Lifestyle Changes Make a Difference

For many of us with RA, the availability of a growing number of Disease-Modifying Anti-inflammatory Drugs, or DMARDs, has been a game changer in altering the course of disease. But medicines often work better when combined with lifestyle changes. Taking care of yourself and staying on top of the disease is a big part of living with RA. Here are some strategies that topped the list.

In addition to your joints, the inflammatory effects of RA can spread to internal organs throughout the body, including your heart. Having RA raises the risk for heart disease. In fact, it's the leading cause of death for those of us with RA. That's why it's important to keep other risk factors, like high blood pressure and high cholesterol levels, under control.

Experts recommend a nutritious, low fat diet and maybe adding cardiovascular exercises to your fitness routine. Not smoking is good for overall health, but you may not realize the dramatic impact it can have on RA.

Unquestionably, smoking cessation should be a major priority for anyone with RA. Smoking is associated with more severe RA, including more active disease and increased joint damage. Smoking has also been linked to the development of rheumatoid factor and anti-CCP antibodies, both markers for more aggressive disease. Evidence shows that those who smoke are less likely to respond to RA treatments. Those with aura who smoke are also less likely to go into remission as compared with non-smokers.

About 2/3 of people with RA are overweight or obese, which is the same proportion in the general population. Being overweight has many negative health consequences. But for those with RA, extra body fat can be especially damaging.

When people are overweight, it puts excess stress on weight-bearing joints, such as the knees and hips, which can worsen RA symptoms. Even a small amount of weight loss, 10 to 12 pounds, can reduce pain and improve functioning. Fat is not simply inert weight. Fat is an active tissue that releases inflammatory signals called adipokines. People who are heavier have more pro-inflammatory adipokines, which promotes inflammation and can worsen RA symptoms. There is also evidence that some DMARDs work less well in people who are obese.

When you're achy and tired, exercising is probably the last thing you feel like doing. But research shows that physical activity can improve mobility, reduce pain and stiffness, and strengthen muscles, provided you're smart about it.

With high impact sports like running, it's possible to speed up knee or joint damage, instead, stick with non-weight-bearing activities, such as walking, bicycling, or swimming. Yoga and Pilates are other good options, but look for an instructor who can modify poses and movements to suit your abilities. You may also want to consider strength training, which research has found can help combat RA-related pain and swelling. Again, work with a trainer who understands your condition, or find a physical activity program designed for those living with RA.

The many emotions one may feel with RA-- fear, anger, frustration, pain, the unpredictable nature of flares-- all of these can increase stress levels. In turn, stress can make living with RA more difficult.

Stress involves more than just emotions. Stress involves the production of a physical response, leading to the release of inflammatory chemicals inside the body. For a disease like RA, more inflammation means worse symptoms. It's impossible to completely get rid of stress, but there are techniques to help manage it. Exercise stimulates the release of feel good endorphins in the brain, the kind responsible for a runner's high, for example, and lowers the levels of stress hormones, like cortisol and adrenaline, in your system.

At the other end of the spectrum, various relaxation techniques-- deep breathing, mindfulness meditation, and progressive muscle relaxation-- are among the most effective tools for managing stress. Deep breathing slows your heart rate and brings on a sense of calm during a stressful event. These techniques can be practiced anywhere but are often underused. Taking a few minutes to meditate or progressively relax tight muscles at various times during the day is good for your mind and also for your body.

Taking control of your disease doesn't mean going it alone. Living with RA can be hard. Chronic conditions are isolating. If you feel anxious or depressed, talk to your doctor or a mental health professional who specializes in chronic conditions. Tell family and friends about your RA to help them understand the disease and enlist their help. The size of your support network is probably less important than the quality of the support that you actually get.

In my own struggles, I joined an online RA support group. The sense of connectedness I felt to others in the group who were going through the same thing was such a relief. Combining these and other strategies in a personalized RA treatment plan and checking in regularly with your doctor to monitor progress are effective ways to take back your health.

Join me next time as we take a deeper dive into the hows and whys of the connection between RA and heart disease and what you can do to better protect yourself.