About 1.5 million people in the United States have rheumatoid arthritis, known as RA, according to the Arthritis Foundation.
Nearly three times as many women have the disease as men. In women, RA most commonly begins between ages 30 and 60. In men, it often occurs later in life.
Glenna Allbritton, an advanced registered nurse practitioner at Mount Baker Rheumatology in Bellingham recently gave insights into this issue:
Question: What is RA?
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Answer: Rheumatoid arthritis is a chronic, systemic (all throughout the body) inflammatory disease characterized by painful, swollen joints and, in advanced cases, deformities. In essence, the immune system that normally protects the body from infection acts inappropriately to start attacking healthy joints.
This inflammation causes thickening of bones, cartilage and ligaments leading to joint damage, deformities and, in severe cases, disability.
Children and adults can be affected by RA. Despite extensive research, the cause of RA remains unknown. Genetic and environmental factors can contribute to RA, and in some cases, patients with family history of autoimmune disease can be more likely to develop RA.
Rheumatoid arthritis generally affects joints in the front of the body, such as hands, wrists, knees, feet, ankles, shoulders and elbows. Rarely RA can affect the neck, so a thorough workup is required.
Rheumatoid arthritis can be diagnosed by patient history, family medical history, physical exam, by labs consistent with RA, including rheumatoid factor, cyclic citrillunated peptide, sedimentation rate and c-reactive protein. Approximately 20 percent of patients can have RA and have a negative RF and CCP. Those with a positive RF generally have more aggressive disease.
Q: How does it affect the body?
A: General symptoms of undiagnosed RA could include indicators such as fevers, fatigue, weight loss, eye inflammation, eye/mouth dryness (Sjogrens syndrome), lung involvement (interstitial lung disease or “rheumatoid lung”), cardiovascular disease, vasculitis (inflammation of blood vessels) and anemia.
Increased mortality with RA is related to cardiovascular disease, infections, cancers and malignancies, renal and gastric disease. Excess mortality has not changed in four decades, although the population’s lifespan has increased.
Q: Who does it affect?
A: Rheumatoid arthritis affects all ages and races, however women are three times more likely than men to have RA. Approximately one percent of adults in the U.S. have RA, and the prevalence increases with age.
Childhood RA is generally referred to as juvenile idiopathic arthritis or JIA. Juvenile RA patients are generally treated at Seattle Children’s Hospital by a pediatric rheumatologist until they reach age 18.
Q: How is it diagnosed?
A: Diagnostic criteria for RA include morning stiffness in and around joints, soft tissue swelling of joints on both sides of the body (symmetrical) and X-ray evidence of joint erosions and destruction.
Q: How is it treated?
A: Rheumatoid arthritis is initially managed with non-steroidal anti-inflammatory drugs (NSAIDS), such as Ibuprofen, Aleve, Advil and Motrin or oral steroids (Prednisone) then disease modifying drugs, such as Methotrexate.
Since the late 1990s, a new class of drug called biologics have had a significant effect on RA disease management and in some cases remission. Physical therapy, occupational therapy, rest, an anti-inflammatory diet and patient education also are effective RA treatments.
Although many patients may want to try a “natural” approach to RA with herbal supplements, the risk for disease progression (even with no symptoms) is so high that earlier rheumatology intervention is strongly suggested.
In general, early diagnosis and treatment can in most cases prevent deformities and disability and in some cases cause the disease to go into remission.
Q: Are treatments improving?
A: The biologic class of medications has greatly improved survival by interfering with an aberrant immune system that causes joint damage, swelling and destruction. These include many self-injectable medications and IV medications, including Enbrel, Humira, Remicade and many others that are recently added to the biologic modalities.
A newer biologic option is Xeljanz, which is in pill form, as opposed to self-injections or intravenous therapies.
With any of these biologics, there is an increased risk for infection, so patients are carefully monitored in the clinic or at home. Communication is the key to better disease management and decreased risks of potential side effects.
Q: Where can I go in Bellingham for RA?
A: Patients with RA can be referred by their primary care physician to a Bellingham rheumatologist. Depending on disease severity, those referrals may take from two weeks to five months, but the primary care physician can request an expedited referral by directly contacting the local rheumatologist. A primary care physician or internal medication provider can often initiate a diagnostic lab and X-rays to speed up the referral process.
Q: Does RA reduce a person’s longevity?
A: Rheumatoid arthritis can lower long-term survival due to inflammation that affects the entire body including the heart, lungs and kidneys. This type of inflammation can place patients at risk for cardiovascular or lung disease.
Approximately 50 percent of patients will be disabled from RA within 10 years of disease onset, and most will leave the workforce within five years of onset of the disease.