Rheumatoid Arthritis: 11 facts and myths explained
1. Rheumatoid Arthritis (RA) is an extreme form of wear and tear arthritis.
False. It is true that Osteoarthritis (OA) the more common form of arthritis, is caused by every day wear and tear with gradual loss of normal joint cartilage, the smooth as glass lining tissue found in joints, OA degeneration of joints is most common in those that carry the greatest stress forces–including the knees, hips, lower back, and thumbs. In contrast, RA often affects all joints–whether weight-bearing or not. That is because RA is an inflammatory, autoimmune illness that affects the lining tissue (synovium) of joints. Virtually all joints have synovium and are at risk, whether big or small, weight bearing or not.
2. RA is an illness of older people.
False. RA can begin at any age, including young children. RA is caused by a broken immune system, in which the weapons of inflammation (that are so effective in fighting infections) are turned against the body’s own tissues. Unfortunately, this breakdown of “immune tolerance” can occur any time in life. Younger adults (ages 30-50) are at the greatest risk for developing RA. Arthritis causes difficulties at any age, but in young adults, it creates severe challenges to gainful employment and raising a family.
3. RA is inherited from your parents.
Somewhat True. RA is seen in about .05% or 1 in 200, individuals in the US. Siblings or children of RA patients have a 4-fold higher risk, making their chances 2%, or 1 in 50. Clearly, factors other than genetics are important. Most RA patients have a same specific form of the gene HLA-DR. HLA genes were first discovered as critical factors in the process of “tissue typing” a donor and recipient of an organ transplant in order to prevent rejection. They determine the immune system’s ability to recognize infections as well as transplanted tissue. The DNA sequence of the gene predisposing to RA is referred to as the “shared epitope.” About 90% of patients carry the shared epitope form of HLA-DR. However, having the shared epitope does NOT automatically result in getting RA.
4. RA is caused by improper diet.
False. We still do not understand completely what the trigger is for setting off RA. For decades, researchers have looked for associations with diet as well as specific infections. No clear and consistent results have yet appeared. A distinct form of arthritis–gout– is clearly affected in part by diets that increase uric acid levels in the bloodstream. However, no simple associations have been found for RA.
5. RA treatment is effective
True. Until the late 1800s, RA was treatable only with opiates for pain and various tree barks containing the anti-inflammatory compound salicylate. However, Willow Bark and other products were subject to enormous variation in potency from season to season. This made safe and effective dosing very difficult. A critical advance was Bayer’s development of the process to synthesize Aspirin, a stable form of salicylate, which allowed consistent and accurate dosing. The next breakthrough came with the first use of cortisone for RA in the 1940’s at Mayo Clinic. In the 1980’s, Methotrexate was recognized as highly effective in most RA patients. In the last 15 years, over a dozen new medications have emerged for the treatment of RA, based on advances in our understanding of the biology of RA. These “biologic” medications can provide remarkable benefit, even to patients afflicted with severe RA inflammation.
6. Joint damage is inevitable in RA patients
No longer true. Typical deformities of RA, especially in the hands, have been well recognized for centuries. Constant and uncontrolled inflammation results in damage to cartilage, ligaments, and tendons. These structures maintain the stability joints. Unstable joints are gradually pulled out of their normal position during everyday activities. Most commonly, the fingers are pulled to the little finger side of the hand. Now, with more treatment options, most patients have sufficient control of inflammation to maintain normal function and prevent deformities, including the hands.
7. Lifestyle changes do not affect the course of RA
Rubbish! Studies have clearly shown that smokers have a much higher risk of developing more severe RA inflammation and disease progression. Obesity is a factor in all forms of arthritis, as extra weight creates higher stress forces on joints. Weight loss can reduce many symptoms in overweight patients, most impressively for patients with arthritis affecting the knees.
8. Weather affects day-to-day joint symptoms in RA.
True. In many forms of arthritis, some patients can literally “feel storms coming on.” This is due to changes in barometric pressure, which typically occur several hours prior to a storm. Most joints have a slight amount of negative pressure or suction that is affected by barometric pressure. Pressure changes in the joints can cause increased pain and stiffness.
9. RA is cured by changes in diet
Not so simple. Some dietary interventions are widely touted as miraculous (on the internet), but are completely unproven. Fish Oil supplements, on the other hand, have been shown to modestly improve symptoms and inflammation in RA. A high does of fish oil–6 to 9 capsules per day– has been found to decrease the number of painful joints by 20%. Whether the “juice is worth the squeeze” will vary among patients.
10. Pregnancy can cure RA
Not Exactly. But about 75% of women with RA do see a temporary remission of their RA during pregnancy, which unfortunately wears off following delivery. In years past, when treatments were few, this naturally led to some large families. The mechanism behind RA pregnancy remission is still not known. Researchers have ruled out the hormone changes of pregnancy as the reason. We recognize that pregnancy requires a critical resetting of the immune system, in order to prevent rejection of the fetus (which genetically is 50% foreign). It appears that HLA molecules are again involved. Specifically, the HLA differences between mother and father can predict which patients have a remission during pregnancy.
11. RA affects only the joints
False. In some patients, RA can affect other organs. Osteoporosis (weak, fragile bones) is seen more frequently in patients with RA. RA inflammation can occasionally attack internal organs including the lungs, skin, and eyes. Recently, it has been shown that chronic RA inflammation affects blood vessels and promotes atherosclerosis–including premature coronary artery disease. Finally, RA can increase risk for developing lymphoma–a malignancy involving the immune system. Each of these manifestations is seen more often in patients with poorly controlled RA.
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