Rheumatoid Arthritis Treatment in Riverside, CA

Overview of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a long-lasting autoimmune disease. It mostly affects the joints. Your immune system normally protects your body from germs and disease. With RA, it attacks your own tissues instead. This causes pain, swelling and stiffness in the joints. The joints may also stop working as well as they should.

Other things to know about RA:

• It affects the lining of the joints. This damages the tissue that covers the ends of the bones in a joint.
• It often affects both sides of the body the same way. If one knee or hand has it, the other knee or hand often has it too.
• It can affect the wrists, hands, elbows, shoulders, feet, spine, knees and jaw.
• It may cause tiredness, a fever now and then, and a loss of hunger.
• It may cause health problems outside the joints, such as in the heart, lungs, blood, nerves, eyes and skin.

The good news is that today’s treatments can help people with RA lead full, busy lives.

What happens in rheumatoid arthritis?

Doctors do not know why the immune system attacks the joints. But they do know that RA can start after a chain of events:

• Genes and things in the world around you work together to start RA.
• The immune system may turn on years before symptoms start.
• The attack may start in other parts of the body. But it usually settles in the joints.
• Immune cells cause swelling in the inner lining of the joint. This lining is called the synovium.
• The swelling lasts a long time. The synovium gets thick as cells and proteins build up in the joint. This can cause pain, redness and warmth.
• As RA gets worse, the thick, swollen synovium pushes farther into the joint. It destroys the cartilage and bone inside.
• The joint capsule stretches, and the joint starts to change shape.
• Over time, the muscles, ligaments and tendons that support the joint get weak and do not work as well. This can lead to more pain, more joint damage and trouble using the joint.

Who Gets Rheumatoid Arthritis?

Some things make you more likely to get RA:

• Age. RA can start at any age. But the risk goes up as you get older. Children and young teens may be diagnosed with juvenile idiopathic arthritis, a disease related to RA.
• Sex. RA is more common in women than in men. About two to three times as many women as men have it. Researchers think hormones and other things linked to having children may play a part for some women.
• Family history and genes. If someone in your family has RA, you may be more likely to get it. Several genes raise the risk a little.
• Smoking. Research shows that people who smoke for a long time have a higher risk of RA. For people who keep smoking, the disease may be worse.
• Obesity. Some research shows that obesity may raise your risk. It may also limit how much the disease can get better.
• Gum disease. Gum disease (periodontitis) may be linked to getting RA.
• Lung disease. Diseases of the lungs and airways may also be linked to getting RA.

Symptoms of Rheumatoid Arthritis

Common symptoms of RA include:

• Joint pain when resting and when moving. The joint may also be sore, swollen and warm.
• Joint stiffness that lasts longer than 30 minutes. It usually happens after you wake up or after a long rest.
• Joint swelling that gets in the way of daily tasks. It may be hard to make a fist, comb your hair, button clothes or bend your knees.
• Feeling worn out or having little energy.
• A mild fever now and then.
• Not feeling hungry.

RA can happen in any joint. But it is more common in the wrists, hands and feet. It often affects both sides of the body the same way. For example, if you have RA in your right hand, you may also have it in your left hand.

RA is different for each person. In some people, it starts with mild or medium swelling in just a few joints. But if it is not treated, or the treatment is not working, RA can get worse. It can spread to more joints. This can lead to more damage and disability.

At times, RA symptoms get worse in “flares.” Something may set off a flare, such as stress, cigarette smoke, a virus infection, too much activity or stopping a medicine all at once. Sometimes there is no clear cause.

The goal of treatment is to get the disease into remission or close to it. That means no signs or symptoms of the disease.

RA can cause other health problems, such as:

• Rheumatoid nodules. These are firm lumps just under the skin, usually on the hands and elbows.
• Too few red blood cells (anemia).
• Neck pain.
• Dry eyes and mouth.
• Swelling of the blood vessels, the lung tissue, the airways, the lining of the lungs or the sac around the heart.
• Lung disease. The lungs become scarred and swollen. This can be severe in some people with RA.

Causes of Rheumatoid Arthritis

Researchers do not know what makes the immune system turn against the joints and other tissues. Studies show that a mix of these things may lead to RA:

• Genes. Some genes that affect how the immune system works may lead to RA. But some people with these genes never get it. This shows that genes are not the only cause. More than one gene may decide who gets RA and how bad it gets.
• The world around you. Researchers are studying how things like cigarette smoke may set off RA in people whose genes also raise their risk. Other things may also play a part. These include things you breathe in, bacteria, viruses, gum disease and lung disease.
• Sex hormones. Researchers think sex hormones may play a part when genes and outside factors are also involved. Studies show that women are more likely than men to get RA. RA may get better during pregnancy and flare after pregnancy.

