Newly diagnosed with RA? A Cleveland Clinic rheumatologist explains some basics for you.
If you’ve just been diagnosed with rheumatoid arthritis (RA), you probably have a lot of questions about the condition and what it may mean for your future health and quality of life.
This inflammatory autoimmune disease affects many people: 1.5 million U.S. adults (or 1 percent of the adult population), according to the Arthritis Foundation.
The severity of rheumatoid arthritis varies from person to person and can be mild, moderate, or severe.
When you have rheumatoid arthritis, your immune system mistakenly attacks the linings of your joints (called synovium), causing them to become inflamed and painful.
RA can begin at any age — most commonly in the forties, fifties, and sixties — and typically causes joint pain, fatigue, and stiffness lasting more than one hour, says Elaine Husni, MD, MPH, a rheumatologist at the Cleveland Clinic in Ohio and director of the Arthritis and Musculoskeletal Treatment Center there.
As with any condition, a number of important questions arise among the newly diagnosed, ranging from the nature of RA itself to treatment options.
Dr. Husni answers some of those questions and addresses queries she and other rheumatologists hear most often.
1. It’s Not Your Fault That You Have Rheumatoid Arthritis
There’s a tendency among newly diagnosed patients to blame themselves, says Husni.
“One of the most common misconceptions about RA is that you did this to yourself,” she says. “We don’t really know the cause of autoimmune diseases, but many times patients will ask, ‘What did I do to get this?’”
The cause of rheumatoid arthritis itself also remains unclear, but like other autoimmune diseases, it’s triggered when the body’s immune system malfunctions and attacks healthy tissues and cells, according to the American College of Rheumatology.
Autoimmune diseases, which range from RA to multiple sclerosis and type 1 diabetes, are fairly common; in fact, the U.S. Department of Health and Human Services reports that autoimmune disorders affect more than 23.5 million Americans.
2. You’ll Want to Educate Yourself About Rheumatoid Arthritis
Another important step when you’ve been diagnosed with RA is to become informed about the condition, says Husni.
The fears and ideas that newly diagnosed patients often have about RA usually come from the internet or somebody they know, says Husni, “so patients sometimes get misinformation. Also, I think the autoimmune disease is a difficult concept to grasp.
“Patients often ask me, ‘What does autoimmune mean? I’ve never heard this before. I was healthy my whole life.’”
Understanding RA can be a bit difficult, she adds, and patient knowledge about the condition tends to fall along a spectrum. “The first phase upon diagnosis is giving patients the correct information that they need,” Husni emphasizes.
3. Ask Your Doctor How Active Your Rheumatoid Arthritis Is
Before you can make treatment choices, you have to determine how active your RA is, which includes your disease burden, says Husni. “We now have many treatment choices in RA, and this allows us to personalize the process for each patient.
Although we do not have a cure, we are better at controlling the signs and symptoms to allow patients to return to their normal lives. We still have patients who do not respond to treatments, but this is rare and there is ongoing research to continue to improve RA treatment.”
“The three things rheumatologists normally do are a physical exam, some blood tests, and examine X-ray changes in the affected joint,” says Husni. “Those are the three pillars that we look at, and based on whatever they show, we can usually categorize you as having mild disease, mild to moderate disease, or moderate to advanced disease. We also want to know about the psychosocial aspects — how else does the disease affect you? This could be disturbing your sleep or mood or ability to work. We weigh all these aspects when treating an RA patient.”
How active the disease is will affect your RA treatment plan. “One of the first things we do is try to figure out where you are on that spectrum because treatment and advice will change for somebody with mild RA versus somebody with severe RA,” she adds.
4. Other Health Conditions May Affect Your Rheumatoid Arthritis Treatment
The CDC reports that about 47 percent of U.S. adults with arthritis also have at least one other condition, referred to by doctors as a comorbid condition.
So another crucial step in treating RA is to find out if you have any comorbidities. “It’s very important to see if you have any associated diseases or disorders that your rheumatologist needs to take into account,” says Husni.
If you have depression, for example, your rheumatologist may not want to prescribe certain RA medications, because they could make your depression worse.
“Another example is if you have a family history of multiple sclerosis. In that case, there are some other medications that can’t be prescribed [for RA],” Husni notes.
It’s also important to have a primary care physician who oversees all aspects of your health, and who can help treat any comorbid conditions you may have, along with the rheumatologist.
5. Eat Well, Stop Smoking, and Do What You Can to Stay Healthy
Adopting healthier habits may make living with RA easier, says Husni, adding that you’ll want to keep up with and even improve the healthy habits you already do have.
“For instance, now is not a good time to increase your smoking,” she says, and if you do smoke, you should really make an effort to quit smoking. Smoking is the strongest modifiable risk factor for RA, according to the CDC, increasing your risk by 1.3 to 2.4 times; the habit also interferes with the effectiveness of some RA medications.
“If you are overweight, this might be the time to lose some weight, because it may contribute to excess stress on your joints in addition to the RA,” she notes.
Diet is another modifiable risk factor. “Healthy eating can’t necessarily stop or cure RA,” but it can help you live better with it, says Husni.
There aren’t many studies that have a strong connection between what you eat and how well you feel with RA. Existing research is either based on small numbers of people or doesn’t show definitive advice on what to eat long-term. Still, if you check with your physician, you may find some relief by following a Mediterranean diet, which is high in vegetables, fruit, and seafood, according to a study published in May 2018 in Rheumatology International.
Although there’s not a lot of evidence right now that diet specifically helps RA symptoms, she says, “I think there will probably be a lot more information about nutrition in the years to come. I think it’s already happening, and I do believe that it will probably play a bigger role in treating RA.”