Early Treatment of Rheumatoid Arthritis is
Special to the
Journal By Robert J. Meador, Jr., MD
Rheumatoid arthritis (RA) is a chronic
autoimmune disease that affects 1.3 million Americans, the majority of whom are
women. RA is a particularly devastating disease that can lead to extensive
joint destruction. However, with early diagnosis and treatment the outlook for
people with RA has improved dramatically over the past 20 years.
What is rheumatoid arthritis?
When it is working normally the bodyÕs
immune system is designed to help us ward off disease. In the person with RA,
the immune system has become confused: rather than protecting the body, the
immune system attacks healthy tissue in the joints, which causes painful
inflammation. Over time this chronic inflammation causes crippling deformities
and can lead to other health problems, as well. RA can affect people of all
ages, including children.
What are the symptoms of RA?
The most telling symptom of RA is prolonged
morning stiffness, especially in the hands and feet. Other common symptoms
include swelling, pain, and a sensation of warmth in the joints. When these
symptoms occur, it is best to address them right away to prevent joint damage
before it occurs. If your care provider suspects RA, he or she may refer you to
a rheumatologist (a doctor who specializes in diagnosing and treating RA and
other autoimmune diseases). This can be important because an early and accurate
diagnosis will help establish a treatment plan tailored specifically for you.
How is RA diagnosed?
Diagnosing RA begins with a your medical
history and a physical exam. This is followed by a blood test to determine if
you have the rheumatoid factor, which is an antibody that most people with RA
have and which supports the diagnosis of RA. Your rheumatologist may also order
a blood test for antibodies to cyclic citrullinated
peptides (CCP), which can be found in the blood of a high percentage of those
with RA. The proper diagnosis of RA can be challenging because occasionally
these identifying antibodies are absent even if there is an inflammatory
process occurring. Increased chronic inflammation not only relates to RA, but it
can also be indicative of other conditions including heart disease. So when
there is an underlying inflammatory process occurring it is very important to
address it with your physician.
What is the treatment for RA?
Over the last two decades there has been a
paradigm shift in how we treat RA. Historically the accepted approach was to
wait until damage to the joint occurred before initiating treatment. Now, with
a number of medications specifically targeted to treat the immune system, we
are better able to reduce inflammation and prevent joint destruction and
deformities from occurring. These new medications can induce remission of RA
and hopefully heal damage that may have already occurred. In addition to
medication, I recommend that people with RA quit tobacco use, get regular
exercise, learn to reduce the stress in their lives, and get plenty of rest.
All of these steps positively support the treatment process. This approach to
treatment enables people with an early diagnosis of RA to return to a healthy
state and prevent the kind of joint damage that leads to joint replacement
Do rheumatologists treat only arthritis?
Rheumatologists routinely treat a number of
conditions of the musculoskeletal and immune systems. Most commonly we treat
patients with RA, osteoarthritis, lupus, psoriatic arthritis, fibromyalgia,
ankylosing spondylitis (an immune condition that attacks the spine), and
Dr. Meador is board
certified in internal medicine and rheumatology. He is on the medical staff of
Cayuga Medical Center and is in practice with Cayuga Medical Associates, where
he can be reached at (607) 257-2920. In addition to rheumatology, Dr. Meador
has fellowship training in geriatrics and palliative care.