Today is Rheumatoid Arthritis (RA) Disease Awareness Day

"Today is RA awareness day, and about one percent of our population lives with this condition," said certified elder law Attorney RJ Connelly III. "To be even more specific, that's about 1.5 million people, and two to three times as many women than men develop RA, resulting in seventy percent of all RA patients being women." Rheumatoid disease, also known as rheumatoid arthritis, is an autoimmune condition in which the linings of the joints are viewed by the body as foreign tissue, and it attacks and causes damage, resulting in inflammation and pain.

RA Disease Awareness Day was created in 2013 by the Rheumatoid Patient Foundation (RPF) to help raise awareness of the disease and to combat the misconceptions that exist about RA.

Research, such as a study published in July 2020 in RDM Open, has shown that a lack of public education and awareness can lead to delays in seeking medical advice, which can result in inadequate treatment.

"Rheumatoid an autoimmune condition in which linings of the joints are viewed by the body as foreign tissue, and it attacks and causes damage, resulting in inflammation and pain."

"I had heard of rheumatoid arthritis and always considered it a condition of age and did not view it as an autoimmune disease until I met a young lady named Melanie," stated Attorney Connelly. "She and her husband had come in to establish an estate plan and we began to speak about this condition which led me to do a bit of research on it. Her story certainly captivated me."

Melanie was a social worker at a long-term care facility in Massachusetts. A graduate of the University of Massachusetts, she had always been interested in working with the elderly -- for an incredibly good reason. "I was my grandmother's pet, and when she was diagnosed with Parkinson's disease, I spent more time with her than anyone else in the family. Seeing what this disease did to her is what led me into the geriatric social work field," Melanie said.

RA - not primarily a disease of age

"Things were going along fine in my life until I hit the age of 31, then my life just seemed to fall apart," Melanie explained. "The pain and the debilitating nature of RA not only scared me, but I realized I was not really emotionally equipped to deal with the condition. I remember telling my husband that I was way too young to feel this old."

Melanie and her husband found one of the best rheumatologists on the South Shore, partly through discussions with the medical team at the long-term care facility. "Everyone there was extremely supportive and helped me do some shopping for a good provider," she said. "Luckily, it paid off as I am extremely thrilled with the provider I have."

Her primary care doctor and her RA specialist helped her come to terms with the disease and the restrictions she would experience. They prescribed medications that reduced the symptoms and allowed her to continue to work.

"Over time, her RA worsened, and she became disabled," said Attorney Connelly. "She tried a number of different drug therapies and ended up getting joint replacement surgery. Thankfully, that turned things around for her and she began feeling better and said she then knew there was a life she could live again."

Symptoms of RA Disease

The Mayo Clinic website lists the following symptoms to be aware of if you have concerns about RA. Signs and symptoms of rheumatoid arthritis may include:

  • Tender, warm, swollen joints

  • Joint stiffness that is usually worse in the mornings and after inactivity

  • Fatigue, fever, and loss of appetite

Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet. As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips, and shoulders. In most cases, symptoms occur in the same joints on both sides of your body. About 40% of people who have rheumatoid arthritis also experience signs and symptoms that don't involve the joints. Areas that may be affected include:

  • Skin

  • Eyes

  • Lungs

  • Heart

  • Kidneys

  • Salivary glands

  • Nerve tissue

  • Bone marrow

  • Blood vessels

Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity, called flares, alternate with periods of relative remission — when the swelling and pain fade or disappear. Over time, rheumatoid arthritis can cause joints to deform and shift out of place.

RA Disease Is Linked to Cardiovascular Disease

“I think the biggest myth about rheumatoid arthritis is that it is a type of arthritis and not an immune system disease,” says Kelly O’Neill Young, president of the RPF and author of Rheumatoid Arthritis Unmasked: 10 Dangers of Rheumatoid Disease. “It has more in common with multiple sclerosis and lupus. It’s not that similar to osteoarthritis.”

