There’s always something new…

RA doesn’t just affect joints.  It can affect the lungs, kidneys, pancreas, and so on – all the body’s systems.  That’s a problem with a systemic disease.

Although I had thought my disease was fairly well controlled, it turns out that even though my joints seem to be okay, and my labs look fantastic, there’s hidden inflammation wreaking havoc internally.  In my ongoing learn-A&P-by-malfunction life-course, I now get to learn all about pericarditis.

Pericard-itis is exactly what it sounds like it would be: inflammation of the pericardium.  And if you’ve ever taken Greek (thank you, Dr. Pecota), the pericardium is exactly what it sounds like it might be:  peri is a preposition meaning around, and cardion means heart, so the pericardium means something around the heart.  Thus pericarditis is inflammation of the thin, double-walled sac that surrounds the heart.  And let me tell you, it hurts!

There are many potential causes of pericarditis, and one is autoimmune diseases like RA.  Other causes include infection, heart attack/surgery, cancer, chest injury, HIV, and TB.  But with RA/SLE/PsA as a risk factor, this is something that the autoimmune community really ought to know more about.

The main symptom is chest pain.  This is most commonly sharp, stabbing pain – particularly in the center.  If you’re atypical like me, it could be more of a dull ache.  Think of your entire sternum hurting.  If you have a history of costochondritis (inflammation of the joints where the ribs attach to the sternum), you might be tempted to dismiss pericarditis symptoms as a costochondritis flare.  We’re talking about chest pain, though.  Go see your doctor!

Other symptoms can include:

  • Fatigue
  • Shortness of breath or difficulty breathing
  • Coughing
  • Palpitations
  • Fever
  • Pain when swallowing

It’s important to know the symptoms and seek help when warranted.  Don’t blow this off as a minor flare.  When we have chest pain, we need an accurate diagnosis and a good treatment plan!

Easier said than done.  I ignored things for a couple weeks, until finally my family members were concerned and insisted that I see our doctor.  Now, I like my doctor, but am not looking for extra excuses to see him.  I tend to figure that if I ignore things long enough, they’ll get better on their own.  After all, the body has a remarkable ability to heal itself!  Nonetheless, to get family members off my back, I went to see my doctor.  He is usually pretty good at the MD’s poker face. Nothing fazes him.  But when we discussed the “what makes it better/worse” question and I told him that it helps to lean forward, he looked at me like I’d lost my mind.  I smiled, “What can I say?  I just report the symptoms. You get to figure out what they mean.”  As it turns out, it’s pretty well documented that sitting up and leaning forward can ease the chest pain associated with pericarditis.  Once the doctors gave a name to my symptoms and I was able to read about it, I exclaimed, “HA! I’m not crazy!”  Well, maybe I am, but not about this!


When you see your doctor for chest pain, tests will be done.  Lots of tests.  Doctors don’t like their patients dying, so take complaints of chest pain quite seriously.  Even if you insist that it’s not your heart, it’s your lungs, they will ignore you and focus on your heart.  Expect to have an electrocardiogram (ECG/EKG) done almost immediately.  This not only tells the doctor what your heart is doing at that moment, but can show evidence of a past heart attack.1

Stethoscopes are a great invention.  In the case of pericarditis, the layers of the pericardium can rub against one another, and doctors are often able to hear this rubbing.  It’s fascinating.  Painful, but fascinating.

Another test, but one that can’t be done in a lot of primary care offices, is an echocardiogram (echo). This is an ultrasound of the heart, and in addition to an ECG is one of the tests that can be used in diagnosing pericarditis.  Positive results are considered conclusive, however negative results are not.

A chest x-ray can show what’s going on with your lungs, and will also show if the heart is enlarged.

MRI can be done to check the thickness of the pericardium, but is not likely to be one of the tests ordered initially.

Labs might also be ordered.  This is especially true if you go to the ER from your doctor’s office.  They’ll completely ignore your pcp’s input and order a plethora of tests to measure inflammation and make sure you’re not having a heart attack.2


  • Acute pericarditis appears suddenly and lasts fewer than three weeks.
  • Incessant pericarditis is continuous and usually lasts 4-6 weeks, but definitely less than 3 months.
  • Recurrent pericarditis is when symptoms of acute pericarditis resolve completely, the patient is symptom-free, and then 4-6 weeks later the symptoms occur again.
  • Chronic pericarditis lasts longer than 3 months.

