What is RA?

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RA is an autoimmune disorder that causes joint inflammation which if left untreated can cause progressive and permanent joint damage and deformities. In this disease, body's immune system attacks the joints and make them inflamed. RA can not only affect the joints, but also other parts of the body as well such as lungs, skin, heart, eyes, salivary glands, rarely bone marrow, blood vessels, kidneys and nerves. There is no one particular cause of the disease, but rather a complex interaction between the genes and certain environmental factors. Women get RA more often than men. 

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What are the symptoms?

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Joint pain/stiffness/swelling-

• Usually both sides,

• Symmetric,

• Multiple joints,

• Predominantly small joints of fingers/wrists and feet

• Can progress to any other joints of the body except usually lower spine. ​

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Other symptoms can include shortness of breath, chronic cough, skin rash, skin lumps/nodules, tingling/numbness, redness and pain in the eyes, chest pain, dry eyes or mouth, depending on the organ system involved outside of the joints. 

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How is it diagnosed?

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Diagnosis is made based on history, physical exam and certain blood tests (such as rheumatoid factor, anti CCP antibodies, inflammation markers), Xray findings (such as bone erosions), MRI or Ultrasound findings. 

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How is it treated?

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Timely detection and early initiation of treatment are crucial for successful treatment of RA which can resolve pain, stiffness and swelling of the joints and halt the progression of joint damage.

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DMARDs (disease modifying anti-rheumatic drugs) are used to treat RA. These includes variety of the conventional oral DMARDs such as hydroxychloroquine, methotrexate etc as well as biologic DMARDs such as Humira, Enbrel, Orencia etc and JAK inhibitor medications such as Xeljanz.  Use of these medications depends on the extent and severity of RA, presence of other organ involvement, associated comorbidities, insurance coverage and certain other factors. 

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Besides medications, having a healthy lifestyle such as weight control, regular exercise and cessation of smoking also help. Even though there is limited evidence of effectiveness, using specific dietary restrictions and using certain herbal supplements may occasionally help reduce overall inflammation. Experiments also suggest that doing yoga, meditation and other stress relieving activities can also help.

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If you have RA, you really need a very good rheumatologist to be with you during the lifelong journey of beating this disease.