One morning in 1972, Bill Mulvihill woke up to severe pain and stiffness in his elbow.
“It was locked in a right angle. I couldn’t unlock it. And I never fully did again,” says Mulvihill, now 68 and living in Cincinnati.
Back then, Mulvihill thought he’d injured his elbow playing basketball. When his doctor told him that he had rheumatoid arthritis (RA), he thought, ‘That can’t be right. Only old people get arthritis!’”
But that’s not true. Nor is it true that the disease only affects women, though they are more likely to get it than men.
Too Tough for Treatment?
Men are more likely to get RA in middle age than in their golden years.
If it happens to you, you might be tempted to tough out the pain, but don’t delay seeing a doctor about it. It’s important to get a diagnosis and start treatment right away, says James O’Dell, MD, chief of rheumatology at the University of Nebraska Medical Center in Omaha.
It may be slightly harder to diagnose RA in men as it often first strikes the small joints of your hand, like the top finger joints or knuckles, or the toes. “In men with large, muscular, or bony hands, it may be harder to find swelling in those joints,” O’Dell says.
Men are less open to talking about their pain, says Tiffany Taft, PsyD, a psychologist at Oak Park Behavioral Medicine in Illinois.
Men and women are different when it comes to being open about an illness, Taft says. Men “are more likely to be stoic and reserved with their emotions. All of these influences can make a man feel ashamed to seek help, especially if he is struggling emotionally with an RA diagnosis.”
What Causes It?
Certain genes put you at risk for getting RA, O’Dell says. Years later, something like smoking or an infection triggers the disease.
“Men with RA may have more of a genetic burden. It takes more to tip a man toward rheumatoid arthritis than a woman, but men may have more of the bad genes,” O’Dell says.
RA affects your immune system. It attacks joints and organs, including the heart, lungs, or eyes. It causes your body to attack its own tissues instead of fighting disease like it should.
Because men get RA less often than women, they seldom take part in studies, so we don’t have a lot of data to show if the disease affects them differently, O’Dell says.
Start Treatment ASAP
Get to a doctor as soon as you notice symptoms, like warm, swollen joints or stiffness in the morning. This way you can rule out other causes, like an injury, O’Dell says. Early and aggressive treatment with drugs can stop inflammation and may protect your joints from damage.
In the 1970s, doctors treated RA cautiously with nonsteroidal anti-inflammatory drugs (NSAIDs) to ease pain and swelling, Mulvihill says.
“I started on four aspirin a day, and eventually up to 28 a day. As a result, I got stomach ulcers,” he says.
Doctors waited until the RA got very bad before prescribing stronger drugs like cortisone shots, Mulvihill says. “I got one particular shot in my baby toe that was so painful, I said, ‘Never again!’”
He’s also had surgery to reconstruct damaged joints in his foot. As a result, he went from a size 11 1/2 shoe to an 8, he says.
Treatment Side Effects
Doctors still use NSAIDs to treat RA symptoms, but they also have more effective drugs that stop the disease itself. They call these disease-modifying antirheumatic drugs, or DMARDs. But you need to be aware of the side effects and risks, O’Dell says.
“Men need to be concerned about conceiving a child while taking these medicines,” he says. Methotrexate, often prescribed as the first RA treatment, may cause birth defects due to DNA changes to your sperm.
Sulfasalazine, another RA drug, can lower sperm count and make it hard for you to conceive, O’Dell adds.
Talk to your doctor if you plan to father a child. You’ll need to stop using methotrexate for 3 months before you try to conceive, O’Dell says. You can switch to other drugs to help control your RA during this time, and if your sperm count is low, you can change medicines.
“It’s entirely possible or even likely that men don’t get the same amount of counseling about these risks as women do, because some doctors may not think about it,” O’Dell says. “You should talk to your doctor before you try to conceive a child, and you want to be careful.”
Don’t keep your feelings about RA bottled up, Taft says. You can try to talk about them in support groups or counseling.
“Self-esteem is often affected by an illness. But the good news is that decreases in self-esteem can be reversed with good support and treatment,” she says.
Mulvihill got involved in the Arthritis Foundation in Ohio, where he met other men with RA. Regular swimming and elliptical training helps him control symptoms and keeps his mood bright, he says.
“If I don’t exercise, the muscles around my joints can atrophy, and that’s no good,” he says. “Working out is a mental thing, too. I believe in the power of positive thinking. Exercise releases natural endorphins, like natural cortisone.”
In 1972, the outlook for men with RA was somewhat bleak, Mulvihill says.
But the prognosis now is very good, “as long as you’re diagnosed and treated early,” O’Dell says. To help you fight your disease, he suggests you stay at a healthy weight, don’t smoke, and get regular exercise.