The Art of Medicine

Eventually I saw a cardiologist.  He’s a fantastic guy.  He read the history my family doctor sent, listened to my story, did an exam, and read the ECG.  Tired of waiting for the ultra-slow wifi to work, he said, “Let’s do this the old fashioned way,” and retrieved a couple tomes from his office – including one that he said used to be the Bible of cardiology.  It was kinda neat to watch him look things up just to confirm he was remembering things accurately, and he showed me in his books what it says about RA and pericarditis. Then he told me that he’d check up-to-date once he had a better internet connection.

After that, he showed me my ECG and explained that the machine was reading it as normal, but that’s not how he read it.  And he carefully showed me the exact places on all those wiggly lines that he thinks look like my readings are abnormal, as if I were able to read ECG’s.  I can’t, but he made it sound fascinating, didn’t treat me like an idiot, and I’m tempted to get a book to see if I can pick up the basics of reading ECG’s.

Medicine isn’t just feeding data into a computer that turns around and spits out a diagnosis and treatment plan.  There’s an art to listening to patients, asking the right questions to get all the assorted symptoms that the patient didn’t even think to mention, and putting everything together.  Then after determining a diagnosis, doctors still need to figure out a treatment plan.  Every patient is different.


Since this is inflammation, it makes sense that anti-inflammatories would be the first line of treatment.  But RA patients already know to take ibuprofen before bothering their doctors with a little inflammation, which means my cardiologist jumped directly to the next step.

Colchicine is a gout medicine that works to reduce inflammation, and is one of the most common pericarditis treatments.  My insurance has this as a Tier II med, so be forewarned.  The most common side effect is needing frequent trips to the bathroom with lots of TP and air freshener, but if you’re already taking something like sulfasalazine, that is unlikely to be a problem 🙂

Steroids can also be prescribed to reduce the inflammation.  It’s nice to know there are options if the colchicine doesn’t work.  Frankly, given the cost difference, my personal preference would be to deal with prednisone, but there’s the usual love/hate issue when that medicine is prescribed.

Here’s hoping your life is less eventful!


1 If the ECG’s automated results say “inferior infarct, age undetermined” do not panic. It might mean that you had a small heart attack at some time in the past, but it also might mean that the machine isn’t particularly reliable and your results should be interpreted by a skilled cardiologist who will say, “don’t worry; you’re fine.”  If the doctor says, “Don’t worry; the machine doesn’t know what it’s talking about,” believe the doctor.

2 If you go to the ER from your doctor’s office, they’ll repeat the ECG and also draw blood to run every test possible in an effort to discover whether or not you’re having a heart attack.  When they announce that you’re not having a heart attack, feel free to respond, “Nobody ever thought I was having a heart attack. I am here because my doctor told me to come here for an echocardiogram because none of the cardiologists can see me sooner than two weeks.”  Better yet, it might be appropriate to be proactive at the very beginning of the visit and insist that they enter “sent by pcp for an echo” as your chief complaint, or they’ll get it all wrong and think that you’re there for chest pain.  To tell the truth, the ER is a horrible experience and if I’m ever sent again, I will take with me the name of the ER doctor with whom my pcp spoke.  And if it’s the height of flu season, beg to be sent anywhere else.


Making Life Easier

RA can make it challenging to accomplish tasks that we once considered easy.  Rather than struggle and be frustrated, or give up activities we enjoy, it makes sense to adapt.

Opening Doors – Just say no to doorknobs.  Save your pennies, then swap out those pesky knobs for levers that work even when your hands don’t.


If you have significant issues with doorknobs and can’t afford levers, get creative. Occasionally a business will change out all the locks in their building – and will change all the levers, even those that don’t lock, so that everything matches.  They work perfectly well, but there isn’t much market for used commercial door hardware. If approached right, some locksmiths might give you a bargain (as long as you realize that it’s clunky, commercial hardware and not the lightweight stuff you normally find in houses).

