The ABCs of Rheumatoid Arthritis
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.
In healthy immune systems, inflammation can help heal the 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.
Treating RA is beyond the scope of a primary care physician — it needs an expert. If your family doctor suspects you may have RA, you will 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.
A number of blood tests are used in diagnosing and managing RA. ESR (or sed rate) and CRP measure levels of 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 tests for an antibody often found in people with RA. The anti-CCP test is a more sensitive test that can indicate the presence of RA.
When the blood test Rheumatoid Factor (RF) is positive, it’s often an indication that you have RA. However, in up to 30% 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 with a negative RF. This can lead to delay in referral to a rheumatologist and therefore delay in diagnosis and treatment.
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.
DMARDs (disease modifying antirheumatic drugs), such as include 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. The Biologics are given through IV infusion or injection, except for Xeljanz, which is a tablet.
Because RA is an autoimmune disease, medications that suppress the immune system also suppress RA. All the Biologics and methotrexate are immunosuppressants. This doesn’t mean they have to live in a 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.
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. Common life events that can also trigger flares include stress, overdoing it and some people find that certain foods can increase symptoms.
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.
RA is a chronic disease for which there is no cure. However, it can be treated and suppressed into remission. The Biologics have significantly increased the rate of remission in RA, but unfortunately not everyone responds to the medications that are currently available. At times, low disease activity is an acceptable goal. New medications are in development that may help many more people.