What is Rheumatoid Arthritis?

In Rheumatoid Arthritis, the immune system affects the tissue lining of the joints (or synovial membrane), causing varying levels of inflammation, pain, swelling and stiffness.

Rheumatoid Arthritis (RA) is a chronic disease marked by inflammation of joints. Patients complain about pain in joints. Most often RA affects both sides of the body at the same time and more commonly, the joints of the hands and feet. The shoulders, knees and spine can also be affected.

Rheumatoid Arthritis is also classed as a systemic disease that can affect the whole body (including the blood vessels, heart, respiratory system, nerves and eyes). When affected for a long period of time, without proper management, the synovial membrane of the joints becomes thick and inflamed, resulting in unwanted tissue growth. In more advanced cases this can cause bone erosion and irreversible joint damage, leading to physical limitations and varying levels of disability.

The cause of RA is currently unknown however genetics, family history, smoking and obesity have been identified as potential contributing factors.

What are the symptoms?

The most common symptoms of RA include:

• joint pain and swelling
• stiffness (morning stiffness lasting more than 30 minutes, unexplained or unreasonable levels)
• tiredness/ fatigue, depression, irritability
• anaemia
• flu-like symptoms, such as feeling generally ill, feeling hot and sweating.

Less common symptoms include:

• weight loss
• inflammation in the eyes dry eyes
• fleshy lumps below the elbows or on hands and feet (rheumatoid nodules)

Symptoms of RA often vary between individuals, start slowly and can come and go. Most often it is the small joints of the hands and feet that become achy and swollen first. You may also feel unexplained levels of stiffness in the mornings.

If you suspect that you have RA, you should consult with your doctor ASAP to discuss your symptoms, organise relevant tests and guide your management.

How is it diagnosed?

Due to the complexity of symptoms people experience, the subtlety, and the gradual nature of rheumatoid conditions, establishing a diagnosis and managing the condition can be a difficult process for both you and your health professional team. After discussing your symptoms with your doctor, you will likely get blood tests and X-rays to investigate the potential causes for your symptoms. You may also be referred to a Rheumatologist.

Blood tests

Blood test you may get will look at the short and long term inflammatory markers in your body that can indicate whether or not you have an inflammatory process happening in your body.

Creatine Reactive Protein (CRp) is used to assess the presence of inflammation in the body, to determine its severity, and to monitor response to treatment.  It can be used to monitor acute or short term levels of inflammation in the body.

Erythrocyte Sedimentation Rate (ESR) is used to assess the amount of inflammation in the body.  It is sometimes seen as a long term indicator of the level of inflammation in the body.

Rheumatoid Factor (RF) is an antibody found in the blood that attacks healthy tissue and leads to joint inflammation.  RF is found in approximately 80% of rheumatoid arthritis patients and so its presence may potentially result in the development of rheumatoid arthritis symptoms. Many people contain the rheumatoid factor antibody in their blood but have different autoimmune or inflammatory conditions, therefore having raised RF in a test does not mean you have RA.

Anti Cyclic Citrullinated Peptide (ACCP) is an antibody that can lead to inflammatory symptoms that cause rheumatoid arthritis.  ANA can be found in a person’s blood for 5 to 10 years before any symptoms arise and is present in between 60% and 80% of rheumatoid arthritis patients.

X-rays, CT Scans or MRI scans

X-rays, CT Scans or MRI scans may be used to look at the condition of your joints to see if there are any signs of inflammation and joint damage.

Depending on the results of your investigations, your doctor should discuss with you whether or not you need to take medication, see a Rheumatology specialist or both.

What can I do about it (5 tips)?

Be Patient

One of the most important aspects of living with RA is to remain patient.  Getting a diagnosis and finding the most effective management plan for your RA symptoms takes time.  It can often take weeks and months before conditions are clarified, treatments started and symptoms are settled. Having patience during the process, and with your body as it adjusts to the condition, and any medications you may be prescribed, will make living with RA much easier and less stressful.

Having patience with your doctors as they try to understand and settle your symptoms, being patient with any medications while they try to work, and being patient with yourself as you adjust to your diagnosis, will all have a more positive and healthy effect on your life with RA.  

Adjusting physically, mentally, and socially to having the condition can also be a challenge and will take time and effort too. Remaining patient during your journey will have many positive effects on your life with RA.

Be Consistent

By maintaining a consistent healthy balance in your life while your condition stabilizes, will make life much easier and less stressful on you. Whether it is at the initial stages or during flare ups of RA, being consistent with your activity levels, diet and lifestyle choices will help you monitor and manage your symptoms more effectively. 

Taking on major physical challenges (physical work commitments, fitness challenges, being more physical within family life) or psychological challenges (new roles at work, family challenges, increased stresses) while trying to get your symptoms under control, can make the process of getting symptom relief more challenging and less effective. By ignoring the signs of symptoms of RA and trying to push through them, you may make the process of getting symptom relief longer and harder for you and your medical team.

Applying techniques such as pacing/activity diaries, mindfulness, self awareness, or speaking to a health professional, can help make you more aware of the impact your lifestyle is having on your RA and provide strategies to help you.

Be Active With Your Condition

When diagnosed with RA it is important to be proactive and fully involved in the management of your condition. This means both physically pro-active and mentally pro active. Having RA does not condemn you to inactivity.

Many famous people like Lady Gaga (Pop star and actor), Michael Slater (ex-Australian cricketer), Seal (Singer), Salena Gomez (popstar and actor) and Jack Bird (rugby league player) have rheumatoid conditions that are managed well enough to maintain very active lifestyles.

