Rheumatoid Arthritis: A Chronic Affliction
By Amal Kebede, DO, Penn State Health St. Joseph Rheumatologist
This article appeared in Women2Women Magazine, Fall 2018 edition
More than 20 years ago, I was diagnosed with juvenile rheumatoid arthritis. Today, I am a rheumatologist who helps others manage their own chronic rheumatologic illnesses, including rheumatoid arthritis. While no one wishes to have a chronic disease, my diagnosis dramatically shaped my life choices as I experienced the medical system firsthand at an early age and decided to pursue a career in medicine. My experience has also given me perspective and a unique insight into the kind of obstacles my patients experience daily. While dealing with a chronic disease like rheumatoid arthritis, can be enormously challenging, I believe that all things are possible when we work together, and I want to empower my patients to believe this, too.
Rheumatoid arthritis is an autoimmune disease that causes pain, swelling, and stiffness in joints. Autoimmune diseases occur when the immune system, which is the body’s defense system, loses its ability to differentiate between what is part of its body and what is foreign. This results in the immune system attacking the body. It is believed that genetics and environmental factors both play a role in developing autoimmune diseases such as rheumatoid arthritis. While rheumatoid arthritis can develop in a person of any age group, it is most commonly diagnosed in people between the ages of forty to sixty years of age, with a higher proportion of women as compared to men.
In rheumatoid arthritis, the body attacks the lining of the joint, which is called the synovium, causing swelling, redness, and pain of the affected joints. This is different than osteoarthritis, which is the wear and tear related arthritis that we will all develop if we become old enough. Rheumatoid arthritis typically involves the small joints of the hands, wrists, and feet, but can progress to involve other joints. Although rheumatoid arthritis is primarily a joint disease, it can also involve other internal organs such as the eyes, heart, lungs, and kidneys. Rheumatoid arthritis can have other complications including osteoporosis – thinning of the bones which increases the risk of breaking a bone, rheumatoid nodules – lesions under the skin, dry eyes and mouth, carpal tunnel syndrome – numbness and tingling in the thumb, index, and middle fingers, and lymphoma – a blood cancer.
Patients usually present to their medical providers with complaints of pain and swelling. The patient’s history, physical exam, and additional data such as laboratory tests (rheumatoid factor and anti-cyclic citrinillated peptide antibodies) and x-rays can help to make this diagnosis. Many pieces of the puzzle have to fit together in order to be diagnosed with rheumatoid arthritis.
Treatment usually involves medications, lifestyle modifications, and therapy.
Medications are often required to control rheumatoid arthritis. Over time, inflammation associated with rheumatoid arthritis can cause joint deformity. Early aggressive treatment is required to help reduce the risk of irreversible joint damage which can cause pain, decreased mobility, and disability. There have been dramatic advancements in the medications for treatment of rheumatoid arthritis over the past twenty years, with many additional medications in the pipeline. The major classes of medications include Disease Modifying Anti-Rheumatic Drugs (DMARD’s) and biologics. Many treatment options are available – but each treatment plan needs to be tailored to each patient’s specific needs. Working together with your healthcare provider is critical to obtaining successful treatment outcomes.
Additional treatments such as physical therapy, occupational therapy, exercise, adequate rest, and counseling may also be needed. As with any chronic illness, getting a new diagnosis can be challenging – both physically and emotionally. Addressing both the physical and emotional aspects of the disease is integral to any treatment plan. Unfortunately, the emotional and mental components of these illnesses are often overlooked in favor of more tangible treatment options. Often, consulting a psychologist to help discuss fears and concerns as well as develop coping skills is helpful in processing the diagnosis and managing the treatment of any chronic illness, including rheumatoid arthritis.
Overall, although having rheumatoid arthritis can be challenging, it is important to note that people with rheumatoid arthritis can still live productive, independent lives.
Tips for all patients:
- Be involved in your healthcare. Take the time to learn about your disease process, the treatments you’re on, and the natural course of the disease.
- Be your own advocate. Speak up about your symptoms and concerns.
- Ask questions. Medicine is a different language. If there’s something you don’t understand, don’t be afraid to ask for clarification.
- Have a positive attitude. Studies show that positive attitudes improve outcomes and life satisfaction. Not always seeing the glass half full? Try simple things like recognizing a positive event each day, recognize and practice small acts of kindness daily, and smile.
Amal Kebede, DO, Rheumatologist If you are experience pain, swelling and stiffness in your joints, contact Penn State Health St. Joseph Rheumatology for an appointment with Dr. Kebede at 610-378-2996.