Rheumatoid arthritis (RA) is a chronic inflammatory condition. It’s an autoimmune disorder, meaning your body attacks its own tissues. It especially affects the lining of your joints. RA can first appear at any age, though it is most common in your 40s, 50s, or 60s.
Because it is a progressive condition, meaning it causes more damage to your body over time, it’s important to get treatment for RA right away. Alireza Meysami, MD, is the division head of rheumatology at the Henry Ford Health System in Detroit. “When the whole thing starts, the train has left the station,” he says. “The sooner we can treat these patients, the better we can control the symptoms and the progression of the disease.”
There is no cure for RA, but there are ways to slow it down.
Watch for Increasing Symptoms
The RA hallmarks, Meysami says, are a combination of low energy, prolonged stiffness in the morning, joint pain, and swelling. This can range from mild to severe, depending on the person.
When you first start getting RA symptoms, they tend to be in the joints of your fingers and toes, especially where they connect to your hands or feet. As time goes on, pain and swelling often spreads to your wrists, knees, ankles, elbows, hips, shoulders, neck, or back.
The inflammation makes some people feel extremely tired or fatigued. “The body is in war,” Meysami says. “The inflammation uses up all their energy.”
In addition to your joints, some people also start having pain or problems with other areas. If you start getting more frequent eye infections, for example, this could actually be inflammation.
You might also see issues arise with your:
- Salivary glands
- Nerve tissue
- Bone marrow
- Blood vessels
- Chest muscles
If your RA is more advanced, you may feel pain from damage that was already done before you started treatment. This can make it hard to distinguish new pain from old. “The damage to that bone could have been done 20 years ago,” Meysami says. “When that happens, it’s going to always be painful” without the right pain management.
See a rheumatologist to help you track your inflammation and stop it from getting worse. “For people who have rheumatoid arthritis, it’s really important for them to learn their specific patterns and to listen to their bodies,” says Amanda Sammut, MD, the chief of rheumatology at Harlem Hospital Center in New York City. “The earlier the symptoms are addressed, the better [the outcome].”
Learn to Recognize Flare-Ups
People with RA often alternate between bouts of increased disease activity, called flares, and periods when their pain and swelling goes down or even disappears, called remission.
During a flare, your regular medications may not seem to be working and you may feel worn out, sensitive, or just plain crummy. Flares may be triggered by many things, including:
- Infection or illness
- Cigarette smoking
- Physical or emotional stress
- Medication changes
- Poor sleep
- Certain foods
Flare-ups can be disruptive. By staying in tune with your body and keeping an eye out for possible triggers, you can recognize a flare as quickly as possible. “Patients usually remember the first time they [felt] the disease,” Meysami says. “The flare-ups usually resemble the first attack.”
This might include feeling more tired. You may feel that familiar joint pain or stiffness, most commonly in your hands or feet. “[Some patients] wake up in the morning, put their foot down, and feel like they’re walking on glass,” Meysami says.
Some people notice swelling or weakness in their joints, he says. “Look at how strongly you can hold your coffee mug. If you can’t hold it tight, that could be a sign that your joints are swollen and inflamed.”
Unfortunately, Sammut says, predicting flares is not easy. “With rheumatoid arthritis, every patient has their own disease,” she says. “It’s just so variable how people will present with flares.” For an individual person, however, your pain often looks similar from one flare to the next.
When you feel joint pain and inflammation from RA, it tells you that there is damage actively being done to your body. Once you feel a flare coming on, see your rheumatologist to stop further damage as soon as possible.
Tune In to Your Pain
Pain can come from other sources, too. Many people with RA have other conditions that can also cause chronic pain, like osteoarthritis or fibromyalgia. It can be hard to know what your baseline is when you aren’t used to being pain-free. You could also have inflammation from an infection, or even normal everyday pain from an active job.