Laundry – First, get a good sorter and train everyone in the house in its use.  I keep my three-bin sorter in my laundry room and taught the kids how to separate their clothes into whites/mediums/darks as soon as they were able to dress and undress themselves.  If I could do it over again, I’d get a fourth bin for denim. We do have a separate bin for clothes that require cold/delicate handling. This method makes things much easier because I don’t have to bend and reach and go through various contortions to retrieve everyone’s dirty clothes and sort them into their respective loads.  When a bin is full, I dump things into the washer. It’s that easy.

That said, there are different styles of sorters.  I highly recommend finding one that has separate bags that lift off the frame, not a single bag with multiple compartments. This will allow you to pick up the bag and empty it into the washer, rather than having to bend over multiple times to dig every last sock out of the bottom of the bag!

In an ideal world, only dry items would go into the sorter, but in the real world, children toss wet socks and washcloths into the sorter and eventually the bag mildews.  Therefore, I highly recommend getting the style that has bags which easily slide off their hangers.  This means that the bag can be tossed into the washing machine and dryer along with the clothes.


My other laundry tip has to do with detergent.  If your hands or shoulders get to the point that pouring detergent into the washer is difficult/painful, spend the extra money for individual pods.  I’m pretty frugal (I have five children, so can’t afford to throw away money), but have decided that these convenience packs are worth every penny.  It works out to 15 cents per pod; I use one in most loads, but two on socks and dirty jeans.  There is a similar option for dishwasher detergent.


Hanging Rods – Closets with rods that hang at (or above) eye level are poorly designed, in my opinion, and not a friend of anyone with shoulder issues. If you have trouble reaching up to hang your clothes, consider modifying things so that you can hang your clothes at waist height.  Fortunately, my closet has rods at two heights; when my shoulders started causing problems we swapped things around so that my husband had all the top rods, and I got all the lower ones that I could reach easily.


Berry Picking – There’s nothing like trekking up into the mountains to get huckleberries.  The peace and quiet, back-to-nature, time with the family… it’s heavenly. Months later you get to re-live the pleasant memories while enjoying the berries you’ve preserved. Unfortunately, huckleberries are tiny little things (half-the size of a blueberry), and not always easy to grasp.  This year I discovered two tools that I love.  While I used them for huckleberries, they’d also work on blueberries, gooseberries, and various other berries (not so great on wild blackberries, imo, but cultivated ones might be okay).  Do these tools work?  I have five gallons of huckleberries in my freezer for us to enjoy all year long. 🙂

The first tool I found is oh-so-imaginatively called a berry picker.  You just stick it under the branch, then gently comb along the branch from the center of the bush out. The berries fall into the picker, while the leaves (mostly) stay on the bush.  A little debris gets mixed in with the berries, but it’s quite easy to shake the container gently and get the leaves to fall out.


The second tool is made by the same company, and just as creatively named:  berry cleanup tray.  This was not something I planned to purchase, but it was suggested when I ordered my berry picker.  I don’t usually fall for those gimmicks designed to part you with your money, but this had very good reviews and my Raynauds-afflicted hands do not appreciate being immersed in cold water.  After some experimentation, I discovered that the most efficient method is to pour the dry berries into this tray and shake it gently.  Most of the debris will fall out of the tray (exactly as designed).  I then grab my blow-dryer and turn it on the low/cool setting; this blows the remaining debris off of the huckleberries. Note that this method is best used on dry berries.  Wet leaves stick to huckleberries and the tray.  It’s a pain.  First get rid of the debris, then rinse the berries after all the leaves and twigs have been removed.


Don’t struggle, making tasks harder than they need to be, and don’t give up things you enjoy.  Invest in tools that will allow you to do the things that you both need and want to do.  What are some gadgets you’ve discovered that make life easier?

Yes, it matters what we eat!

The science is clear. It matters what we eat.  Research that is especially pertinent to people with any type of autoimmune arthritis is the apparent link between diet and inflammation.  Barry Sears, PhD, calls RA (and other types of autoimmune arthritis) “screaming inflammation.”  He also claims that it’s possible to stop the screaming.  Unfortunately, he doesn’t go so far as to claim a cure.

