8/22/2017 12:46:00 PM Treatments for rheumatoid arthritis unique to individual patient
DEAR DOCTOR: We were shocked when our daughter, who is 26, was diagnosed with rheumatoid arthritis. I thought arthritis was something that elderly people got. What treatments are available, and what are our daughter's prospects for an active and healthy life?
DEAR READER: We're very sorry to hear about the medical challenge your family is facing and hope the information we offer will be of help.
When it comes to what is commonly referred to as "arthritis," we're actually talking about two different conditions. Osteoarthritis, which is the type of arthritis you're thinking of in regards to a more elderly population, is a degenerative disease. In osteoarthritis, the tissues of the joints deteriorate due to wear and tear. When the cartilage that cushions the joints begins to break down, it leads to swelling, stiffness and pain.
Rheumatoid arthritis, or RA, is an inflammatory autoimmune disease. Joint damage occurs because the immune system has gone haywire and begins to target the body's own tissues. Although RA most commonly affects the joints, it can also involve other parts of the body, including the lungs, digestive system, circulatory system, skin and eyes.
In the United States, about 1.5 million people (more women than men) are living with RA. It generally doesn't appear until the 40s, and becomes increasingly common as we hit our 50s and beyond, but cases in younger people are not rare.
The most common sites of inflammation in RA are the wrists and the finger joints closest to the palm. However, the knees, neck, ankles, feet, elbows and shoulders can also be involved. RA has a symmetrical pattern, so the joint on each side of the body is usually affected. In addition to that symmetry, symptoms of RA include tender and swollen joints, a feeling of warmth within the joints, fatigue and occasional fever. For many people, prolonged morning stiffness or difficulty moving again following a long period of inactivity can be some of the early signs of RA.
Treatment is tailored to each person's symptoms. Your daughter's rheumatologist will discuss lifestyle changes to address inflammation. This includes using special tools or aids to help with difficult tasks, pursuing the right kind of exercise -- hatha yoga has been found to be helpful -- and striking the optimal balance between activity and rest.
Eating a well-balanced anti-inflammatory diet can help manage RA symptoms. This treatment approach got a boost recently when a study found that RA patients who ate fish twice a week (baked, steamed, raw or broiled, but not fried) scored measurably lower on a standardized scale that measures disease activity.
Some medications for RA address pain and inflammation. Others take aim at the disease process itself. All have potential side effects, so urge your daughter to learn the risks and benefits of any proposed medication.
Looking to the future, advances in immunotherapy and the expanding study of the ever-surprising gut biome offer hope for RA sufferers. In the meantime, prompt treatment is crucial. Make sure your daughter finds a good rheumatologist she likes and begins her medical care.
(Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.)
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