Dealing with Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic condition that causes joint inflammation, pain, swelling and stiffness. It usually affects finger and wrist joints, but it can attack just about any joint in the body, including feet, knees, elbows, hips or shoulders. And the damage doesn't stop there. RA can hurt other parts of your body as well, such as your heart, lungs, eyes, nerves and digestive system.

Left untreated—or undertreated—many people with rheumatoid arthritis develop some form of disability, so early, aggressive treatment is key to maintaining an active life.

Signs and Symptoms of RA
The most common symptoms of RA are:

• Morning joint stiffness—usually in the hands or feet—that lasts more than 30 minutes to an hour after getting out of bed
• Pain, stiffness or swelling in three or more joints
• Symmetrical joint pain (i.e., joints on both sides of the body are affected)
• Fatigue
  

Other early warning signs of rheumatoid arthritis include:

• Pea-size lumps, called nodules, under the skin
• Chronic low-grade fever
• Loss of appetite
• Anemia
• Accumulation of fluid (swelling) in your ankles or behind your knees
  

If you experience any of these symptoms—particularly joint discomfort—for more than two or three weeks, make an appointment to see your doctor as soon as possible. Why the rush? If it is RA, your best chance of stopping it is with early, intensive therapy—ideally within three to six months of your first symptoms.

Pain, stiffness and other symptoms similar to those of rheumatoid arthritis can be caused by many things, from a viral or bacterial infection, to Lyme disease, chronic fatigue syndrome, lupus (another type of arthritis), fibromyalgia or simply an injury or strain.

If you experience unusual or persistent pain of any kind, make an appointment with a doctor to determine what may be causing your symptoms.

What are the causes and risk factors of RA?

Causes and Risk Factors 
RA develops when part of the immune system, which is supposed to protect you from outside invaders, instead attacks your joints. It's not fully understood what causes the immune system to malfunction in this way, but RA is believed to be influenced by a combination of genetic susceptibility and environmental factors.

Your genes: People with a family history of RA are more likely to develop it themselves, and susceptibility to this disease has been traced to specific genes. But not everyone with a genetic predisposition gets RA, which suggests there may be other contributing factors.

Your environment: Environmental triggers may help set off RA in people who already have a genetic susceptibility. Research suggests a viral or bacterial infection is the most likely trigger, but other environmental factors that may play a part include prolonged exposure to cigarette smoke and/or silica dust.

Gender: Women are two to three times more likely than men to develop RA. The reason for this is unclear, although there's some evidence that hormones—particularly estrogens—may play a role in RA.

Age: RA usually begins between the ages of 30 and 60, but it can develop at any time.

Smoking: Smoking—and exposure to secondhand smoke—increases a person's risk of RA and may also increase the severity of the disease.

Ethnicity: RA occurs in people of all ethnicities, but some American Indian and Alaskan Native populations have a significantly higher incidence of RA than other ethnic groups.

When should you see a doctor?

Should You See a Doctor? 
Occasional joint pain or discomfort doesn't usually require medical treatment, but unusual pain that doesn't go away or that gets worse rather than better should not be ignored. Make an appointment with your doctor if you experience any of the following for more than a couple of weeks:

• Morning joint stiffness that lasts more than 30 minutes to an hour after getting out of bed
• Pain, stiffness or swelling in three or more joints
• Symmetrical joint pain (i.e., the same joints on both sides of the body are affected)
• Low-grade fever and fatigue
  

Try to get an appointment as soon as possible—ideally, within a week—to find out what's causing your pain. Time is of the essence because if it is RA, early treatment offers the best chance of slowing or even stopping the disease.

If your primary care physician can't see you within a week, consider making an appointment directly with a rheumatologist. Ask your doctor for a referral or find a rheumatologist yourself with this list from the American College of Rheumatology.

Tip: Some hospitals and medical centers run dedicated arthritis centers or early arthritis centers. Contact your local hospitals and ask if they operate—or know of—any programs like these.

What are the best ways to manage RA?

Self-Care: Managing RA 
The more you know about RA, the better equipped you'll be to manage your condition—whether it's dealing with doctors, nurses and health insurance reps or coping with the highs and lows of remissions and flare-ups.

Learning the language of rheumatoid arthritis, for example, can help you communicate with your doctors, understand test results, discuss treatment options, and be an active member of your healthcare team. So if you don't understand what your doctors or nurses are telling you, ask them to explain it in everyday language and to write down technical terms so that you can become more familiar with them. And keep in mind that amid all the white coats and specialists, you too are an expert—on you. You know better than anyone else how you feel and what feels normal or different, better or worse.

Taking care of yourself—physically and emotionally—is also a vital part of successfully managing RA, and there are many things you can do as part of self-care:

• Eat healthfully.
• Stay as physically active as possible.
• Get plenty of rest and relaxation.
• Be kind to yourself, and celebrate your triumphs, both big and small.
• Protect your joints.
• Try to quit, if you smoke.
• Maintain your social network of friends and family.
• Ask for support when you need it, and consider joining a support group of other people living with RA.

Tip: Make a list of the drugs you're taking (both their generic and brand names), the doses, and the purpose of each medication. Carry the list in your wallet or purse in case you're caught out of town with a short supply or are hospitalized unexpectedly.

How can you protect your joints?

Protecting Your Joints
Why do your joints need protection? RA makes your joints more vulnerable to injury. Inflamed joints can be damaged by everyday activities you may not even think of as risky. And repeated jarring or stress may eventually cause joints to become deformed.

Learning how to avoid overstressing your joints can help you through flares and also help maintain your range of motion.

Joint protection involves first paying attention to how you use your body and then using all of your joints efficiently to avoid excess stress on any one joint. Here's an example: grocery shopping. You want to use your largest, strongest joints for carrying things, so don't carry a heavy shopping bag with your hands, wrists or fingertips. Instead, wrap both arms around and under the bag. And take rest stops to put the bag down. Even
better: Take a cart or a bag with wheels to the supermarket.

Good ergonomics—comfortable and safe positioning at work and at home—can also help protect your joints. Maintain proper posture—don't slouch. And if you spend a lot of time sitting, take a break every couple of hours to get up and walk around for a few minutes. If you spend a lot of time standing, take breaks to sit or lie down.

An occupational therapist can give you practical tips and how-tos for protecting your joints, such as the best ways to open jars (press down with the flat of your hand), and can tell you about assistive devices that may make everyday tasks easier, both at home and at work.

In addition, a splint, brace or cane can provide temporary rest and support for a specific joint. A physical therapist or occupational therapist can fit you appropriately and train you how to use the device properly.

Worried that you may have RA? Take this assessment