“One of my patients is a chef,” Sammut says. “He has rheumatoid arthritis that is very well controlled. But at the end of the day, after working, and holding heavy pots, his hands and fingers can become quite achy. But that is not from rheumatoid arthritis; that’s related to what he’s doing.”
If your pain is worse in the morning, or it comes with stiffness or swelling, it is likely RA-related. By listening to your body’s cues, you can learn how to judge the source of your pain.
Take Your Medication
Research has shown that early treatment with disease-modifying antirheumatic drugs (DMARDs) is the best bet for keeping RA in check.
Medications to treat RA include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
- Corticosteroids, such as prednisone
- Conventional DMARDs, which can slow RA progression and possibly save the joints from permanent damage
- Biologic agents, a newer class of DMARDs. They target chemicals that cause inflammation. They relieve symptoms and can limit joint damage
- JAK inhibitors, which can be used if other medications aren’t working
Stick with your medications. Stopping meds is a big reason for flare-ups, Meysami says. “Most of the treatments for rheumatoid arthritis, unfortunately, have side effects,” he says. “That sometimes is very scary to the patient, to the point that they are hesitant to take their medication as prescribed, or even at all.”
If you feel that your medication is not working and you’ve been on it for less than a few months, be patient. “On average,” Meysami adds, “most of the rheumatology medication takes about 10-12 weeks to start to work.”
Eat a Healthy Diet
“What we put in our body actually has a lot to do with our inflammation, our immune system, and metabolic disease,” Meysami says. Many people have found that certain foods cause them to flare up. Sugar, alcohol, and red meat are commonly reported triggers.
Eating too much processed sugar can cause the body to become more inflamed. If you have RA, this will make it worse. “Sugar -- based on my experience, and there’s some small research supporting that -- seems to be the fuel for inflammation,” Meysami says.
Other foods have been shown to reduce symptoms in some people. These are often referred to as “anti-inflammatory foods.” These include fish, berries, leafy greens, and extra-virgin olive oil. “I usually recommend my patients follow Mediterranean diets,” Meysami says. These foods have lots of other benefits to your body as well.
Meysami also recommends turmeric, a spice that has been used in medicine for thousands of years. Its active ingredient, curcumin, is widely recognized for its anti-inflammatory properties.
But, Sammut says, there is no single magical anti-inflammatory diet that works for everyone. The most important thing is to tailor diets to individual patients. “Everyone has such a different metabolism. Mediterranean diets, in general, are a healthy diet, so it’s a good diet to follow. But it may not work for everyone.”
Sammut often sends her patients to a nutritionist who can create a program specifically designed for that person’s needs, lifestyle, and any other conditions they might have.
Take Care of Your Mental Health
Pain and poor mental health are linked. “Having anxiety and depression is very, very common as part of having to deal with a chronic disease,” Sammut says. “In pretty much all of our patients, we screen for that.”
If left unchecked, the pain and discomfort caused by RA can have a profound negative effect on your mental health. If you are anxious or depressed, it’s harder to take care of your physical health. Untreated depression can even make RA treatments less effective.
Stress and anxiety can also worsen RA, Meysami says. “How many times have I seen a patient come in, going through difficulty in life -- say divorce, loss of job, COVID distress -- and their rheumatoid arthritis is flaring up?”
To battle RA most effectively, it’s important to address both your physical and emotional health head-on. Talk to your doctor about any stress, anxiety, or depression you may feel.
In addition to taking medications, it’s critical to get regular exercise to keep RA symptoms at bay and help keep you mentally healthy.
“It’s important to keep the muscles strong, because it takes pressure off the joints,” says Sammut. “Exercising also decreases inflammation.” One of her patients was a fitness instructor, and when he started teaching classes, he said it helped his RA so much that he was able to reduce his medications.
If you have mobility issues, it’s important to see a physical or occupational therapist who can show you how to do exercises to keep your joints flexible. They can also help you find ways to make daily tasks easier on your joints.
