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Expert Answers to Top Questions About Rheumatoid Arthritis

What causes RA? How is RA diagnosed? What about RA treatment? These questions and more
WebMD Magazine - Feature

Whether you have just been diagnosed with rheumatoid arthritis (RA) or have been living with this autoimmune disease for years, you no doubt have many questions and concerns. To help you get up to speed on the best ways to manage your RA today and for years to come, we took your top questions to rheumatologist Linda A. Russell, MD, an assistant professor of medicine at Weill Medical College of Cornell University and an assistant attending physician at the Hospital for Special Surgery in New York City.

What causes RA?

The precise cause of RA is not yet known. Some research suggests that genes play a role. Other potential culprits include environmental factors such as smoking, and also hormones, since women are two to three times more likely to develop RA than men. Scientists have long suspected infectious agents such as viruses and bacteria may play a role. Either a single factor or a combination prompts the immune system to misfire, attacking its own joints and resulting in pain and inflammation.

How is RA diagnosed today?

We take a thorough history, perform a physical exam, and then evaluate blood work and X-rays. Currently two acceptable blood tests help us make an RA diagnosis. We test for the presence of rheumatoid factor [RF] and anti-CCP [anti-cyclic citrullinated peptide antibody]. [But] these blood tests are not definitive. Anywhere from 10% to 30% of people with RA can be RF-negative or anti-CCP-negative.

When should I start seeing the effects of my new medication?

If you don’t start feeling better within three months, there is probably reason to change or tweak your medication regimen. Feeling better means having more energy, less morning stiffness, less joint pain, and less swelling.

When should I get a second opinion about my treatment?

Get one if you feel that your RA is active and your current doctor doesn’t have anything else to offer or if you are concerned about the side effects of your current medication regimen.

Is there a cure for RA?

Not yet—but many effective medications can control inflammation and help prevent lasting joint damage. In the last 10 years, we have seen a whole new class of drugs called biologics, which exert a greater control over inflammation and have changed the course of RA. These drugs mimic the effects of substances naturally made by the body’s own immune system. The biologics target very specific inflammatory proteins called cytokines such as tumor necrosis factor-alpha. Even with no cure, 10% of people with RA will go into complete remission and be able to stop all of their medications indefinitely.

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