O'Neill Young notes that one study published in November 2018 in Arthritis Care & Research found that people with RA under age 45 had an almost threefold increased risk of cardiovascular disease death compared with the general population, in large part because of the high-grade, systemic inflammation that goes along with RA. Beyond the heart disease connection, it is well-established that rheumatic diseases increase the risks for developing a variety of other health conditions.

"The most common RA comorbidity is cardiovascular disease...including heart attack, stroke, congestive heart failure, peripheral vascular disease, and atherosclerosis."

The most common RA comorbidity is cardiovascular disease, but the condition is also associated with several specific cardiovascular issues, including heart attack, stroke, congestive heart failure, peripheral vascular disease, and atherosclerosis. Some research even suggests the heart risks associated with RA are comparable with those linked to diabetes.

“Patients with RA constantly ask us, ‘What else can I do to help control my disease, increase my energy, reduce my inflammation and pain, and help me be more functional?’ How diet may impact those issues is a part of that conversation. I think there’s a huge need for this kind of research,” he says.

RA Misconceptions

WebMD, a health information site on the internet, published these seven myths about Rheumatoid Arthritis.

Myth 1: Only older adults can get RA.

Adults and children alike can develop RA, says Max Konig, MD, a rheumatologist at Johns Hopkins University School of Medicine in Baltimore. He says this misconception might be floating around because kids are often diagnosed with a subtype of juvenile idiopathic arthritis (JIA) rather than RA. Kids with this type of JIA -- known as polyarticular arthritis, rheumatoid factor positive -- have a protein called rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP antibodies) that shows up in their blood, as do most people with RA.

RA becomes rarer as you get older, notes Nilanjana Bose, MD, a rheumatologist at Rheumatology Center of Houston. You’re more likely to have osteoarthritis than RA as you age, she says.

Most people are diagnosed with RA between their 30s and 50s, according to Konig. He says that problems in your immune system -- like RF and anti-CCP antibodies -- may show up over a decade before your symptoms start, indicating that RA can start much earlier than it’s diagnosed.

Myth 2: RA is the same as osteoarthritis.

Osteoarthritis and RA both affect your joints, but Konig says they’re different diseases with different treatment approaches. RA is an autoimmune disease, meaning your immune system sees normal proteins in your joints and other tissues as a threat and tries to destroy them, he explains. "It's kind of like your immune system is turning on your own body and causing a lot of inflammation,” Bose says. “As a result, you get joint pain and swelling, and you can also get other symptoms like weight loss, fever, and fatigue.”

"...your immune system is turning on your own body and causing a lot of inflammation. As a result, you get joint pain and swelling, and you can get other symptoms like weight loss, fever and fatigue." --- Dr. Nilanjana Bose

Because it’s a systemic disease -- meaning it affects your entire body -- RA can also involve things like your lungs and heart, says Bose. Lung disease is especially common in people who have RF or anti-CCP antibodies in their blood, known as seropositive rheumatoid arthritis, Konig says. He notes that RA can also affect your skin, eyes, and, in rare cases, blood vessels. “You really have to treat RA more aggressively because we’re not just talking about joints, we’re talking about your whole body,” Bose says.

RA disease nodules

In comparison, osteoarthritis is limited to your joints. It’s the wear-and-tear type of arthritis rather than an autoimmune disease because it doesn’t involve the immune system, Konig says. Bose explains that, unlike RA, osteoarthritis has no other symptoms beyond pain, swelling, stiffness, and tenderness.

Myth 3: There isn’t any treatment for RA, so you just have to live with it.

In the past, Konig says, people who ended up in the hospital with RA were treated with bed rest, cold compresses, massage, and leg elevation. This may have eased some of their symptoms, but it didn’t stop the disease from getting worse. Over time, this led to deformed joints and exhausting pain.

Thankfully, this is no longer true. “Over the past 40 years, the treatment of rheumatoid arthritis has changed dramatically,” Konig says. “We now have a plethora of highly effective therapies that can not only reduce or eliminate pain, but also quench joint inflammation and prevent the development of structural bone damage, joint deformity, and disability. "Not only are there many treatment options for RA flares, but there are plenty to help manage the disease, explains Bose. Your rheumatologist will help you find the best treatment for your needs.

