Your grandmother’s rheumatoid arthritis (RA) does not have to be yours. Sheila Arvikar, MD, a rheumatologist at Massachusetts General Hospital, says the outlook for newly diagnosed patients is better than it was for their older relatives.
“Some people’s images of RA are of a person with a really debilitating disease in a wheelchair with deformed hands,” Dr. Arvikar says. “But those older patients did not have the benefit of today’s medicines.”
RA, the most common autoimmune form of arthritis, affects 1.3 million people in the United States. It causes inflammation in the body as well as joint swelling and pain. There is no cure. And its cause is unknown, although research is revealing clues.
Dr. Arvikar says the good news is that RA can now be well managed with medication and lifestyle choices.
Rheumatoid Arthritis Diagnosis
RA differs from osteoarthritis, the form of arthritis in which joints degenerate from the wear and tear of living.
Women are two-to-three times more likely to develop RA than men.
In RA, the immune system attacks the joints, resulting in inflammation. Typically, patients notice stiffness and swelling in their hands and feet. But the inflammation can also raise patients’ risk of heart disease and affect the lungs, eyes, skin and voice box. Although patients can be diagnosed at any age, diagnoses peak during middle age and in the elderly. Women are two-to-three times more likely to develop RA than men.
Today, blood antibody tests can identify the disease in about 70 percent of rheumatoid arthritis patients. MRIs and ultrasounds can detect joint inflammation in patients who lack positive blood tests.
Most patients begin treatment with conventional oral disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate. DMARDs are anti-inflammatory medications which slow the progression of RA.
There are also biologic DMARDs, most of which are injection medications. One DMARD pill is also available. These drugs can be expensive and have more insurance restrictions, but they work extremely well for many patients.
Rheumatoid Arthritis Research
Investigators suspect microorganisms in the mouth, gut and lungs play a role.
Research aims to find causes of RA and ways to better manage or prevent it. Genes are linked to RA, but explain only a minority of the risk of developing the disease. The environmental factors which trigger RA are not well understood. However, investigators suspect microorganisms in the mouth, gut and lungs play a role.
For one study, Dr. Arvikar and her colleagues in the laboratory of Allen Steere, MD, are collaborating with dentists at The Forsyth Institute in Cambridge, Mass. They would like to learn whether gum disease or oral microbes can cause rheumatoid arthritis and whether treating gum disease will improve patients’ RA.
The Mass General researchers are also studying how bacteria that live in the human gut can affect the chances of developing RA or influence its severity.
In addition to genes and infections, other factors can play a role in triggering and worsening RA.
- Smoking: According to the U.S. Surgeon General, smoking can compromise the immune system and toxins in smoke may trigger inflammatory problems like RA. Dr. Arvikar advises patients to stop smoking as soon as possible because quitting improves the effectiveness of RA treatments.
- Obesity: Losing weight can reduce the pressure on aching joints and decrease the burden of inflammation in the body.
- Alcohol: Modest alcohol consumption of one-to-two drinks a day may be protective against development of RA, Dr. Arvikar says. But drinking more could increase the risk, she says. And heavy consumption limits the choice of medications for treatment.
- Exercise: Exercise and physical therapy can help patients feel better and maintain mobility. Low-impact aerobic exercise activities that are easy on joints include biking, elliptical machines and swimming. But it is best to get inflammation in joints under control first to avoid aggravating them.
- Diet: Doctors suspect an anti-inflammatory diet, like the Mediterranean diet, can help. These diets emphasize fruits, vegetables, fish and whole grains and replacing unhealthy fats like butter with olive oil.
- Supplements: Supplements such as folic acid and vitamin D are important in preventing complications. Fish oil and the spices turmeric and curcumin may also help.
The most important thing patients can do is to take their medication as prescribed and see their rheumatologist for monitoring of side effects.
Dr. Arvikar says most RA patients live full lives, working and doing activities they enjoy. “I have a number of patients who say they forget they have RA,” Dr. Arvikar says. “That’s achievable for many people today.”
To support the patient care and research of Dr. Arvikar and her colleagues, please contact us.