Ins and Outs of Rheumatoid Arthritis

Pain, swelling, and stiffness – things you’re familiar with if you have 

rheumatoid arthritis (RA)

. You may wonder what causes these symptoms, how to treat them, and if alternative therapies can help.

In the WebMD webinar, “
Ins and Outs of Rheumatoid Arthritis,
” Stanley B. Cohen, MD, broke down all things RA, including people most often affected, risk factors for additional health issues when you have RA, and lifestyle habits that can help. 

Cohen is a clinical professor in the Department of Internal Medicine at the University of Texas Southwestern Medical School. He directs the rheumatology division of Texas Health Presbyterian Hospital in Dallas and serves as co-medical director of the Metroplex Clinical Research Center.

“People with untreated rheumatoid arthritis who have ongoing, active inflammation have a higher risk of cardiovascular outcomes, similar to diabetics,” he says.

“We’ve worked a great deal on things that we can manage, such as inflammation, hypertension, and elevated cholesterol. And we’ve been successful. Our therapies have shown a reduction in premature death risk and at this point, the mortality rates are more similar to the normal population.”

Poll Question

Cohen explained how lifestyle changes often help RA symptoms. A webinar poll found 31% of viewers used low-intensity exercises to reduce RA symptoms. Eating healthy foods and staying informed about RA were nearly tied for the second most common response.

Question: Lifestyle habits that ease my RA symptoms are:

• 
  Doing low-intensity exercises: 31%
• 
  Eating healthy foods: 28%
• 
  Staying informed: 26%
• 
  Not smoking: 9%
• 
  Having support from family and friends: 7%

Viewer Questions

Is the COVID vaccine linked to RA?

How does hydroxychloroquine work to help RA?

Do RA meds sometimes stop working after long-term use?

With any vaccine, adverse events occur. But in general, the answer is no, the COVID vaccine isn’t linked to RA and doesn’t cause it. Can it happen? Yes.

There’s some information showing that, rarely, after COVID vaccination, there have been some new cases of RA and other forms of inflammatory arthritis. We saw a handful of people, early only on in COVID, who developed musculoskeletal symptoms that often lasted for a few months and then resolved.

There probably are some cases, however, of actual RA that do develop. But I think the benefits of the vaccine far outweigh the risks.

Hydroxychloroquine works in a complicated way. It’s quite effective therapy for RA.

You have a normal immune system that helps you fight infection. But in RA, your immune system goes on autopilot. It starts to upregulate and won’t turn off. It keeps creating antibodies and leads to the development of disease.

We believe that hydroxychloroquine tries to turn off your overactive immune system.

Sometimes medications do stop working. We frequently cycle through therapies to continue to achieve low disease activity.

There’s probably a third of people who do great on their therapy and stay on it forever. But the other groups of people do require cycling of medication.

Why does RA often lead to mental health issues?

What other health conditions can look like RA?

What should you not do during an RA flare?

Having a chronic illness can be tied to anxiety and depression. The fact that you can’t function in your daily activities, or you may be limited in your ability to be productive at work, may cause issues with your mental health. 

Adults with arthritis are more likely to have anxiety or depression. Treating these mental health disorders can also help your arthritis treatment and management succeed.

Other types of inflammatory arthritis, like psoriatic arthritis, can mimic RA. People with lupus might have similar musculoskeletal complaints. Fibromyalgia, which isn’t associated with joint swelling, also has chronic musculoskeletal pain and fatigue like RA. And axial spondyloarthritis, which is an inflammation of your spine, can have peripheral joint involvement, too.

During an RA flare, you need a rest. You need to rest yourself and also rest your joints that are flaring. Don’t go to the gym and work out. Contact your provider and let them know you’re flaring. 

They may want to give you a short course of steroids, and they might modify your treatment. If you’re flaring, that says your treatment isn’t working.

Is it OK to drink alcohol when you have RA?

Is intermittent fasting helpful or hurtful for RA?

Can medical marijuana help RA?

With alcohol, moderation is fine. When we first started using methotrexate in the ‘80s, we said you can’t have any alcohol. But later studies show that moderate alcohol consumption isn’t a problem.

As for intermittent
fasting,
I don’t think there’s data saying it makes a long-term impact on RA. But it’s okay to pursue it. Weight reduction in people who are obese and don’t respond as well to medications can be helpful. If intermittent fasting helps this, then it can also help with RA.

I don’t think medical marijuana will help the inflammation. We have no data saying it can help with that. But from a pain standpoint, a stress standpoint, or an anxiety standpoint, it might have some benefit for RA.

Who Gets Rheumatoid Arthritis?

It’s unclear exactly why certain people get RA. But there are some 

factors

that put you at a higher risk:

Genetics. Your genes may put you at a higher risk for RA. 

“We know there are certain genes involved in the immune system which lead to regulation of the immune system. These are more common in people who have RA,” says Cohen.

Environment. Certain things in your environment may trigger RA. This could be something as simple as an infection, smoking, or being exposed to silica.

“One of the greatest risk factors for developing RA is smoking. If you have the genetic makeup for RA and you’re a smoker, your risk for developing RA is increased 20- to 40-fold,” he says. 

Treatment for Rheumatoid Arthritis

RA isn’t curable, but there are effective 

treatments

. The goals are to avoid damage to your joints, lower inflammation, lessen symptoms, and achieve remission. 

Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, disease-modifying antirheumatic drugs (DMARDs), and biologics can provide relief.

Lifestyle. Lifestyle changes can also help. They include:

• 
  Physical therapy
• 
  Occupational therapy
• 
  Quitting smoking
• 
  Losing weight (if you’re overweight or obese)
• 
  Eating a balanced diet
• 
  Getting social support
• 
  Staying informed
• 
  Reducing your stress
• 
  Doing low-impact exercises

In some cases, surgery may help. But one of the goals of proper treatment is to avoid that.

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Ins and Outs of Rheumatoid Arthritis

.”

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