When your doctor told you she suspected you had rheumatoid arthritis, you probably thought, “Arthritis – that’s a disease old people get.”

You’re thinking of osteoarthritis, the most common kind of arthritis, a disease in which cartilage in the joints breaks down. It does become more prevalent with age.

Though RA affects the joints, it’s a disease of the immune system, which normally protects us from infection by attacking viruses and bacteria. For reasons no one fully understands, RA causes the immune system to go awry and mistakenly attack healthy cells such as the synovium, a thin membrane that lines the joints. As a result of the attack, fluid builds up in the joints, causing pain and inflammation. Over time this can wear away the cartilage and erode bone, causing a lack of function and mobility. In most people, the inflammation usually becomes systemic, affecting organs such as the skin, heart and lungs.

RA most commonly affects the joints of the hands, feet, wrists, elbows, knees and ankles. Joint involvement is usually symmetrical, meaning if one joint is affected the same joint on the opposite side of the body is involved as well.

While there’s no cure for this chronic disease, its symptoms often come and go. Periods of mild disease activity may be punctuated by flares – bouts of more intense activity and symptoms. In some cases, with appropriate treatment, the disease goes into remission.

If you’ve just been diagnosed with RA, you should know you’re not alone – the disease affects an estimated 1.5 million Americans. Three times more women are affected than men. The usual age for adult onset is between 40 and 60 years, but it can begin at any age, even in childhood.

Diagnosing RA Can Be Tricky

Because no single laboratory test instantly confirms a diagnosis of RA, doctors must employ a variety of methods to make the call.
If your doctor thinks you might have RA, the first order of business will be to take your medical history. This helps him gather specific information about your symptoms that might point to RA: Do you have pain in several joints? Do the same joints hurt on each side of your body? Do you experience stiffness in the morning? Are you often fatigued?

Doctors also may use a Health Assessment Questionnaire or an Arthritis Impact Measurement Scale, sets of questions and answers that gauge your pain level and your outlook on life. Then comes a physical exam. The doctor will look for swelling, warmth, tenderness and limited motion in joints, or nodules under the skin. He might ask you to perform certain tasks to see how well you function.

Although your doctor will probably test your blood for rheumatoid factor – an antibody that can indicate RA – its presence is not a sure sign: While many people with RA test positive for rheumatoid factor, 20 to 30 percent test negative. Sometimes people who don’t have RA test positive. A newer, more specific test measures the presence of anti-cyclic citrullinated peptides (anti-CCP) – proteins found in tissue damaged by RA. People with a positive anti-CCP test are 90 to 95 percent likely to have RA.

Other blood tests look for anemia (a low red blood cell count) or an elevated erythrocyte sedimentation rate (ESR) – how fast your red blood cells cling together, fall and settle at the bottom of a test tube. The higher the rate, the greater the inflammation. Testing for c-reactive protein (CRP) also indicates the extent of inflammation. Doctors frequently take X-rays to assess joint damage – typically bone loss at the edges of a joint, or erosion, combined with a loss of cartilage.

What Causes RA?

Despite extensive research, the cause of RA remains unknown. Scientists have learned much about the immune response and the mechanisms of inflammation over the years, but the events that trigger the abnormal process remain a mystery. Most doctors agree that a combination of genetic and environmental factors is responsible. 

Researchers have identified genetic markers that cause a ten-fold greater probability of developing rheumatoid arthritis. These genes are associated with the immune system, chronic inflammation or the development and progression of RA. Still, not all people with these genes develop RA, and not all people with the disease have these genes. 

Researchers are investigating infectious agents, such as bacteria or viruses, which may trigger the disease in someone with a genetic propensity for it. Other suspects include female hormones (70 percent of people with RA are women) and the body’s response to stressful events such as physical or emotional trauma. Smoking may also play a role.

How Will RA Affect You?

Symptoms vary from person to person, and almost everyone with RA notices a change in symptoms from day to day. Any joint may become involved, but many people first experience inflammation in the knuckles of the hands, feet and wrists. Later, the elbows, shoulders, hips and knees can become involved. Some people experience RA as a mild condition with occasional flares. In other people the disease is continuously active, worsening over time.

RA can make you feel fatigued and sick all over, especially during a flare. You might lose your appetite, lose weight or run a low-grade fever. Your doctor, who will monitor your blood as part of your treatment, may discover you have a low red blood cell count – a condition known as anemia.

You may also experience stress, frustration, helplessness and a sense of loss of control. While such feelings are common for someone newly diagnosed with a chronic disease, they make coping with RA more difficult and even increase pain. Getting proper medical treatment and developing skills to help you cope with pain and stress in positive, constructive ways will help you fight back.

Early, Aggressive Treatment Might Save Your Joints

While there’s no cure for rheumatoid arthritis, at least not yet, researchers are focused on finding one. In the meantime, remission is the goal. The good news is there have never been more options for aggressively – and often successfully – treating RA.

Today’s research shows that irreparable damage can occur early on, so many doctors focus on slowing or even stopping the disease before that occurs. To do so, they may begin treatment with a class of medications known as disease- modifying anti-rheumatic drugs (DMARDs), which actually inhibit the processes in your body that cause inflammation.

At the outset or if your RA doesn’t respond well to traditional DMARDs, doctors may opt for one of a new breakthrough category of DMARDs called biologic response modifiers, or biologics. Made from genes, or from a living organism such as a virus or protein (not synthetic chemicals), these drugs interrupt the inflammatory process.