Between mtx, ssz, and a biologic, my RA symptoms seem to be mostly under control.  It’s taken a while, but I’ve discovered that when I make different nutritional choices, I can drop the “mostly” from my “mostly under control” statement.

In pursuit of better health, I’ve been changing the way I eat.  Honestly, it’s a struggle.  Food choices are habits, and like any other habit, it’s hard to break.  Add to that the fact that I have a family.  If we go three days without any grain products, they all start begging me to bake bread!

I am discovering that I must plan.  Without menus planned in advance, I wander around the kitchen and grab easy foods, then get hungry and snack between meals, and it’s a terrible cycle that perpetuates itself and makes me feel awful.  Planning makes a world of difference.

But what to plan?  Unless my goal is to join the circus as the fat lady who can’t walk, planning to eat cinnamon rolls is a bad idea.  Although many diets count carbohydrates, newer research also considers the glycemic load of carbohydrate-containing foods.  It’s not just the number of carbohydrates, but the amount of insulin your body needs to produce to metabolize the glucose from those carbs.  The goal is a slow, steady release of glucose, not a dump-it-all-at-once release which then leads to a crash.  Have you ever eaten a sugary snack, then needed a nap?  That’s due to the snack having a high glycemic load.  The Insulin-Resistance Diet, The Anti-Inflammation Zone, and Grain Brain are unanimous in recommending that people control their glucose levels.  Meal plans need to consider glycemic load.

This is incredibly important for anyone with RA, because it turns out that not only does dumping glucose into the bloodstream leads to a release of insulin, this release of insulin stimulates the body to make arachidonic acid, which is a building block of inflammatory proteins.  Dumping glucose increases inflammation.

Glycemic Index and Glycemic Load

Controlling the release of glucose into the bloodstream is important.  The rate at which that release occurs is quantified by a number called the glycemic indexFor fats and proteins, the glycemic index is zero (fats and proteins don’t lead to a significant release of glucose into the bloodstream).  For carbohydrates, the glycemic index tells how fast the food’s glucose will be released.  High-numbered foods release faster than low-numbered foods.

Many people consider not just the raw index, but also the amount of the food eaten.  Obviously a whole pineapple will release more glucose than a modest-size bowl.  The load is easily calculated by multiplying the GI by the number of carbs in the food to be eaten, then dividing by 100 (to make the number sound smaller).  Even easier, google “glycemic load of ___.”  I like the website  All sorts of nutritional information is included, including the estimated glycemic load:


So What?

The goal for most women should be a glycemic load of no more than 15 at every meal.  Most men, being larger, can aim for 20.  And, before you ask, no, we don’t get to save up from one meal to pig out at another!  The goal is steady levels of glucose in the bloodstream.

So is a glycemic load of 15/20 (women/men) a target or a limit?  It’s an upper limit, but very low can be bad for two reasons.  First, the brain needs glucose to function.  Second, low blood sugar can make you feel hungry (maybe it’s the brain saying, “Hey! I need some glucose!”), so although it’s important not to ingest too much in the way of a glucose source, it’s also important to get enough.  The glycemic load should probably be at least 8-10 per meal (5ish for a snack).  While it’s important to not eat too much, it’s also important to eat enough.


If I serve cinnamon rolls for breakfast, a 2-roll serving contains 516 calories, 81 g of carb, and has a glycemic load of 57.  This means, basically, that if I eat half of one cinnamon roll it uses up the entire allowed glycemic load – and I still need protein and a nap.  In contrast, a breakfast containing a fried egg with hashed browns and bacon contains 495 calories, 27g of carb, and has a glycemic load of 12.  It’s delicious and filling, and will last me until lunch time.  Basically, we should be getting our carbs from fruits and vegetables, not from grains.

By keeping an eye on the glycemic load of the foods to be eaten (as well as balancing proteins and carbs) I’m discovering that it’s easy to get enough food and never feel hungry. I’m feeling better, and as a bonus, my extra weight is slowly coming off.  What we eat has a huge impact on how we feel.