israel Medical Center.
But they do know that treating this condition early helps avoid permanent damage to joints, other serious diseases (including heart attacks and strokes), and death.
“RA can kill you, but that’s rare because there are so many advances in RA treatments,” Lahita says.
Below, we ask Lahita – the author of Women and Autoimmune Disease (Harper’s) – for answers about how to spot RA warning signs and get the treatment you need.
What is rheumatoid arthritis (RA)?
RA is the most common autoimmune disease. It’s very destructive, involving inflammation of the joints, muscles and other parts of the body.
How does it differ from osteoarthritis?
Osteoarthritis is a disease of wear and tear, a degenerative joint disease that’s not as inflammatory or systemic as RA; it never affects the organs.
And there are marked differences in X-rays of the two: An X-ray of RA shows erosion of the bone surface, but osteoarthritis X-rays show osteophytes, or bone spurs – not erosion.
Also, osteoarthritis can affect people on one or both sides [of the body]. RA affects people on both sides.
And osteoarthritis affects many more people – about 27 million, compared to 2.1 million affected by RA.
RA is also a younger person’s disease, striking people typically between ages 30 and 45. But osteoarthritis is a disease of older people, usually those between 50 and 70. Although both cause stiffness, people with RA feel less stiff as the day goes on; people with osteoarthritis feel stiffer.
Who’s likely to get RA?
Both men and women are at risk, women predominantly: Four women get RA for every man. But there’s no tendency for race as there is with other autoimmune diseases [such as lupus]; all races are involved.
Is it hereditary?
To a degree, but not like cystic fibrosis where the genetic defect is known.
RA is associated with certain immune response genes, but not always. You can have the genes and not have the disease. The genes may increase the likelihood of RA, but they’re just one of several factors: gender, genetics and some unknown trigger.
What causes it?
No one knows. [Researchers] have looked at everything from viruses to bacteria to a variety of conditions. We’ve looked at many possibilities, and none have been shown to be the trigger.
What are its primary symptoms?
Joint pain, exhaustion, stiffness – morning stiffness in particular. Most people get better as the day goes on.
In its worst form, joints can feel red-hot and so stiff you can’t move them. And I’ve never seen anyone with RA whose wrists and feet were not affected.
It’s also symmetrical, involving the same joints on both sides of the body.
Does it affect only joints?
Because this is an autoimmune disease, certain immune molecules [called autoantibodies] increase, causing fever, pain and swelling. The molecules can also cause weakness and anemia. White blood cell and platelet count can drop as well; the latter is essential for blood clotting.
RA can also cause cardiovascular disease, congestive heart failure, vascular disease [of the blood vessels], heart attack and stroke.
The pericardium [the sac around the heart] and lining around the lungs can become inflamed [affecting heart and lung function]. And you can develop tendonitis and bursitis [inflammation of the tendons and bursa, tiny fluid-filled sacs separating the tendons].
When should you go to a doctor?
That’s a very good question – and a controversial one. Most primary care physicians should know how to diagnose RA, but that’s not always the case. Because therapies for RA are complex, patients should be treated by a rheumatologist [a physician specializing in arthritis].
You should go to your doctor if you feel you have a chronic case of flu, along with pains and muscle aches. Or if you wake up and feel like you’re swimming through Jell-O. If you’re running a fever, have sores in your mouth, or a red rash that’s not going away, go to your physician.
If you’ve made a doctor’s appointment, what information should you bring?
Take your medical history and be prepared to tell the doctor what your symptoms are. It’s up to the physician to make the diagnosis.
Lots of patients do an Internet search and think they have a syndrome when they don’t. Just give the doctor your symptoms and let them decide. RA isn’t hard to diagnose.
How do doctors diagnose RA?
Eighty percent of the diagnosis is based on what a patient tells you: her family history, when symptoms started, how bad they are.
That’s followed by a detailed physical exam. The doctor will examine every joint and bit of skin for rashes. He or she will then take a review of systems, which moves from the hairline to the toes, asking about specific symptoms.
The last step – to confirm what the doctor probably suspects – is to take urine and blood samples, and perhaps put a needle in the joint so that he/she can analyze joint fluid. If you have joint inflammation, the fluid will be cloudy. If you have a low white cell count, that means your joints aren’t inflamed but you probably have osteoarthritis.
What treatments are available?
RA is the single disease offering the most possibilities of new treatments, because we’ve discovered how to tame the immune system. If it’s overactive, we can tone it down. You know the rheostat in your dining room that dims the lights? We do that with the immune system.
We’re aggressive. We start with DMARDs – disease-modifying antirheumatic drugs – like methotrexate [Rheumatrex, Trexall], azathioprine [Imurin], hydroxychloroquine [Plaquenil] and leflunomide [Arava].
With DMARDS, you also use NSAIDS [non-steroidal anti-inflammatory drugs] like celecoxib [Celebrex] and ibuprofen [Advil], which help with inflammation and pain.
In severe cases, we may use steroids like prednisone or cortisone. Steroids are very effective, but they have to be taken short term – I never continue them beyond 30 days – because over time they destroy other parts of the body, attacking the bone and skin.
We follow, or accompany, DMARDS with biologicals, also known as cytokine inhibitors. Cytokine inhibitors – a revolution in the field for 10 years – are called biologicals because they inhibit a fundamental biological process.
Cytokines are chemicals that the immune system uses to talk to other cells. Every cell in the body responds to cytokines. If you can inhibit cytokines, you can control the severity of RA.
One major cytokine involved in the inflammatory process is called tumor necrosis factor, or TNF. The cytokine inhibitors etanercept (Enbrel), adalimumab (Humira) and infliximab (Remicade) either soak up TNF cytokines in the blood or attack TNF cytokines and remove them from circulation.
Does early treatment affect success rate?
The earlier the treatment the better, because then there will be less erosive destruction of the joints. I think the optimum window is about 2-3 months from the first symptoms.
Is RA curable?
No. We can cause RA to go into remission, but there’s always the possibility of it reccurring. We have no idea what the triggering mechanism is.
Are new treatments being developed?
Multiple companies are working to target other cytokines besides TNF – there must be 50 of those kinds of trials.
Are there “quack” treatments you should avoid? How can you recognize them?
Quack treatments abound. The less that’s known about a disease, the more you have [people selling unproven remedies] like copper wristbands. No home folk remedy works to [halt] RA.
In general, you can use [alternative] remedies providing you’re also treating the underlying disease and don’t try things that are unsafe. Echinacea and melatonin, for example, stimulate immune function. That’s not a good thing for people with RA since their immune systems are already overactive.
Beware of snake oil salesman - people who tell you they have a cure - because it’s usually very expensive. And there’s no cure.
Health writer Dorothy Foltz-Gray is a frequent contributor to Lifescript.
For more information, visit our Rheumatoid Arthritis Health Center.
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