Rheumatoid Arthritis – Pain, Swelling & Stiffness

Rheumatoid Arthritis is a chronic autoimmune inflammatory disorder affecting your joints and may cause pain in your hands, feet, knees, shoulders, neck, elbows and hips.

Know Your Level of Disease Activity

Rheumatoid arthritis or RA affects approximately 1 percent of the population translating to more than 2 million Americans yearly, with a 5:2 ratio of women to men. RA strikes many people in the prime of their lives and most often affects people in their early 30s – 60s. Rheumatoid arthritis is different than osteoarthritis. RA causes considerably more inflammation than osteoarthritis. It is considered an autoimmune disorder– meaning that the body’s immune system reacts against itself. Inflammation from RA may result in swelling, pain, and subsequent damage to the joints. Unlike osteoarthritis, RA affects the entire body. People diagnosed with RA often complain of extreme fatigue and a general sense of malaise.

RA can range in severity from manageable to mildly debilitating to completely disabling. Early diagnosis is important in slowing the progression of joint damage as damage can sometimes occur in as few as six months of the disease’s onset. Some common medications, which have been used for years to treat RA, include Plaquenil, Azulfidine, Methotrexate, Arava, and Minocycline. Minocycline is not FDA approved but has been useful for patients with mild disease. These medications may be all that is needed to treat mild RA and may be sufficient for patients with moderate to severe RA.

Medications for Rheumatoid Arthritis

If you read magazines or watch television, you will most likely see advertisements for newer medications to treat Rheumatoid arthritis. Some examples include injectable biologics such as Enbrel, Humira, Remicade, Simponi, Cimzia, Rituxan, Orencia, and Actemra as well as oral Xeljanz. These anti-inflammatory medications have been miracles for some patients who have moderate to severe RA. But, on the other hand, these medications can also have potential side effects in some patients, which include but not limited to serious infections, some types of cancers, and other risks. Just because you have a diagnosis of RA, does not mean that you need to take these medications. Whenever you’re prescribed a new drug, it is good to ask the doctor, do you feel that the benefits of taking these medications outweigh the potential risks?

Am I a Candidate for Medications?

If you’re newly diagnosed with RA, there is no way to know for sure whether or not you will develop damage and deformity in your joints and might benefit from aggressive management. On the other hand, your Rheumatologist should be able to tell you if you are at increased risk of joint damage and might benefit from medication. Know your level of disease activity. Ask your Rheumatologist if they feel you are in remission or have mild, moderate, or severe RA activity?

Most patients with mild disease activity do not go on to damage their joints and do not need biologics or Xeljanz.

Do I Have a Mild, Moderate or Severe Case or RA?

There are many tools Rheumatologists use to determine your disease activity. Examples include:

  • DAS Score – This is a number that is calculated based on your pain, how many tender and swollen joints you have and a lab test called the sedimentation rate (ESR) or C-Reactive Protein (CRP) Based on the number, your doctor can classify you as having no disease activity (or remission) low, moderate or high disease activity.
  • HAQ Score – This score is entirely based on your symptoms and your level of function.
  • VECTRA Blood Test – This is a new blood test that measures 12 markers of inflammation and will give you a number that corresponds to low, moderate, and high disease activity. It’s expensive, but currently, the company that sells the test caps patient charges around $25.
  • Imaging
    • Plain Radiographs – If your doctor feels you have signs or symptoms of active RA, and there is already damage on your plain x-rays, then most likely you will be classified as having moderate to severe activity.
    • Ultrasound ­– Some doctors are using ultrasound in their office to look for early joint damage. The doctor doing the test must have a lot of experience with this technique to use it effectively.
    • MRI – Doctors may order this test to look for early damage. Word of caution! Radiologists who read these films sometimes comment on findings that may not be clinically significant. Your Rheumatologist in response to an MRI report may feel the need to be overly aggressive in their management and in some cases may not be warranted.

Know Your Body & Educate Yourself!

Always consider a second opinion if there is a question about diagnosis and treatment of your RA. RA is a chronic condition, and most patients take medications for a long time that may have potential risks. If you’ve recently been diagnosed with RA or arthritis or have been suffering from the disease for some time now, consider reading “Arthritis without Pain; the miracle of TNF blockers,” by Laurie Hesser and Dr. Scott Zashin to learn more. It’s easier to manage a disease process when you understand it.

Dr. Scott Zashin is a respected Dallas Fort Worth Texas Rheumatologist. He is dual board certified by the American Board of Rheumatology and the American Board of Internal Medicine. Dr. Zashin is the Medical Director of Dallas Rheumatology. Some of the above information about rheumatoid arthritis is from his and Laurie Hesser’s book Arthritis Without Pain, a comprehensive guide for patients considering or undergoing treatment with the TNF blockers Enbrel®, Remicade®, or Humira®. All rights reserved. For more information on rheumatoid arthritis, pain relief and getting back to feeling great visit his website: http://www.scottzashinmd.com/ or call today to schedule a time to meet with Dr. Zashin 214-363-2812 personally.

Disclosure: Dr. Zashin currently or has been in the past, a speaker or consultant to some the manufacturers of the products mentioned in this blog.