Things You Think You Know, But Don't, About RA

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Rheumatoid arthritis (RA) is a rheumatic disease that affects a small portion of the American population. If you ask around, I bet you know at least one person living with RA. It can often be an invisible disease and there’s more to RA than meets the eye.

Test your knowledge about RA with these facts that separate truth from fiction.

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True or False: Rheumatoid arthritis is a common disease.

False.

Although arthritis in general is very common — affecting approximately 54.4 million or 25 percent of adults in the United States, according to a 2017 report by the Centers for Disease Control and Prevention (CDC) — only 1.3 million American adults live with RA. This disease is the third-most-common form of arthritis after osteoarthritis and gout. An additional 294,000 people live with some form of juvenile arthritis. Even fibromyalgia is more than three times more prevalent than RA in the American population.

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True or False: Rheumatoid arthritis is just a joint disease.

False.

While the inflammatory effects of rheumatoid arthritis primarily target joints in the body, RA can attack other important body parts — skin, eyes, heart, lungs, kidneys, intestines, blood vessels, and the nervous system. This is in contrast to osteoarthritis (OA), which is a joint disease. Both RA and OA can cause significant pain that can be hard to distinguish if you live with both diseases.

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True or False: More women than men have rheumatoid arthritis.

True.

RA is not strictly a female disease, but there are about two to three times more women diagnosed with RA than men. This is similar to other autoimmune diseases, such as multiple sclerosis, lupus, or scleroderma. Ankylosing spondylitis, however, is an autoimmune disease that affects more men than women. RA occurs in all races and ethnic groups.

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True or False: Rheumatoid arthritis, rheumatoid disease, and rheumatic disease are all the same thing.

False.

RA is an inflammatory disease that primarily attacks the joints and may attack other parts of the body. Some people living with RA prefer to call it rheumatoid disease (RD) to emphasize the more systemic nature of the disease. Rheumatic diseases (also RD) encompass more than 200 different diseases that span from various types of arthritis, to osteoporosis, to systemic connective tissue diseases. RA is just one of the rheumatic diseases.

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True or False: You can have RA without swollen or red joints.

True.

Unlike gout or septic arthritis, redness of affected joints is not a prominent feature of RA, which can make diagnosis more challenging. Careful palpation of joints helps to distinguish the swelling from joint inflammation from bony enlargement seen in osteoarthritis. Pain on passive motion is the most sensitive test for joint inflammation and occasionally inflamed joints may feel warm to the touch. Inflammation, structural deformity, or both may limit joint range of motion in RA.

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True or False: You have to wait for deformities to show before starting treatment for RA.

False.

Don’t wait! Rheumatologists often give patients powerful medications early on, particularly if they have a severe case of arthritis, that help to prevent permanent joint damage by reducing swelling, inflammation, and associated joint pain. Doctors may start with “triple therapy” — methotrexate, hydroxychloroquine, sulfasalazine — before adding a different medication, such as one of the anti-TNF (tumor necrosis factor) drugs or other biologics.

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True or False: Once a finger deformity starts to show, there’s nothing you can do about it.

False.

People might think that a crooked finger will always be a crooked finger, but that’s not necessarily true. Early intervention is key. An occupational therapist can recommend strengthening exercises, targeted supportive devices (such as ring splints), and joint-protection techniques to reduce the chance that minor deformities get worse. A ring splint can be a fashionable way to stabilize finger joints, improve function, and compensate for loose ligaments.

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True or False: Rheumatoid arthritis can attack the eyes.

True.

The most common eye problem seen in RA is keratoconjunctivitis sicca — otherwise known as “dry eye” — which may affect up to 10 percent of people living with RA. Sometimes, the condition may develop into secondary Sjogren’s syndrome. Other less-common eye problems seen in RA include episcleritis, scleritis, and peripheral ulcerative keratitis. Regular visits with your ophthalmologist are recommended when you have RA.

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True or False: Exercise is good for you when you have RA.

True.

When you are in the middle of an RA flare, rest and gentle motion are key in protecting joints from damage. But joints affected by RA need daily movement, strengthening, and exercise to stay healthy. Strong and flexible muscles help to stabilize joints and reduce chance of injury during activity. Gentle exercise, such as swimming, reduces strain on joints, allows you to exercise your cardiovascular system, and can gently strengthen muscles as you move against the resistance of the water.

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True or False: Rheumatoid arthritis is hereditary.

False.

While RA is not hereditary, there are more than 50 genes associated with the disease that make people more susceptible. But even if you have one or more of these genes, you may not develop RA. Environmental factors appear to be involved — sex hormones, viral or bacterial infections, long-term smoking, and occupational exposure to certain kinds of dust or fibers. However, having a close relative with RA is likely to increase your chance of developing RA as well.

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True or False: A rheumatologist is the only type of doctor you will see for RA.

False.

Ideally, a rheumatologist is the primary doctor consulted for diagnosis and treatment of RA, but there are times that other specialists may be called upon. Since people with RA are at increased risk for respiratory disease, rheumatologists and pulmonologists often work closely together. Other specialists who might join your RA team include occupational and physical therapists, an orthopedic surgeon, a nutritionist, an endocrinologist, an immunologist, and a cardiologist.

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True or False: People with RA are at increased risk of cardiovascular disease.

True.

The risk of cardiovascular disease (CVD) for people with RA is about twice that of the general population. While people with RA may share many of the traditional risk factors for CVD — insulin resistance, smoking, high blood pressure, and high cholesterol — the systemic inflammation related to RA may also contribute to cardiovascular risk. The higher cardiovascular risk starts in early RA and increases over time.

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True or False: Rheumatoid vasculitis is responsible for many of the extra-articular manifestations of RA.

True.

Rheumatoid vasculitis is a complication of RA that can contribute to the development of extra-articular problems, including rheumatoid nodules (in the skin, lungs, or heart), skin ulcerations, scleritis, neurological problems (such as sensorimotor neuropathy or neuritis), and swelling of the lining of the heart or lungs. Rarely, vessels in the brain, heart, and abdomen can be affected and ups the risk of stroke, heart attack, or insufficient blood flow to the intestines.