Myth 4: You shouldn’t exercise when you have RA.

This one may seem believable because you don’t want to put more wear on your joints. But the only time it may be true is if you’re having a flare-up when you should scale back your activity. “We don’t want to stress out the joints, so we don’t recommend vigorous exercise at that time,” Bose says. Otherwise, exercise is an important part of managing RA. It can lessen fatigue and depression, make you stronger and more flexible, and even help prevent disability.

"Exercise is an important part of managing RA. It can lessen fatigue and depression, make you stronger and more flexible, and even prevent disability."

One big reason exercise is crucial is that when you have RA, you have a higher risk of heart disease, notes Konig. Getting regular exercise can lower your risk. The American Heart Association recommends a minimum of 150 minutes of moderate-intensity or 75 minutes of high-intensity aerobic activity every week.

Make sure you’re doing the right kind of exercise so you’re not too hard on your joints, Bose says, especially if your hips or knees are affected. She recommends low-impact aerobic exercises like swimming, light walking, or using an elliptical machine or stationary bike. Your rheumatologist or physical therapist can help you design an exercise plan that works for you.

Myth 5: You’re definitely going to have joint damage if you have RA.

There are so many effective treatments, especially when RA is diagnosed and treated early, that joint damage can often be prevented, Bose says. That’s why it’s so important to act as early as possible. “The goal is to get the disease into remission quickly since considerable damage can occur early in the disease course,” says Konig.

Everyone’s RA works differently, says Konig, due to things like their environment, their genes, and how the disease shows up. Some people have aggressive RA, and even with treatment, they can have joint damage and deformity. But this is a minority of patients, Bose says.

"There are so many effective treatments, especially when RA is diagnosed and treated early, that joint damage can be prevented." --- Dr. Nilanjana Bose

Myth 6: It doesn’t help RA to make lifestyle changes.

Beyond exercise, other lifestyle changes can make a significant impact, such as ditching cigarettes. “We know that cigarette smoking is a significant risk factor for the development of RA, and smokers tend to have more severe disease,” Konig says. Quitting can improve RA as well as your risk for heart disease.

Eating a healthy diet, exercising regularly, sleeping well, managing stress, and adding mind-body relaxation techniques are all key to helping control pain, fatigue, and inflammation and managing RA, says Bose. People with RA are at a higher risk of certain types of cancer because of chronic inflammation. Lifestyle changes can also help lower this risk, Bose says.

Myth 7: Once you feel better, you can stop taking your medication.

“The reason you’re feeling better is that you’re on the medicine, so when you stop it, your disease will come back,” Bose explains. RA is a chronic condition. Some people go into remission, but for most, “the disease stays at a baseline, smoldering level with effective treatment,” she says.

Your rheumatologist wants to give you as little medication as possible. If your disease has been in remission for a long time, they’ll try to slowly reduce or stop your treatment, says Konig. This process helps some people pinpoint the minimum amount of medication they need to control their RA. Others can stop treatment altogether, at least for a time, he says. It’s important to note that you should never stop your medication without talking to your doctor first. For one thing, these drugs work by weakening your immune system from its unusual response, explains Konig. If you stop taking them suddenly, there’s a substantial risk that your immune system will decide to act up again.

Sometimes, people stop taking their medicine because they’re having side effects or don’t like how it makes them feel, notes Bose. If this is the case for you, it’s important to let your rheumatologist know that you’re having trouble rather than changing or stopping it on your own, she advises. If your next appointment is some time away, try sending a message through your online patient portal, or call your rheumatologist’s nurse for guidance.

"I think it's important that those with RA disease never give up hope," said Attorney Connelly. "Those who we have spoken to find ways to get through this disease, which means staying in control of managing your health on multiple levels, including diet and exercise. Thanks to modern treatments, it's now possible for RA patients to have excellent outcomes."

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