29Mar 2017

By Magdalena Cadet, M.D. – Rheumatology

shutterstock_128950370A few months ago, a professional female in her late thirties walked into my office complaining of several months of joint pain in both of her wrists, hands, knees and feet and she also reported feeling “achy and stiff.” As she went on to describe her symptoms of joint pain, swelling, stiffness that lasted into the middle of her workday, loss of energy, and occasional dry eyes, I started to focus on a diagnosis of rheumatoid arthritis (RA). She had been married for a few years and had started to think about having a baby but because of this recent development in her health, she wanted to have an evaluation before thinking about family planning. She couldn’t believe that she was having arthritis at her age and was very anxious about it. The difficulty with typing and writing was making her job harder and her fatigue posed a challenge since she had to be vigilant for her office meetings and work events. She was sent to me by her primary care doctor because her lab tests were abnormal and she revealed feeling fearful of having RA.

In the past, I would see individuals who had extensive hand deformities and immediately knew that they had RA. Patients used to fear a diagnosis for rheumatoid arthritis because they pictured a very disabling type of arthritis. Now, newly diagnosed individuals may develop symptoms early and not have any joint deformities. The outlook for these patients has dramatically improved. Treatment advances have made it possible to stop or slow the worsening of joint damage. My patient was so disappointed when she walked into the office that day because in RA, the cells of the immune system may not function properly and start attacking healthy tissue in the joints and other organs by releasing chemicals. I reassured her that her diagnosis was like any other chronic medical condition like high blood pressure, diabetes or thyroid disease and may require lifelong treatment and that she was lucky to have an early diagnosis and treatment could start immediately if there were no major contraindications.

joint-with-rheumatoid-arthritisRA is a chronic autoimmune disease that causes pain, stiffness, swelling and limited range of motion and function. Usually this type of arthritis is associated with inflammation. Middle-aged females (fourth and sixth decades) are more commonly affected, but RA can occur in any age group and in males. Small joints are commonly affected like in my former patient and stiffness is usually worse in the morning and can last from one hour to all day. Joint damage can happen because the chemicals that are released by the immune system can destroy the cartilage tissue that cushions the space in between the joints and bone. Most people don’t realize that although inflammation is commonly seen in the joints, other organs such as the eyes, lungs, blood vessels, liver, heart, and skin can be affected. Once a diagnosis for RA is made by clinical history, physical exam, X-rays and other imaging and blood work, frequent checkups with a rheumatologist are crucial to strive for remission. The goal of RA therapy is to improve the individual’s symptoms, prevent or stop joint damage, and prevent complications from the disease, such as accelerated heart disease, osteoporosis and cancer (lymphoma).

The positive side of this condition is that there are so many medications out there today that can help women and men with this disease. Before taking a medication that suppresses the immune system, a thorough discussion should take place between the doctor and individual to discuss benefits and risks of the medication. In addition to medications, making healthy dietary changes, cutting back on smoking and alcohol intake, and establishing good exercise and sleep habits can help with feeling better but cannot treat RA alone. For those individuals that are interested in alternative therapies such as acupuncture, yoga and massage, these interventions can help with some symptom relief but should not replace the need for treatment with conventional medicines. I always encourage my patients to KEEP MOVING since a common mistake for many patients living with RA is to stop using their joints and stop exercising because of the pain and stiffness.

Several months after the initial consultation, that young lady returned for a follow up visit. After finding the right medication combination and making certain lifestyle changes such as resuming some aerobic exercise and modifying her diet to include more omega 3 fatty acids and less gluten, it was great to see her walk into my office with a smile and proclaim that she began feeling like herself again. She still wanted to be in remission before discussing having a baby again, but I knew she was on the road to living well with rheumatoid arthritis.

For more info on Dr. Cadet and the Bone & Joint Health and Osteoporosis Center of The Spine & Pain Institute
of New York, please visit: www.OsteoCenterNY.com

References:
American College of Rheumatology (www.rheumatology.org)
www.everydayhealth.com