Rheumatoid Arthritis

Rheumatoid arthritis usually affects the large joints of the body, as well as the hands and the feet.

Sometimes Rheumatoid arthritis can start slowly, occurring in one joint then another and sometimes with time and space between affected joints. This is what we call ‘palindromic’ rheumatoid arthritis. Other times, it starts symmetrically with many joints affected.

Rheumatoid arthritis is not thought to be caused by an infection, but I have noticed many patients develop the onset of arthritis after a ‘flu like’ illness. It may be that the flu like illness is just the activation of the immune system prior to the rheumatoid arthritis occurring in the body.

Rheumatoid arthritis can affect anyone from childhood to late adulthood. I see people with adult onset rheumatoid arthritis, and those who developed rheumatoid arthritis when they were children and are now adults with the same disease.

We don’t really know. It appears to be triggered by something, possibly a virus, but we really don’t know medically what that is! I often see people who get arthritis who tell me it came on after some sort of ‘flu-like’ illness.

There is an increased risk of getting Rheumatoid Arthritis if there is a history of people in the family getting it but there is no strict genetic inheritance.

It can also cause quite profound fatigue. Sometimes non specific symptoms of fatigue and widespread aches and pains can precede the onset of joint swelling and pain by a few months.

In the long term, different people have different outcomes. 20-50 years ago a diagnosis of rheumatoid arthritis was a very negative one, effectively meaning that you were going to be crippled in the course of your lifetime. These days, with the advent of effective drugs and a diverse selection of drugs, we see very different outcomes, with most people having disease that is controlled during their lifetime. Of course, not everyone’s disease responds to medications and there can be side effects to medications. If that occurs, that can be a very challenging situation both for the person with the disease, as well as the treating doctor.

There is a higher risk of cardiovascular disease with longstanding Rheumatoid. It is important to regularly see your GP to have your cholesterol and blood pressure checked and treated if you have RA. Rarely there can be a vasculitis that occurs that affects the eyes, and also the skin. It appears to be less common these days in the advent of good drugs to control the disease.

Sometimes people with Rheumatoid arthritis can get lumps under the skin around the border of the olecranon and on fingers and toes. These are called ‘Rheumatoid Nodules’. According to research, 20-25% of people get Rheumatoid nodules. I don’t see them commonly in my clinical practice though!

Other uncommon things that can happen are:

• Vasculitis affecting other organs, including the eye, skin and kidneys.

• Sometimes the lungs and heart can be directly affected by inflammation but that is not common.

RA is mainly a clinical diagnosis. Your Rheumatologist will make sure that certain tests have been done to confirm the diagnosis and to eliminate any other possible causes for your arthritis, depending on what it looks like.

If these antibodies are present it confirms the diagnosis, but these antibodies are not present in everyone with RA.

Other blood tests would be a full blood count, liver function tests, kidney function and inflammatory markers, known as ESR and CRP. These measure the activity of the immune system and are often high. Uric acid is often checked to rule out Gout as a cause of arthritis. Sometimes viral screens will be done to rule out possible known viral causes of arthritis. Other autoimmune testings will be done such as ANA to eliminate the possibility of a different autoimmune disease causing the arthritis.

Sometimes other tests are done depending on what your Rheumatologist is suspecting is going on to evaluate your arthritis.

A Chest Xray is often done as well as Xrays of the hands and the feet.

The best thing that we have in Rheumatology to treat Rheumatoid Arthritis are medications called DMARDs. These are immune modifying drugs that modify the immune process to stop it attacking itself in the autoimmune process that is rheumatoid arthritis. These are effective medications for most people.

For more information on DMARDs read here…

If DMARDs do not work, there are a new generation of medications that are injectable called the biological drugs (click here to read more about biologicals). These drugs are very expensive and there are strict criteria for the government to fund access to these medications in Australia. They are also very effective, but they are not a cure for Rheumatoid Arthritis, and its important to note that not everybody responds to these drugs either.

Many people speak to me expressing their desire to pursue a more ‘natural’ approach to the management of their arthritis. This is understandable as nobody wants to take drugs with the risk of side effects. Its important to note that with Rheumatoid Arthritis, medications are the best things to best control the disease for best results, as with untreated rheumatoid arthritis the risk of serious joint problems and pain later on is quite significant. Evidence has shown that early intervention with medications improves long term outcome with RA.

That said, the way we eat makes a big difference to our health and well-being, having an impact on our immune system. Many people find changing their diet and taking some supplements to be a support in their well-being in addition to taking medications. That said, there is no one diet for Rheumatoid Arthritis, and this needs to be tailored for each person.