Is Rheumatoid Arthritis Preventable?
Affecting more than 1.3 million Americans (and as much as 1% of the world’s population), rheumatoid arthritis (RA) is one of the more common autoimmune disorders and chronic illnesses in the United States. This health condition involves long-term swelling, stiffness, pain and redness in multiple joints, and these symptoms may permanently damage those joints. RA can also affect other bodily systems as it progresses.
While RA can become debilitating, effective treatment can slow the progression of the disease and lessen the severity of symptoms. Understanding prevention and its possibilities in the context of RA can help you learn what to expect from treatment and guide the decisions that you and your doctor make to facilitate long-term management of this condition.
Rheumatoid Arthritis and the Possibilities of Prevention
When many people talk about arthritis, they’re referring to osteoarthritis — a condition that differs from RA in both its causes and its effects. Osteoarthritis develops when a physical breakdown of your joints occurs. The cartilage, which normally serves as a cushion between the bones that make up a joint and facilitates smooth movement of that joint, wears down over time. This causes the bones to rub against each other and against newly exposed nerves as the joint articulates because there’s no cartilage left. Osteoarthritis is a degenerative disease, meaning it’s the result of continuous physical processes (in this case, movement) that break down the joint material.
In contrast, RA is an autoimmune condition, not a degenerative one. When you have an autoimmune disease, your immune system mistakenly interprets healthy body parts as threats and goes to work trying to eliminate them. Normally, it’s your immune system’s job to detect germs like bacteria and viruses — germs that can cause harm to your body — and send out special cells to dismantle and get rid of the pathogens before they have a chance to make you seriously ill. When you have an autoimmune disorder, however, your immune system "sees" healthy organs, systems or areas the same way it does pathogens and attempts to remove their cells. In the case of RA, your immune system misinterprets your joints’ synovia — the soft linings around those joints — as a threat and sends out proteins called autoantibodies to attack the synovial cells.
As a result of these protein attacks, the synovia, which normally produce a viscous fluid that fills hollow spaces in your joints to limit friction, swells and thickens. This swelling causes the synovia to produce more fluid, and this liquid overfills and surrounds the joints and creates even more inflammation, along with stiffness and pain. Unfortunately, researchers still don’t fully understand why autoimmune diseases like RA happen in the first place. And because they can’t pinpoint a cause or trigger, it’s impossible to know how to prevent RA — stopping it before it starts requires knowing how and why it starts. Though RA’s onset can’t be prevented, with proper treatment you may be able to prevent debilitating pain and other symptoms from developing or worsening.
Managing Rheumatoid Arthritis Symptoms and Complications
RA is a chronic disease that cannot be cured. However, the complications of RA — in particular its characteristic bone loss that can cause life-altering pain and disability — can become easier to manage with the right medications and lifestyle changes. With effective diagnosis and medical management from a skilled physician, it’s possible to control your symptoms of RA.
Telling your doctor if you have family members with RA is a very important step in preventing severe manifestations of this disease. It’s also important for giving your doctor a clear picture of your medical history and health, and it may set the stage for important preventative care. If you have a strong family history of RA, you have a higher likelihood of developing the disease, too. Your doctor may want to test you for rheumatoid factor or anti-CCP antibody in your blood as a precautionary measure before you start experiencing symptoms such as pain and swelling in your joints. The presence of these proteins and antibodies is associated with the development of autoimmune diseases and RA. The earlier your doctor detects RA and begins your treatment, the better your chances are at mitigating symptoms. In some cases, early treatment can even prevent irreversible bone loss from occurring, according to New York’s Hospital for Special Surgery.
This early detection and treatment of RA can help you prevent some of the significant pain and joint symptoms typical of the disease, which can be debilitating. In most situations RA affects people gradually, beginning with subtle pain and escalating into severe symptoms as the condition worsens. To prevent this progression of joint and bone damage, it’s important to follow your doctor’s treatment plan. This may include a combination of physical therapy, light strength training, diet changes and medications. If you have a strong family history of RA your doctor may put you on an RA treatment plan as a preventative measure, even if you don’t have symptoms yet. Medication is an important part of RA management but is rarely the only element of managing your symptoms.
People with RA may develop vision problems as a result of complications from this disease. Symptoms can range from mild dry eye to retinal detachment, retinal vasculitis and blindness. If you’ve been diagnosed with RA you should ensure that you continue regular follow-ups with an ophthalmologist. You should see a doctor immediately if you notice your vision changing, and make sure you mention you have RA. Your ophthalmologist or RA physician may also want to double-check whether you have any other conditions that can cause vision problems, such as diabetes.
The Impact and Importance of Diet and Lifestyle Choices
If you have RA, there are several lifestyle choices you can make that may reduce the severity of some of your symptoms. People with RA should quit smoking, which has been found to trigger and sometimes worsen disease symptoms. Your doctor may refer you to a dietician to make sure that you’re taking effective supplements for your cartilage, bones and joints.
Certain foods, such as those that are high in fat, can make symptoms worse. Each person’s symptoms will vary, and over time you may identify specific foods that exacerbate your RA. It can help to keep a food journal to determine any patterns in your eating habits and a worsening in the severity and type of your symptoms.
Make sure that your diet is well balanced. If you lose energy, you may find it more difficult to keep up with your therapy and exercise, and you may lose strength and flexibility as a result. Weight gain increases the stress put on your joints, which can also increase your pain. Losing weight may improve your pain. Your doctor can help you better manage your weight through diet if you find exercise with RA difficult.
If you’re able to exercise — even if you start very slowly — your physician will likely recommend diet changes and an exercise or physical therapy routine that focuses on strength training, improving your range of motion, and developing more flexibility and stamina. Your doctor may also ask you to start taking walks or using certain machines at the gym.
Treating Rheumatoid Arthritis With Medication
You may be able to prevent the symptoms of RA from intensifying with medication, which can help with pain and flare-ups. A specialist physician called a rheumatologist typically oversees this medical management of RA, although some primary care physicians feel comfortable starting medication therapy themselves. Not every therapy works the same for everyone, and some people might have a better response to medication than others. Once you start medications, it’s important to discuss changes in your pain and joint symptoms with your doctor, as this will play a part in developing a regimen that’s ideal for you.
The backbone of RA management is a combination of therapy and medications. Because there is no cure for RA, doctors use medications to relieve RA symptoms and minimize the potential for future damage. Anti-inflammatory drugs like ibuprofen, antimalarial medications and corticosteroids are common. Other medications that have been shown to slow RA disease progression include immunomodulators called disease-modifying antirheumatic drugs (DMARDS), which inhibit the uncontrolled immune response that leads to the joint erosion and pain typical of RA.
Can Surgery Help People With Rheumatoid Arthritis?
Some people whose joints have extensive damage from RA may need surgery to alleviate their joint pain and improve their mobility. This can include total joint replacement in which some or all of an affected joint is removed and replaced with a prosthesis.
It’s important to note that joint replacements in people with RA can be a challenge. Those patients are at an increased risk of experiencing complications — such as infections and poor wound healing, which are more common with hip and knee replacements in people with RA — after these types of surgeries. This may happen due to the medications people with RA often take, which suppress their immune systems’ functions.
Joint replacements are also not guaranteed to completely resolve or relieve pain. Bone deformities that have developed due to RA may also need correction during this type of procedure. You should consult a board-certified orthopaedic surgeon who is a total joint replacement specialist to see if you’re a candidate for these procedures.