Physically Proactive – While it is understandable and common to feel that doing very little helps your pain, protect your joints and helps your condition. Over time, inactivity and disuse will have a detrimental effect on your physical and mental wellbeing. Maintaining good joint mobility and muscle condition through exercise and activity will maintain your joint, and heart health for longer, and will have many more health benefits over inactivity.

There are times when you may have to reduce the intensity at which you do your activities to a level that does not aggravate your symptoms. BUT keeping the joints moving through their range of movement, and maintaining good muscle condition (cardiac and body muscle) is essential for your health.

Being Mentally pro active – Structuring your days, having goals and being objective towards the management of your RA will provide you with good foundations from which to measure, monitor and manage your condition effectively. Applying practices such as training diaries, pain diaries, recording blood tests and monitoring your successes and failures will help you plan your life around your condition effectively. Also, in doing this you can help your Doctors or health professionals identify changes in your condition and implement effective management plans much more effectively.

Be Objective

The journey that you are going through with your condition, is exactly that. A journey.  It has many highs and lows, during which, your pain, symptoms and emotions can vary greatly making the journey unclear at times. Being objective throughout your journey by through the use of objective measures (pain scores, blood markers, quality of life measures) and goal setting (short term, long term, health related, mental, social goals), can provide you, and your health team, with a clear impression of your condition from which to monitor, manage and control your condition more effectively.

Be Smart

When diagnosed with a rheumatoid condition it is important to educate yourself on your condition and how it is affecting your life. 

Obtaining information from respected sources and organisations devoted to rheumatoid conditions is a great starting and reference point.

By understanding exactly what your condition is, what your medications are and how your condition can affect your body, you will be able to make informed decisions about your health. Having good information can help you plan and discuss the most appropriate course of action and management strategy for your symptoms. This will ideally result in the reduction of any pain or difficulties you experience due to your RA.

Many organisations and charities offer education and self management courses for people with RA. These can help you build skills and confidence in managing your health and rheumatoid arthritis. These courses often cover issues such as medication, exercise, managing day to day with RA and accessing further resources that may be relevant.

What can other people do to help me?

The management of RA can vary between individuals, however, early diagnosis and appropriate treatment are essential to relieve symptoms, reduce joint damage and help you continue to lead a normal life.

Doctors

Initially, the most important thing you can do is discuss your symptoms and diagnosis with your doctor. They may prescribe medications that can help your symptoms immediately, order tests to confirm your diagnosis and refer you to a specialist (Rheumatologist).

Finding the right doctor for you is very important. For the long term outlook It is important to find a Doctor you feel is approachable and effective. You may have to call upon them at various times of your life, therefore having a positive relationship with them, and confidence in their management of you is important.

The most common medications your doctor will manage are 

• Painkillers/ analgesics
• Anti-inflammatories
• DMARDS
• Biologics

Specialists / Consultant Rheumatologists

Once diagnosed with RA your doctor may refer you to a Specialist Rheumatologist to oversee your condition. Specialists are Doctors who have dedicated their professional lives to managing rheumatology conditions and have years of invaluable clinical experience in diagnosing and managing Rheumatoid conditions. They also have specialised medication prescribing rights and qualifications to help manage your condition.

The main roles of the specialist are to use their knowledge in conjunction with your GP and regular tests, to get your symptoms under control, and then monitor your condition over a longer period of time.

Rheumatology specialists appointments are often in high demand and can often be shorter than patients expect. However, rest assured your Rheumatologist understands your condition, understands what you are going through and is working hard to find the most effective management strategy for your symptoms. Due to the complex nature of Rheumatoid conditions and the effect they can have on the various systems of the body, finding the right medication and management can take time.

Depending on your symptoms, blood tests and medical history, the medications commonly prescribed by specialists in relation to RA are one, or a combination of the following medication groups:

• Painkillers / analgesics
• Anti-inflammatories
• Corticosteroids medications or injections
• DMARDS (Disease modifying anti rheumatic drugs)
• Biologic DMARDS (made from living protiens and may prescribed by Rheumatologists in certain clinical circumstances)

While the thought of taking any of these medications can be both daunting and unpleasant, the medications prescribed by your GP or Specialist will have the most evidence base and research backing their effectiveness.

Therapists

Based on the symptoms and issues you may be experiencing, your Specialist or GP may refer you to a variety of health professionals to help manage your condition.  

Physiotherapists, Occupational Therapists, dietitians and Podiatrists are the most common health professionals used to help people with RA, and each have their own individual areas of expertise 

When choosing which therapist to see it is beneficial to discuss your plan with your GP, research the therapist you intend to see, and ensure the therapist applies some sort of evidence based practice to the treatments they are providing you.

Many people do try alternative approaches to help their RA and its symptoms, with mixed effect. Some of these we have discussed within this website.

However, no matter what approach or therapist you see, it is a good idea to discuss your approach with your GP, Rheumatologist or relevant health professional. More importantly, please ensure you feel better after seeing them and have a clear plan on how your progress will be monitored.

Family, Friends and Support Networks

The most important members of your RA team are your family, friends or support network.  Talking and sharing in your highs and lows is very important in maintaining good physical, mental and spiritual health. Attending events, remaining active and living your life can be a challenge at times for all of us, however, for people with RA, the symptoms and systemic effect of the condition can impact their life significantly if poorly managed.

Participating in physical activity with others can provide you with an opportunity to you’re your joints and body healthy while sharing positive experiences with others. Activities such as walking, hydrotherapy, Tai chi, pilates or mindfulness sessions are all low impact activities that can be enjoyed at all stages of RA.

LINKS