Doctors often combine DMARDs and biologics. And because they may take a while to work, your doctor may also prescribe a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin, to control inflammation; analgesics, such as  acetaminophen (Tylenol), for pain; and possibly a short-term corticosteroid, such as prednisone, to lower inflammation.

Tackling RA is a True Team Effort

Managing rheumatoid arthritis requires a team approach. Your primary doctor should be a rheumatologist, an internist (a specialist in internal medicine) who has additional training to diagnose and treat arthritis or related diseases that affect the joints, muscles, bones, skin and other tissues. Some rheumatologists may also have special training in pediatrics, orthopaedics, physical medicine, sports medicine or other medical fields.

As your treatment progresses, you may see a variety of health care professionals, including orthopaedists who specialize in diseases of the bone; nurses and nurse practitioners who assist with or support your doctor’s care; physiatrists, doctors who direct physical therapy and rehabilitation programs; physical therapists who show you exercises to help keep your muscles strong and prevent joint stiffness; occupational therapists who teach you how to reduce strain on your joints while doing everyday activities; pharmacists who fill your prescriptions; psychologists who help you handle the mental and emotional concerns of chronic disease; social workers who direct you to community resources and find solutions to social and financial problems related to your arthritis; and nutritionists who create a balanced eating plan that will boost your overall health.

In the end, however, you are the most critical member of your disease-management team. You’ll want to learn as much as possible about your RA, its potential course and available treatments. Be proactive in monitoring your symptoms and treatments and in handling the day-to-day challenges your disease brings. Rely on your doctor for treatment, prescriptions and advice, but manage your own health and care.

Insurance and RA

Insurance will cover RA treatment – up to a point. If you have insurance, your general arthritis care should be covered, but you’ll still have to make co-payments for doctor visits, procedures and prescriptions.

Some treatments may be covered partially or not at all. For example, you may have trouble getting approval for cutting-edge biologic medicines, which are quite expensive. Even if they are covered, insurance companies frequently put them in the highest formulary category – tier 4 – which means restricted access and higher-than-usual copays.

If you’re denied coverage for a biologic but you’ve been under a doctor’s care for a while and other treatments have proved ineffective, you may be able to appeal. Investigate your insurance company’s appeals process and ask your doctor to write a letter on your behalf. Check your state insurance commissioner’s office for more tips on working with insurance companies.

Once you’re diagnosed with arthritis, you have a “pre-existing condition,” in insurance industry terms, and are likely to have difficulty getting a new individual insurance policy. If you switch jobs, ask about pre-existing condition waiting periods. If you lose employer coverage due to resignation, divorce or the company closing, be sure to maintain continuity of coverage through COBRA, even if the premiums are expensive. 

Having RA Doesn’t Mean Losing Your Job

Depending on your job and the severity of your symptoms, you might want to make some changes, whether it’s working more flexible hours or using ergonomic office equipment. Those changes are known as accommodations, and according to the Americans with Disabilities Act of 1990, as long as you work for a company with more than 15 people, your employer is required to work with you to make them – within reason.

Here are some coping techniques:
• Create an efficient work environment; arrange your responsibilities and your workspace to limit the amount of lifting, reaching, carrying, holding or walking necessary.
• Vary activities periodically to avoid sitting in one position or doing too much repetitive activity for too long.
• Set priorities and pace yourself. List the tasks you must do in order of importance, and tackle the most critical ones while you feel strongest and most energetic.
• Stick to a schedule and get enough rest to carry you through the next day.

Taking Care of Your Body is Critical

When you have RA, it’s important to keep extra strain off your stressed joints, exercise and eat a balanced diet to promote overall health.

Keep your back straight and your shoulders back; use simple assistive devices such as a thick pen that’s easy to write with or jar openers. Rethink your approach to daily activities and find ways to accomplish tasks in less taxing ways.

Keep your weight under control; those extra pounds put added stress on joints. And keep moving. Moderate physical activity on a regular basis helps decrease fatigue, strengthen muscles and bones and improve flexibility and stamina – along with your sense of well-being.

Research shows that some foods affect inflammation – for better or worse. Items on the to-eat list include whole grains and nutrient-rich foods such as fruits and vegetables.

If you’re on steroids, be sure to eat a calcium-rich diet with dairy products and leafy green vegetables to combat the drugs’ effects on bones. If you’re taking medications such as methotrexate, which sometimes causes liver problems, watch your alcohol intake.

Self-management is Key to Living Better
Living with a chronic disease is certainly a lot to handle. But rest assured, you can manage it. One of the best ways to cope is to take a proactive role in your own treatment and, by extension, your own life – a process called self-management.

First, make a conscious decision to maintain a positive attitude and lead an overall healthy lifestyle. Your body’s going through enough – do everything you can to give it a break!

Learn all you can about your condition from other people with RA, from trusted sources such as the Arthritis Foundation (www.arthritis.org) and Arthritis Today (www.ArthritisToday.org) and from your medical team.

Take control of your treatment by doing things that will help your doctor help you: Keep track of symptoms, medication regimens, side effects, pain levels, etc., for your doctor. Maintain an open line of communication with your physician – don’t hold anything back.

Finally, develop a network of friends, family members, even co-workers you can count on for emotional support when you’re down – and share good news with. In addition to people you already know, don’t be afraid to go online to talk about your arthritis with other people who have it. The Arthritis Foundation offers an online community with blogs and support groups.