Women’s Day magazine recently had an article about an often misunderstood disease. The first two sentences of the article are pretty good. The third sentence is okay. After that, it’s hard to know what happened. Maybe the author was on deadline and didn’t have time to learn the facts. Here, then, is my re-write:
What’s the difference between rheumatoid and osteoarthritis?
There are over 100 different types of arthritis. As the aforementioned article states, osteoarthritis (OA) is the most common form of arthritis. There’s no denying that OA can be painful. Sometimes the cartilage that cushions one bone from another can deteriorate. Bone grinding on another bone - with no cushion in between - hurts. This can happen when people age (years of use), when people are very active in sports (extreme use), and when people weigh too much (excess use). OA can affect a single joint.
Rheumatoid arthritis (RA) is different. RA is not a matter of old-age or being too-fat. Young people can get RA. Skinny people can get RA. It is not limited to a single joint. Joint involvement tends to be symmetrical with RA. Not just one hip; both. Not just one shoulder; both. Not just one elbow; both. Multiple joints in the hands and feet on both sides of the body. And it isn’t limited to joints.
RA is a systemic autoimmune disease. Systemic means that the entire body is affected in a person who has RA. Organ systems as well as joints are affected. RA can cause blindness or hearing loss. It can affect a person’s heart, lungs… everything.
What does it feel like?
Imagine having pneumonia. The fever, the exhaustion, the feeling that it would take dying to get better: RA feels like that.
Imagine the redness, pain, and swelling that accompanies an infection. Now amplify that and spread it to both of your hands – red and painful, swollen so large that it looks like someone turned a doctor’s rubber exam glove into a water balloon.
Imagine having both tendonitis and bursitis – in both shoulders at the same time – and it never gets better. Simultaneously, you have tendonitis in both Achilles tendons, tennis elbow and golfer’s elbow, bursitis in both hips making it impossible to walk, as well as plantar fasciitis – in both feet.
Imagine crying out in pain because it hurts when your feet touch the floor.
Imagine never being able to rest your elbows on your desk, the table, the floor, or even a pillow, because it feels like you were in a car wreck and have ground glass stuck in your elbows.
Imagine the horror of watching as your hands and feet change shape. Damage isn’t just visible on x-rays; it’s visible to anyone who happens to glance at you. And it hurts – the bones hurt when they’re twisted like that because they aren’t supposed to be in that position.
How is RA treated?
Back up just a minute. RA can’t be treated until it’s diagnosed. That’s not so easy to do. Many people who go to the doctor due to RA symptoms are told to get more sleep and return if things don’t get better. Returning a month later leads to a prescription for a sleep medicine. When that doesn’t work, returning again leads to a misdiagnosis of depression and doctors no longer listening. And all this time, the disease is wreaking havoc inside – damage that can never be undone. Some people report taking five years to get a diagnosis of RA. Years of crippling damage before treatments ever begin. Some even die of RA induced heart disease, never getting treatment because the doctor never made a diagnosis.
The “lucky” people get a diagnosis. People who are able to show hot, red, swollen hands to their doctors get a faster diagnosis. Some people are blessed with doctors who listen, who don’t write everything off as “depression,” and who are good diagnosticians. Some doctors know that it’s a clinical diagnosis (made based on symptoms), not a diagnosis based on lab values. I got lucky. My doctor listens and I got a quick referral to a rheumatologist.
Once a diagnosis is made, how is RA treated?
Rheumatoid arthritis is incurable. “Treatment” in this case does not mean cure; it means hoping to prevent further damage. Once a diagnosis is made, treatment can begin, but it can never reverse damage that has already occurred. Treatment is two-pronged: medication and exercise.
The inflammation from RA can sometimes be reduced with anti-inflammatory medications. Steroids such as prednisone can help, but it often takes high doses to get the inflammation under control. Steroids have unpleasant side-effects such as weight gain and sleeplessness. Those who are fortunate are able to reduce the use of prednisone, and switch to a prescription-strength non-steroidal anti-inflammatory medication. Since NSAIDs can eat away the lining of the stomach, an additional medication is required to protect the stomach. Long-term NSAID use can also lead to heart attack or stroke.
Anti-inflammatories help reduce the swelling that occurs with rheumatoid arthritis, but they do nothing to halt the progression of the disease. Additional medications are used, and sometimes they’re even effective. Disease Modifying Anti-Rheumatic Drugs (DMARDs) slow the rate of damage caused by rheumatoid arthritis. A person with RA usually takes two or three DMARDs; this is called combination therapy. DMARDs do not take affect immediately. It takes between two and six months to know whether these medicines will work for a patient.
Some people’s RA does not respond to treatment with first-line DMARDs. Insurance companies require that these DMARDs be tried first, and if they don’t work, the person can then try stronger medicines (if the person has enough money to buy them). Biologic Response Modifiers (BRMs, aka biologic DMARDs) are given by injection or IV infusion.
All these medications can damage the kidneys and liver, and some of them increase the chances of certain types of cancer. Blood must be drawn regularly to monitor for toxic side effects.
As the disease is controlled, a physical therapist can prescribe exercises for strengthening the muscle-groups surrounding affected joints. Stronger muscles can help. It is important, however, that the exercises be low-impact to avoid additional damage.
What else works?
Nothing. There is no cure for RA. That doesn’t stop well-meaning friends from recommending every snake-oil treatment they hear about, though.
Did you know?
People with rheumatoid arthritis cannot obtain private insurance. RA is considered a pre-existing condition.
RA is expensive. Even with good insurance coverage, people with RA will easily meet their out-of-pocket max every year. Except that many people with RA have too much disease activity to be able to work. High medical costs combined with zero income means that people with very active RA are in danger of losing their homes.
For some people, RA can be affected by their diet. Try to eliminate all dairy products and everything containing gluten from your diet. It will take a month or two to show improvement, if it helps at all, so long-term diligence is necessary without any guarantee that it will help. It doesn’t help everyone, though.
RA symptoms fluctuate from day to day. A person with rheumatoid arthritis might be able to bicycle ten miles one day, and another day be unable to walk ten feet.