Ultimately, simply moving your body around is the first goal. “It could mean something like sitting on a chair and lifting your arms,” Sammut says. “Everyone has to go at their own rate.” But the more you can safely move your body, the better.
“A person with rheumatoid arthritis has joint pain, and they might try to avoid using that joint because of pain,” Meysami says. “But if they don’t use the joint, they lose it.” Keeping joints strong is critical for controlling RA.
Activities should include:
- Range-of-motion exercises. Exercises like arm raises and shoulder rolls relieve stiffness and help you stay flexible.
- Strengthening exercises. These keep your support muscles strong. This is essential to take the pressure off your joints and bones.
- Aerobic or endurance exercises. These help you stay fit and healthy and can lower your risk of developing other conditions linked to RA.
Get creative with your exercise. There are countless ways to get moving every day, including chores, yardwork, child care, or walking the dog. Experts often recommend yoga for tuning in to your body and gently increasing your strength, flexibility, and endurance.
Exercises should be low impact, meaning you aren’t jarring or twisting your body. Try cycling or swimming rather than high-impact activities like tennis or running, especially when you’re starting out. Go slowly, move gently, especially if you’re not normally active and make sure you always include a warm-up. Afterward, ice joints that tend to swell.
Other low-impact exercises include:
- Some kinds of dance
- Tai chi
- Core strength exercises
- Weights or resistance bands
- Elliptical trainer
- Rowing machine
- Mountain climbers
- Rock climbing
You should tailor your activity levels to how you’re feeling on a given day. If you’re having a flare-up, you can scale back the intensity. Get some rest and stick to gentle stretching until your pain subsides.
Certain habits can speed up RA progression. Do not smoke. Cigarettes can worsen symptoms and make it harder to stay active. “Smoking increases the risk of getting rheumatoid arthritis by 1.8 times, especially if you smoke more than 20 packs per year,” Meysami says. “Unfortunately, that risk factor remains with the smoker even 10 to 20 years after quitting.”
Smoking also puts you at risk of more severe RA, Sammut says. “Rheumatoid arthritis can be very mild, or can be super aggressive, or anything in between,” she says. “For people who smoke, they’re more prone to having the more aggressive forms.”
“Also, some of the medications we use are less effective in people who smoke,” she adds.
Smoking also wreaks havoc on our teeth, and dental health is another surprising thing to watch for, Meysami says. The gingivitis-causing bacteria P. gingivalis has been directly linked to rheumatoid arthritis. This may be because the bacteria turns on an inflammatory response in our bodies very similar to the one that causes RA. “Think about your mouth as one of the entrances of rheumatoid arthritis,” Meysami says. “Keep it clean.”
Watch Your Weight
Body weight is another factor in RA. Increased body weight puts more physical stress on your joints. For every pound you gain, you add 4 pounds of pressure on your knee with each step you take. This can be particularly dangerous if you do not lead an active lifestyle.
If you have a higher body weight, you need to take extra care to keep your body strong so your joints are not put under stress. But weight loss, even a small amount, will make your journey easier. “There are some studies that show that for people who are overweight, when they lose 10% of their body weight, their pain in their knees gets better by 50%,” Sammut says.
On top of the physical risk of damage, Sammut says that high body fat itself can worsen the damage done by RA. “Adipose tissue, [or] fatty tissue, actually gives off inflammation,” she says. Losing weight is not a silver bullet, but it can go a long way in reducing inflammation and making you feel better overall.
You don’t have to live with chronic pain. “In having rheumatoid arthritis, the goal should be to wake up in the morning and not even think about it,” Sammut says. “Early help is really important.”
RA can be serious, but it is very treatable. By sticking with it, Meysami says, you and your rheumatologist can find a solution together. “It’s just a matter of finding the [treatment] that works for an individual patient.”
Alireza Meysami, MD, division head of rheumatology, Henry Ford Health System, Detroit.
Amanda Sammut, MD, the chief of rheumatology, Harlem Hospital Center, New York City.
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