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Diagnosis of Rheumatoid Arthritis

Doctors diagnose RA by:

• Asking about your health history.
• Giving you a physical exam.
• Ordering lab tests.
• Ordering scans, such as X-rays or ultrasound.

RA can be hard to diagnose early on because:

• It builds over time. You may have only a few symptoms at first.
• No single test can show it.
• Symptoms are different for each person.
• Symptoms can be like those of other types of arthritis and joint problems.

So doctors use many tools to diagnose RA and rule out other problems.

Medical History

Tell your doctor:

• About your symptoms, when and how they started, and how they have changed.
• What you have trouble doing, such as at work, in your free time or around the house.
• About your other health problems.
• If anyone in your family has the same symptoms or has RA.
• What medicines you take.

Your answers can help your doctor make a diagnosis. They also help your doctor understand how the disease affects your life.

Physical Examination

Your doctor usually gives you a physical exam. It may include:

• Checking your joints.
• Watching how you walk, bend and do daily tasks.
• Looking for a rash or lumps (nodules) on your skin.
• Listening to your chest for signs of swelling in the lungs.

Laboratory Tests

Lab tests may help diagnose RA. Common tests include:

• Rheumatoid factor (RF). This blood test checks for RF. It is an antibody that many people with RA have in their blood at some point. An antibody is a special protein made by the immune system. It normally helps fight germs. Not everyone with RA tests positive for RF. Some people test positive but never get RA. Others test positive but have another disease. Still, doctors use this test along with other results to diagnose RA.
• Anti-CCP antibody (anti-cyclic citrullinated peptide). This blood test checks for anti-CCP antibodies. Many people with RA have them. Anti-CCP can show up before RA symptoms start, which can help doctors find the disease early. This test and the RF test together help a lot to confirm RA. But some people have RA even when their blood tests are normal.
• Complete blood count. This test counts different blood cells. It can help find anemia, which is common in people with RA.
• Sed rate (erythrocyte sedimentation rate). This test measures inflammation in the body. It also shows how active the disease is and how well treatment works.
• C-reactive protein. This is another common test for inflammation. It can help diagnose RA and show how active the disease is and how well treatment works.
• Other blood tests. Your doctor may check your kidneys, liver, thyroid, salts in the blood (electrolytes), muscle markers, other autoimmune markers and signs of infection. These help check your overall health and rule out other diseases. Other tests just for RA are sometimes used, too.

Imaging Tests

To check for joint damage, doctors may use scans such as:

• X-rays. They help check for RA. But they usually look normal early in the disease, before the joints are damaged. Doctors may use X-rays to track the disease over time or to rule out other causes of joint pain.
• MRI and ultrasound. These can help find RA early. They also help show how much damage is in the joints and how severe the disease is.
• Other scans sometimes used for RA. These include a CT scan, a PET scan, a bone scan and a DEXA scan.

Treatment of Rheumatoid Arthritis

Treatment for RA keeps getting better. Many people get relief from symptoms and enjoy a better quality of life. Doctors may use these options to treat RA:

• Medicines.
• Physical therapy and occupational therapy.
• Surgery.
• Regular checkups and ongoing care.
• Complementary therapies.

Your doctor may suggest more than one treatment. Your treatment may change over time, based on your symptoms and how severe the disease is. Whatever your plan, the goals are to help:

• Ease pain.
• Lower swelling.
• Prevent, slow or stop damage to joints and organs.
• Help you do more of your daily tasks.

RA may start to damage the joints in the first year or two. Once joint damage happens, it usually cannot be undone. That is why early diagnosis and treatment are so important.

Medications

Most people with RA take medicine. Studies show that starting early with a mix of medicines may work better than one medicine alone. It may do more to lower or prevent joint damage.

Many RA medicines lower swelling and pain. They also slow or stop joint damage. They may include:

• Anti-inflammatory medicines to ease pain and swelling.
• Corticosteroids. They can lower swelling, ease some pain and slow joint damage. Because they are strong and can have side effects, your doctor will give you the lowest dose that works.
• Disease-modifying antirheumatic drugs (DMARDs). They can slow or change the course of the disease.
• Biologic medicines. These are also DMARDs. Doctors use them if your disease does not get better with the first treatments. They block certain signals the immune system sends, which helps lower or stop swelling.
• Janus kinase (JAK) inhibitors. These are also DMARDs. They act inside certain cells to stop inflammation. Doctors may also use them if your disease does not get better with the first treatments.

Physical Therapy and Occupational Therapy

Your doctor may suggest physical therapy and occupational therapy. Physical therapy can help you get back and keep your strength. It can also focus on the joints that bother you. Occupational therapy helps you build, regain and keep the skills you need for daily life and work. Sometimes tools or braces can help you move better, ease pain and keep working.

Surgery

Your doctor may suggest surgery if you have lasting damage or pain that keeps you from doing daily tasks. Surgery is not for everyone. You and your doctor can talk about the choices and pick what is right for you.

