What Are The Different Types Of Rheumatoid Arthritis – Rheumatoid arthritis (RA) is a chronic disease that has no cure. But even though the disease continues, newer drugs to treat the disease can slow or even stop it from getting worse. “We have many effective treatments for RA that help control the symptoms of joint pain and stiffness, but also prevent the progression of the disease and the development of permanent damage,” says Lindsay Lally, MD, an orthopedic surgeon at the Hospital for Special Surgery in New York. City.
Early treatment for RA is important, because any joint damage that has already occurred cannot be left undone. Find out how to recognize the symptoms at each stage of RA, and what to do to treat it.
- 1 What Are The Different Types Of Rheumatoid Arthritis
- 1.1 The Three Most Common Types Of Arthritis
- 1.2 Rheumatoid Arthritis Treatment: Drugs And Alternatives
What Are The Different Types Of Rheumatoid Arthritis
In the autoimmune process of RA, the body mistakenly attacks its own joint tissue. “In early RA, the patient may not have many symptoms except for some stiffness in the morning, especially in the small joints – hands, feet, sometimes knees,” says Rajat Bhatt, MD, a rheumatologist at Allergy and Rheumatology. Houston Professionals. Stiffness gets better with movement, which distinguishes it from osteoarthritis, a “wear-and-tear” type of degeneration.
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Ideally at this stage you would see a specialist called a rheumatologist. The only problem is that symptoms can be vague or come and go, making diagnosis of RA difficult. “It can be difficult to diagnose RA in the very early stages,” says Dr. Lally. “Often patients with early RA will have joint pain without the swelling characteristic of RA. Additionally, in the early stages of rheumatoid arthritis there may be only one affected joint that has evidence of swelling compared to the typical presentation of RA, which tend to involve the small limbs of the arms and legs in a symmetrical fashion.
Dr. Lally says that antibodies in the blood, though, can be present for years before symptoms appear. In addition, “although X-rays at this time are usually normal, more sensitive images such as ultrasound can show fluid or inflammation in the affected joint,” Dr. Lally says. Still, early diagnosis of RA is difficult because although these markers of inflammation may show up in blood tests, they may not occur, Dr. Bhatt says. An ultrasound may or may not show anything abnormal.
Often, RA progresses to the second stage without being diagnosed. “In the second stage the body makes antibodies [expressed in the blood] and the organs begin to swell,” Dr. Bhatt says. “It can affect other organ systems and cause inflammation there: lungs, eyes, skin rash, and it can even affect the heart.” Lumps on the elbows called rheumatoid nodules may also occur. (Note, however, that some people have what is known as seronegative RA, where blood tests do not show antibodies such as rheumatoid factor or anti-citrullinated protein antibodies, or anti-CCP.)
When it comes to imaging results, “the second step is further confirmation of the diagnosis,” Dr. Bhatt says. “It has a kind of moth-eaten, cut appearance on X-rays. Ultrasound can also be done, and the most sensitive is MRI, which can pick up if there are any problems even if the X-ray is normal.”
Rheumatoid Arthritis Symptoms You Might Be Ignoring
In this last, more severe stage, blood tests and imaging are not very important for diagnosis because you can see the effects of the disease. “Joints begin to bend and deform, fingers bend,” Dr. Bhatt says. These misshapen joints can press on nerves and can cause nerve pain as well, he says. “In the old days we used to see more damaged joints when we didn’t have much treatment, but now we see less and less,” Dr. Bhatt says.
If left untreated, the disease will progress to the end stage, where “there is no limb left at all and the limb is fused,” Dr. Bhatt says. Fortunately, with treatment, people with RA do not reach this stage.
“You’ll know – your organs will tell you,” Dr. Bhatt says. “The pain will be worse and you may have more swelling.” Dr. Lally says that although episodes of pain may resolve on their own in early RA, “these episodes tend to become more frequent and more frequent over time until the typical features of RA persist.” In addition, Dr. Bhatt says to pay attention to non-physical symptoms such as shortness of breath or red, painful eyes, which may be signs that RA is affecting other body systems. Let your doctor know if your RA symptoms change completely.
