The ABCs of RA: Basic Terms You Need to Know
Getting a diagnosis of rheumatoid arthritis (RA) can be a confusing time. While you’re trying to adjust emotionally, there’s also a steep learning curve to figure out what life with the condition involves. Knowing what your doctor is talking about is the first step to getting control of the situation.
Here are some of the key RA terms you should know:
Autoimmune disease: Our immune system protects us by attacking bacteria and foreign objects. In autoimmune diseases, such as RA, lupus and MS, the immune system malfunctions and attacks healthy tissue. In RA, the attack is focused on the synovium tissue in joints, as well as other systems in the body, such as tendons, blood vessels and internal organs.
Inflammation: In healthy immune systems inflammation can help heal a wound or injury. In RA, the immune system malfunctions, causing inflammation in previously healthy tissue. With RA, this inflammation is most visible in joints that become swollen, warm and painful. The inflammation of active disease erodes the cartilage in joints, causing damage that can result in deformity.
Rheumatologist: Treating RA is beyond the scope of a primary care physician—it requires an expert. If your family doctor suspects you may have RA, get a referral to a rheumatologist. This is a specialist who focuses on the diagnosis and treatment of arthritis and other types of rheumatic diseases that involve joints, muscles, bones and sometimes internal organs.
Blood tests: A number of blood tests are used in diagnosing and managing RA. ESR (or sed rate) and CPR measure levels of inflammation—the higher the numbers, the higher the inflammation. CBC counts white and red blood cells, and platelets in your blood, giving clues to what kind of condition you may have. Rheumatoid factor (RF) tests for an antibody often found in people with RA. The anti-CCP test is a newer, more sensitive test that can indicate the presence of RA. When it’s positive, 90 percent of the time, the person has the disease.
Seronegative: When the blood test Rheumatoid factor is positive, it’s often an indication that you have RA. However, in up to 30 percent of people with RA, RF is negative. This is called having seronegative RA. Many family doctors do not know that it’s possible to have RA, even when a person has a negative RF. This can lead to delay in referral to a rheumatologist and therefore a delay in diagnosis and treatment. If you feel you have symptoms that may indicate you have RA, but your family doctor tells you your RF is negative, push for a referral to a rheumatologist.
Medications to manage pain: NSAIDs (nonsteroidal anti-inflammatory drugs) treat the symptoms of inflammation and pain, but not the disease itself. They include Celebrex, Mobic and naproxen, and can be hard on the stomach. Opioids are narcotic painkillers, such as oxycodone, fentanyl and codeine, that can be used to treat severe chronic pain. When opiods are prescribed and taken correctly, the risk of addiction is fairly low.
Medications to treat RA: DMARDs (disease modifying antirheumatic drugs), such as sulfazalazine, Plaquenil and methotrexate, affect RA processes to slow down the disease. The biologics were introduced in 2000. Genetically engineered to inhibit responses involved in RA, the biologics include Enbrel, Humira and Orencia, and are administered through IV infusion or injection, except for the recently introduced Xeljanz, which is a tablet.
Immunosuppressed: Because RA is an autoimmune disease, medications that suppress the immune system also suppress RA. The biologics and methotrexate are immunosuppressants. This doesn’t mean you have to live in a sterilized bubble, but you should pay more attention to preventing infection. Stay away from sick people, wash your hands frequently and talk to your doctor about what to do if you get sick or injured.
Flare: A flare happens when your RA gets more active and symptoms such as pain and inflammation increase. A flare can be triggered by your medication not working as it should. If you’re having a bad flare, call your doctor to ask what you should do. Dealing with this kind of flare may mean that you increase the dose of your DMARDs or biologics medication, or use a booster pack of prednisone. Events that can also trigger flares include stress, over-exertion and for some people, certain foods. To identify your triggers, keep a symptom diary for three to four weeks. Record your symptoms, pain levels, weather, what you eat, stress levels, etc., every day. This can help you identify patterns and connections between symptoms and what’s going on in your life.
Fatigue: RA includes a high level of chronic fatigue that has been described as feeling as if your power supply has been cut off. Many people with RA need to sleep up to 10 hours a night, or eight hours plus a two-hour nap in the day. There are a number of techniques that can be helpful in managing fatigue, including supplements, pain management and meditation.
Remission: RA is a chronic disease for which there is no cure. However, it can be treated and suppressed into remission. Biologics have significantly increased the rate of remission in RA, but not everyone responds to the medications currently available. Sometimes low disease activity is an acceptable goal. Many new medications are in development, which could help more people go into remission in the future.
Lene is the author of Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain. Her new book is 7 Facets: A Meditation on Pain.