Before suggesting surgery, your doctor will think about:

• Your overall health.
• The state of the joint or tendon.
• The risks and benefits of the surgery.

Surgery may repair a joint or replace it.

Routine Monitoring and Ongoing Care

Regular checkups are important because your doctor can:

• Check how the disease is changing.
• See how well your medicines work.
• Talk with you about side effects from your medicines.
• Change your treatment as needed.

Checkups usually mean regular visits to the doctor. They may also include blood and urine tests, and X-rays or other scans. Having RA raises your risk of osteoporosis, mostly if you take corticosteroids. Osteoporosis is a bone disease that makes bones weak and easy to break. Talk to your doctor about your risk. Ask whether calcium and vitamin D supplements or other osteoporosis treatments could help you.

RA can affect other organs. So your doctor may also check your heart and lungs. Many RA medicines can raise the risk of infection. Your doctor may watch for infections. They may suggest vaccines to lower the risk of infections and make them less severe.

Who Treats Rheumatoid Arthritis?

Diagnosing and treating RA takes a team. The team includes you and several kinds of health care workers. They may include:

• Rheumatologists. They are experts in autoimmune diseases, arthritis and other diseases of the bones, joints and muscles.
• Physician assistants. They help doctors diagnose, treat and track diseases.
• Primary care providers, such as internists or nurse practitioners. They diagnose and treat adults.
• Orthopaedists. They treat bone and joint diseases and injuries and do surgery on them.
• Other specialists, such as lung doctors (pulmonologists) or heart doctors (cardiologists). They help people whose RA affects organs like the lungs or heart.
• Podiatrists. They treat foot problems and do surgery on the feet.
• Physical therapists, who help your joints work better.
• Occupational therapists. They teach ways to protect your joints, ease pain, do daily tasks and save energy.
• Pharmacists. They fill your prescriptions. They also check your doses and make sure your medicines are safe to take together.
• Dietitians. They teach you how to eat well to improve your health and keep a healthy weight.
• Nurse educators. They help you understand your condition and set up your treatment plan.
• Mental health professionals and social workers. They help people cope with problems at home and at work that may come from their health.

Living With Rheumatoid Arthritis

Research shows that people who take part in their own care have less pain. They also go to the doctor less often and enjoy a better quality of life.

Caring for yourself helps you manage your RA and improve your health. You can:

• Learn about RA and its treatments.
• Use exercise and ways to relax to ease pain and stay active.
• Talk openly with your health care team, so you have more control over your disease.
• Get support to help you cope with the effects of RA on your body, feelings and mind.

Taking part in your care can help you feel sure you can handle daily tasks. That helps you live a full, active life on your own terms.

Lifestyle Changes

Some habits can help you do more on your own and stay positive.

Rest and exercise. Balance rest and exercise. Rest more when your RA is active and exercise more when it is not. Rest helps lower swelling, pain and tiredness in active joints. Short breaks now and then usually help more than long stretches in bed. Exercise keeps your muscles healthy and strong. It helps your joints move and stay flexible. Exercise can help you sleep better, ease pain, stay positive and keep a healthy weight.

Doctors sometimes suggest gentle exercise, such as exercise in water. Talk to your health care providers before you start any exercise program.

Joint care. Some people find that wearing a splint for a short time on a painful joint eases pain and swelling. Splints are mostly worn on the wrists and hands. They can also be worn on the ankles and feet. Talk to your doctor or a physical or occupational therapist before you wear a splint. Other ways to protect your joints include:

• Self-help tools, such as items with large grips, zipper pullers and long shoehorns.
• Tools that help with daily tasks, such as special toothbrushes or forks and spoons.
• Devices that help you get on and off chairs, toilet seats and beds.
• Choosing activities that put less stress on your joints. For example, use the stairs less, or rest when you walk long distances.
• Keeping a healthy weight to take stress off your joints.

Watch your symptoms. Keep track of any changes or new symptoms. Knowing your symptoms and how they change can help you and your doctor manage pain during a flare.

Manage stress. RA can bring fear, anger and frustration. Pain, limits on what you can do and flares that come without warning can add to it. All of this can raise your stress. Stress can make living with RA harder. It may also make you feel more pain. Ways to cope with stress include:

• Taking regular rest breaks.
• Deep breathing, meditation, or listening to quiet sounds or music.
• Exercise programs such as yoga and tai chi.

Care for your mental health. Living with RA can be hard and lonely. If you feel alone, anxious or depressed, talk to your doctor, a social worker who supports people with RA, or a mental health professional. Keep talking. Tell your family and friends about your RA to help them understand it. You may find it helps to join a support group online or in your area.

Eat a healthy diet. A healthy diet with the right balance of calories, protein and calcium helps keep you well. Ask your doctor about drinking alcohol. It may not mix well with your RA medicines.

Talk to your doctor before you change your diet or activity.

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