Your primary care physician has referred you to a rheumatologist, a specialist in diseases of the joints, because you’ve been experiencing several months of pain, swelling and tenderness in your hands, wrists and feet, accompanied by morning stiffness that lasts for an hour or more. You also have less energy than usual and seem to tire easily.
After conducting a physical examination and ordering a blood test and X-rays, the rheumatologist gives you a diagnosis: You have rheumatoid arthritis.
Although you’re not exactly sure what RA is, you’ve certainly heard of arthritis and know that folks who have it complain of pain and stiffness in their joints. But you are probably thinking of osteoarthritis, not RA.
According to the Centers for Disease Control and Prevention, OA is clearly the more common form of arthritis, afflicting 30 million people in the U.S. It usually does not occur until after age 40 and becomes increasingly common with advancing age. It is more prevalent in women than men, especially after age 50.
Osteoarthritis is largely caused by mechanical wear and tear on the joints that accumulates with age. It can be triggered by strenuous sports, injury, overuse, obesity and genetics. Osteoarthritis occurs most often in the weight-bearing joints of the knees, hips and spine, but it is also seen in the fingers, thumbs and neck.
Like OA, RA also causes joint degeneration, with resulting pain and stiffness, and is more common in women than men. However, RA is much less common than OA, affecting about 1.5 million people in the U.S. But less common doesn’t mean less threatening. In fact, RA is a much more immediate and grave threat to health than OA.
“It’s an incredibly serious disease,” says Dr. John J. Cush, a rheumatologist and the director of clinical rheumatology for the Baylor Research Institute in Dallas.
Rheumatoid arthritis is an autoimmune disorder in which the body’s immune system turns on itself and creates antibodies to its own cells. These antibodies produce inflammation that attacks the joints and other tissues throughout the body.
According to the Mayo Clinic, joint destruction takes place when the immune system attacks the synovium, the lining of membranes that surround the joints. Inflammation thickens the synovium, and that can eventually destroy the cartilage and bone within the joint. Over time, the tendons and ligaments in the joint weaken and stretch, causing the joint to lose shape and even its alignment.
The symptoms most commonly appear between the ages of 40 and 60, though they can begin at any age. They include painful, tender, swollen joints, usually of the hands, wrists, elbows, feet and knees. The joints often feel warm to the touch. Both sides of the body are typically affected, in contrast to OA, which often occurs on only one side.
Because RA causes system-wide inflammation, people with the disease also often complain of increased fatigue and decreased stamina, general malaise, fever, weight loss and even “brain fog.”
Over time, the inflammation can progress to affect the heart, lungs, eyes and blood vessels. Ultimately, RA can cause devastating joint deformities, disability and even premature death.
Early, aggressive treatment is the best defense against the debilitating, progressive effects of RA, so it’s imperative to find a rheumatologist who will tackle the disease head-on, according to Cush.
“Run, don’t walk, from the doctor who tells you it’s only arthritis and there’s nothing he or she can do for you,” he warns.
The main treatment for RA is with the use of several classes of powerful drugs that are designed to alter the disordered immune response in various ways.
All of these drugs are powerful medications that can have serious side effects, and you may be so frightened of them that you’re tempted to try other, less-traditional remedies instead, such as magnets, vitamin supplements and progressive muscle relaxation exercises.
But if you refuse or delay traditional treatment, you do so at your own peril, Cush says.