Different factors influence the speed and progression of RA in individual patients. Some things you cannot control, such as whether you have a family history of the disease. In addition, although women are more likely to develop RA, when men develop rheumatoid arthritis, their prognosis is generally worse, Dr. Bhatt says.
The Three Most Common Types Of Arthritis
But there are things you can control and change. “We know smoking makes RA more severe, so quitting smoking is important,” Dr. Lally says. Also, people with “heavy manual jobs may stress the joints more and may have faster progression,” Dr. Bhatt says. If your workplace can accommodate your illness, that will help. Read more about how to work with simple arthritis.
Exercise and maintaining a healthy weight can also help reduce stress on joints, Dr. Bhatt says. But talk to your doctor before starting an exercise routine. “A physical therapist can advise patients on the right type of exercise,” he says. “If patients exercise poorly it can stress the joints even more.” In addition, getting enough sleep, starting an anti-inflammatory diet, eating less red meat, and perhaps using herbal remedies like turmeric can help manage RA, Dr. Bhatt says. Here are some more healthy habits to follow if you have RA.
Perhaps the biggest factor affecting how RA progresses is whether you are treated by a specialist who can prescribe medications to reduce the disease. “Being on a DMARD or biologic therapy for RA is the best way to prevent progression,” Dr. Lally says.
Antirheumatic drugs (DMARDs) are usually the first line of medicine. “Methotrexate [DMARD] is a drug used to treat rheumatoid arthritis,” Dr. Bhatt says. “Some patients are afraid because methotrexate is also used for the treatment of cancer so they don’t want to take the ‘chemo pill,’ but the ones we use for RA are very low doses and less likely to have side effects.” Your doctor will reassess in a month or so and see if it is necessary to add other medications.
Rheumatoid Arthritis Treatment: Drugs And Alternatives
“If after three to six months they still haven’t responded then we continue with drugs called biology,” Dr. Bhatt says. These genetically engineered drugs specifically target the inflammatory process, and are usually injected or infused through an IV at your doctor’s office or medical center. “There are subclasses and different types,” Dr. Bhatt says. Your doctor will try different medications to see which one you respond to best.
Rheumatologists follow a “treat-to-target” strategy when it comes to how to manage the disease and prevent progression. This means treating the disease aggressively until a treatment goal, such as low disease activity, is achieved.
“The concept of targeted treatment is a collaboration between the patient and the doctor to find RA in a state of low disease activity or remission,” Dr. Lally says. “This method requires regular examinations usually every three months. If there is evidence that the RA is not adequately controlled, the drug regimen is changed to try to achieve the goal of remission.
But, Dr. Bhatt says. “there is a balance – if we treat RA too aggressively it can cause harm; at the same time we don’t want to leave the inflammation of the joints developing.” Working with the level of RA control the patient wants, the main goal is normal joints and minimal disease activity within a specified period of time.
Arthritis 101: Causes, Symptoms, Types And Treatment
Thanks to new treatments available — and more on the horizon — RA doesn’t have to mean a life of disability or even limited mobility. “It’s not inevitable these days,” says Dr. Bhatt. “People can have normal lives.”
But patients must make sure to follow their treatment plan and doctor’s recommendations. “Regular follow-up with a rheumatologist who performs joint exams, follows systemic inflammation levels in the blood and can assess function is the best way to ensure RA is controlled and does not progress,” Dr. Lally says.
This video is part of an educational project from researchers at Yale University, Berkshire Medical Center, Carnegie Mellon University, Hospital for Special Surgery, and the Global Healthy Living Foundation, and ArthritisPower. It was made possible with support from the Rheumatology Research Foundation. See more videos from this series here.
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