The immune system generally keeps you healthy, but there are times when these biological processes can actually harm you. Rheumatoid arthritis is an autoimmune disease -- which arises when the immune system mistakenly attacks its own bodily tissues.
This week, on “Take Care,” Dr. Robert Shmerling explains the symptoms, diagnosis and treatment of rheumatoid arthritis. Shmerling is clinical chief of the rheumatology division of Beth Israel Deaconess Medical Center, associate professor of medicine at Harvard Medical School and a senior editor of internet publishing at Harvard Health Publications.
Rheumatoid arthritis (RA) can occur at nearly any age, in adults as young as 20 or 30. Children can also develop juvenile RA. In the case of RA, the immune system primarily attacks joint tissue, primarily, causing painful swelling. But it also can cause inflammation body-wide -- in the skin, eyes, lungs and other body parts.
Rheumatoid arthritis is a chronic disease that, typically, does not go away.
“We don’t have cures for it. We have some very good treatments, but it tends to be chronic,” Shmerling.
If left untreated, RA can be crippling. The disease can damage joints in just a number of months (typically years) to the point where function is very difficult and quality of life is severely impaired.
RA also increases the risk of heart attack and stroke, although the details about why aren’t completely understood.
“In general, conditions that cause a lot of inflammation throughout the body are associated or linked with a higher risk of cardiovascular events, such as heart attack or stroke,” Shmerling says.
It’s not the arthritis that causes issues with the heart, but the fact that it’s a systemic condition affecting the entire body that makes a sufferer of RA more prone to cardiovascular disease.
“Most people in their 30s, 40s, 50s, who develop rheumatoid arthritis do not attribute it necessarily to age, because they’re too young to make that connection,” Shmerling says. “It’s also often somewhat of an explosive onset. It’s so many joints and they’re so swollen that it’s really out of the realm of what you’d expect with age-related osteoarthritis.”
Most patients with RA don’t have a family history of the condition. But there are some cases where multiple members of a family will have RA or other autoimmune diseases. Shmerling says some families probably have a genetic tendency to develop autoimmune diseases.
Taking a thorough history of the symptoms is usually the first step, according to Shmerling. A first visit may include reviewing what makes the pain worse or better and what time of day the symptoms develop. There is then, usually, a thorough examination of the joints. There is also frequently a blood test ordered that can indicate if the immune system is attacking itself, to rule out other diseases or conditions and to establish the diagnosis.
There are some very effective treatments or therapies for RA.
“It’s relatively rare now that we see a patient with newly diagnosed rheumatoid arthritis who winds up with crippling arthritis because the treatments are so good,” Shmerling says.
Anti-inflammatory medications are often used in initial treatments. For patients with severe pain who are limited in function or quality of life, corticosteroids in low doses can be very effective. The most important medication is one that can protect the joints: immunosuppressive medication and injectable medications. There are also some non-invasive activities that can help.
Enough sleep, supervised physical therapy or exercise can help someone suffering from RA. As can loss of excess weight. Although joint pain makes it very difficult to exercise, “moving joints is better than not moving joints,” Shmerling says.
There’s also been a fair amount of recent research into diets and supplements that are anti-inflammatory but none of them have found consistent scientific proof that these dietary changes are significantly helpful.