Rheumatoid arthritis, also known as RA, is a joint disease characterized by inflammation and pain. The condition is also three times more likely to impact women, according to research published in the journal Rheumatology International. And one of the trickiest things about treating rheumatoid arthritis is that this autoimmune disease doesn’t progress the same in everyone who has it. Some people will be able to manage their symptoms entirely, while others will see their disease grow worse.
Despite all the research that’s been done, who may develop severe rheumatoid arthritis and joint damage and whose joint damage will slow over time still remain somewhat of a medical mystery. “I don’t know when I see someone over the first two or three visits how serious it will be,” says John J. Cush, MD, a professor of internal medicine and rheumatology at UT Southwestern Medical Center in Dallas.
Effective Treatments for RA Are Available
But the good news is that in 2023, the treatments for rheumatoid arthritis are better than ever. “There are phenomenal therapies for RA, and most patients will have a completely normal life, provided they take their medications,” says Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida, and a medical advisor to CreakyJoints, a support, education, advocacy, and research organization for people living with arthritis and rheumatic disease. Here are five important things to note about disease progression:
1. The Number of Swollen, Painful Joints You Have Is an Indicator of Disease Severity
The more joints that are painful and swollen, the more severe the disease may be, says Dr. Cush. Joint pain and swelling are characteristic signs and symptoms of rheumatoid arthritis. Rheumatologists consider this a very important way to measure disease severity.
Your doctor should examine joints in your hands, feet, shoulders, hips, elbows, and other spots to see how many are causing problems. Symmetrical symptoms, such as having the same swollen joints on both sides of the body, are also hallmark symptoms of rheumatoid arthritis, Cush says.
Dr. Domingues adds that the traditional morning stiffness and joint swelling that are characteristic symptoms of RA should be discussed with a rheumatologist as soon as possible. “Those are signs of active rheumatoid arthritis, and when it presents like that, it gives doctors an opportunity to be aggressive in early treatment or to switch to another class of drugs if symptoms are worsening.”
2. Your Lifestyle Is More Sedentary and You’re Moving Less
Regular physical activity is necessary for everyone but especially for people with RA. Research has shown that regular cardiovascular exercise and weight training can substantially improve daily function without exacerbating rheumatoid arthritis disease activity. There are numerous health benefits associated with regular physical activity — like improved muscle strength and better bone and joint health — which all help your aches and pains feel better. But rest is also needed to restore the body from the bouts of intense pain and fatigue that are characteristic of rheumatoid arthritis. But you can’t let “taking it easy” become a way of life. A sedentary lifestyle may eventually lead to increased pain, fatigue, and weakness, and a lower quality of life.
Regular exercise also has another life-enhancing benefit: It helps reduce your odds of developing cardiovascular disease. Taking good care of your ticker is essential for people with rheumatoid arthritis, because heart problems are more prevalent in people who have RA compared with the general population. “It’s heart disease that kills you, not the RA,” says Domingues. “It’s very important to talk to your primary care doctor or a cardiologist if you have RA to control your risk factors, such as high cholesterol, obesity, and diabetes.”
3. Your Doctor Can’t Fully Appreciate Potential New Symptoms via Telemedicine
In the COVID-19 pandemic era, people with rheumatoid arthritis can’t always make it into the doctor’s office for a physical visit. But a telemedicine, or telehealth, appointment, which is unquestionably better than not checking in with health professionals at all, may not detect that the disease is progressing as well as an in-person visit.
Domingues says that rheumatologists should definitely notice if joints are swollen and warm to the touch in an office consultation — signs of active inflammation — but they may not catch the severity of those symptoms on a computer screen. “If we’re not physically examining them, the communication between doctors and patients needs to be even better,” Domingues says. He says to make sure that you mention how your joints feel when you wake up, how much stiffness you experience in the morning and for how long, if you’re able to make a full fist early in the day, and if you see red, warm, or swollen joints. “Those are the pivotal signs of worsening RA,” he says.
4. Imaging Test Results Help Paint a Picture
X-rays, CT scans, MRIs, and ultrasounds are all tests that can help track and detect the severity of joint and cartilage damage. Bone erosion and destruction of cartilage can happen quickly within the first two years that you have rheumatoid arthritis, and the damage may continue to develop over time.
5. Some Daily Activities Are Difficult
Pay close attention to how you truly feel. Rheumatoid arthritis is one of the few diseases where subjective measures of how a patient feels are among the best predictors of how well a person will respond to treatment and how much the disease will progress. Doctors may measure severity of symptoms using both the Health Assessment Questionnaire Disability Index (HAQ) and the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire.