The Most Surprising Lessons I’ve Learned About Treating RA
If you’ve recently been diagnosed with rheumatoid arthritis (RA), you’ve probably got questions. Answering the basic ones is easy. But a lot of what we know about this painful inflammatory condition changes almost daily. Even the most veteran practitioners are constantly discovering unexpected aspects of the disease. We asked some of the top rheumatologists in the country to share the surprising things they’ve discovered in treating patients with RA—the good… and the not-so-good. This is what they told us.
RA Is Years in the Making
Even though joint pain is probably what drove you to see your doctor—where you were diagnosed with RA—it’s possible you had the disease for a long time before realizing it, according to Cornelia M. Weyand, M.D., Ph.D., a professor of medicine at Stanford University’s School of Medicine in California. “It has become clear that the disease process of rheumatoid arthritis starts years or even decades before the patients seek help for swollen and painful joints,” she says.
Early Treatment Is Everything
Earlier is always better than later, but it’s amazing the difference in results when RA treatment begins right away, preventing disease progression and the development of permanent damage. It's tricky to get an early diagnosis, though, when you have no clue for years about what’s going on. “The most surprising thing is that RA is the end point of a continuum that takes years for progression to full disease,” says Paul Emery, M.D., professor of rheumatology and director, Leeds NIHR Biomedical Research Centre, in Leeds, England.
Tendons Change Before Joints
While RA is known as a disease of the joints, the first musculoskeletal abnormalities seen on ultrasound or MRI are usually of the tendons, says Dr. Emery. Soreness of tendons and ligaments occurs because the inflammatory process—the same one that damages the joints—can also affect the connective tissues. If you frequently have sore muscles or tendons with no apparent explanation, it is smart to see your doctor to determine if your pain is related to RA or a different reason such as an overuse injury.
RA Is a Bit of a Chameleon
“The disease is much more heterogeneous than one would expect,” says Avram Z. Goldberg, M.D., a rheumatologist and clinical director at NYU Langone Rheumatology Associates in Long Island, NY. “Some patients have very mild joint problems and respond to NSAIDs alone while others have aggressive inflammation of multiple joints and need combinations of immune suppressing drugs to control their disease.” Because each case of RA is unique, it may be helpful to keep a journal of symptoms so you can clearly describe what’s going on to your doctor.
Different Meds Yield Different Responses
“I have been amazed that some patients will not respond at all to an initial biologic, but when we change to a different biologic in the same class, they do great,” says Dr. Goldberg. Anti-TNF drugs, which interfere with the action of a protein called the tumor necrosis factor (TNF), are one example. “I have found one anti-TNF drug will only provide minimal relief, and another anti-TNF drug will almost entirely cure someone,” he adds. The bottom line: It may take more than one try to find the treatment that works for you, so don’t give up.
Patient Power Is Real
The most cutting-edge treatments in the world can’t hold a candle to your input in disease management. “I am surprised at how much success comes from the patients,” says Ali Ajam, M.D., a rheumatologist at The Ohio State University Wexner Medical Center in Columbus. “When patients adopt a holistic approach to their treatment, addressing things like nutrition, sugar, and gluten, their results are more robust.” While each small decision you make throughout your day may not seem overly important, it all adds up.
Exercise Matters More Than You Think
“Movement makes a really big difference when it comes to RA,” says Dr. Ajam. “My patients who are in motion do so much better than those who are sedentary.” He’s not alone in his observation: According to the journal Current Opinion in Rheumatology, in addition to improving cardiovascular health, metabolic syndrome, and reducing obesity, exercise has consistently shown RA-specific benefits of reducing fatigue and pain, and improving function and mental health.
Weightlifting Is Actually Good for RA
“Universally, my RA patients who lift weights do better,” says Dr. Ajam. “Because RA involves tendons and muscles as well as joints, lifting weights can improve blood flow and provide great benefits.” On the opposite end of the fitness spectrum, practicing yoga may also improve overall physical functioning for someone with rheumatoid arthritis. If you’re new to yoga, take a class or sign up for a virtual session on Zoom so that you reap maximum benefits of the practice with minimal risk of injury.
The Bottom Line
If you’ve just been diagnosed, there’s a good chance you’ve had RA for far longer than you realized. There’s nothing easy about managing RA pain, but new drugs are making it easier to keep moving forward. That, and the inherent toughness of people who struggle with this disease, make it possible to live a robust life with RA. “Individuals with RA are required to manage their pain at the same time they are managing everything else in their lives,” says Dr. Ajam. “I am always impressed with their ability to adapt.”
Tendons vs Joints: Arthritis Foundation. (2020). “Tendonitis with Rheumatoid Arthritis?” arthritis.org/diseases/more-about/tendonitis-with-rheumatoid-arthritis
Movement Benefits: Current Opinion in Rheumatology. (2020). “Benefits and Promotion of Physical Activity in Rheumatoid Arthritis.” journals.lww.com/co-rheumatology/Abstract/2020/05000/Benefits_and_promotion_of_physical_activity_in.14.aspx?context=LatestArticles
Weightlifting and Yoga: Frontiers in Medicine. (2020). “Yoga for Treating Rheumatoid Arthritis: A Systemic Review and Meta-analysis.” frontiersin.org/articles/10.3389/fmed.2020.586665/full