The Battle Against Rheumatoid Arthritis Progression

Rheumatoid arthritis (RA) is a chronic inflammatory condition. It’s an autoimmune disorder, meaning your body attacks its own tissues. It especially affects the lining of your joints. RA can first appear at any age, though it is most common in your 40s, 50s, or 60s.

Because it is a progressive condition, meaning it causes more damage to your body over time, it’s important to get treatment for RA right away. Alireza Meysami, MD, is the division head of rheumatology at the Henry Ford Health System in Detroit. “When the whole thing starts, the train has left the station,” he says. “The sooner we can treat these patients, the better we can control the symptoms and the progression of the disease.”

There is no cure for RA, but there are ways to slow it down.

People with RA often alternate between bouts of increased disease activity, called flares, and periods when their pain and swelling goes down or even disappears, called remission.

During a flare, your regular medications may not seem to be working and you may feel worn out, sensitive, or just plain crummy. Flares may be triggered by many things, including:

• Infection or illness
• Cigarette smoking
• Physical or emotional stress
• Medication changes
• Overexertion
• Poor sleep
• Certain foods

Flare-ups can be disruptive. By staying in tune with your body and keeping an eye out for possible triggers, you can recognize a flare as quickly as possible. “Patients usually remember the first time they [felt] the disease,” Meysami says. “The flare-ups usually resemble the first attack.”

This might include feeling more tired. You may feel that familiar joint pain or stiffness, most commonly in your hands or feet. “[Some patients] wake up in the morning, put their foot down, and feel like they’re walking on glass,” Meysami says.

Pain can come from other sources, too. Many people with RA have other conditions that can also cause chronic pain, like osteoarthritis or fibromyalgia. It can be hard to know what your baseline is when you aren’t used to being pain-free. You could also have inflammation from an infection, or even normal everyday pain from an active job.

“One of my patients is a chef,” Sammut says. “He has rheumatoid arthritis that is very well controlled. But at the end of the day, after working, and holding heavy pots, his hands and fingers can become quite achy. But that is not from rheumatoid arthritis; that’s related to what he’s doing.”

If your pain is worse in the morning, or it comes with stiffness or swelling, it is likely RA-related. By listening to your body’s cues, you can learn how to judge the source of your pain.

Research has shown that early treatment with disease-modifying antirheumatic drugs (DMARDs) is the best bet for keeping RA in check.

Medications to treat RA include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
• Corticosteroids, such as prednisone
• Conventional DMARDs, which can slow RA progression and possibly save the joints from permanent damage
• Biologic agents, a newer class of DMARDs. They target chemicals that cause inflammation. They relieve symptoms and can limit joint damage
• JAK inhibitors, which can be used if other medications aren’t working

Stick with your medications. Stopping meds is a big reason for flare-ups, Meysami says. “Most of the treatments for rheumatoid arthritis, unfortunately, have side effects,” he says. “That sometimes is very scary to the patient, to the point that they are hesitant to take their medication as prescribed, or even at all.”

If you feel that your medication is not working and you’ve been on it for less than a few months, be patient. “On average,” Meysami adds, “most of the rheumatology medication takes about 10-12 weeks to start to work.”

“What we put in our body actually has a lot to do with our inflammation, our immune system, and metabolic disease,” Meysami says. Many people have found that certain foods cause them to flare up. Sugar, alcohol, and red meat are commonly reported triggers.

Eating too much processed sugar can cause the body to become more inflamed. If you have RA, this will make it worse. “Sugar — based on my experience, and there’s some small research supporting that — seems to be the fuel for inflammation,” Meysami says.

Other foods have been shown to reduce symptoms in some people. These are often referred to as “anti-inflammatory foods.” These include fish, berries, leafy greens, and extra-virgin olive oil. “I usually recommend my patients follow Mediterranean diets,” Meysami says. These foods have lots of other benefits to your body as well.

Meysami also recommends turmeric, a spice that has been used in medicine for thousands of years. Its active ingredient, curcumin, is widely recognized for its anti-inflammatory properties.

But, Sammut says, there is no single magical anti-inflammatory diet that works for everyone. The most important thing is to tailor diets to individual patients. “Everyone has such a different metabolism. Mediterranean diets, in general, are a healthy diet, so it’s a good diet to follow. But it may not work for everyone.”

Sammut often sends her patients to a nutritionist who can create a program specifically designed for that person’s needs, lifestyle, and any other conditions they might have.

Pain and poor mental health are linked. “Having anxiety and depression is very, very common as part of having to deal with a chronic disease,” Sammut says. “In pretty much all of our patients, we screen for that.”

If left unchecked, the pain and discomfort caused by RA can have a profound negative effect on your mental health. If you are anxious or depressed, it’s harder to take care of your physical health. Untreated depression can even make RA treatments less effective.

Stress and anxiety can also worsen RA, Meysami says. “How many times have I seen a patient come in, going through difficulty in life — say divorce, loss of job, COVID distress — and their rheumatoid arthritis is flaring up?”

To battle RA most effectively, it’s important to address both your physical and emotional health head-on. Talk to your doctor about any stress, anxiety, or depression you may feel.

In addition to taking medications, it’s critical to get regular exercise to keep RA symptoms at bay and help keep you mentally healthy.

“It’s important to keep the muscles strong, because it takes pressure off the joints,” says Sammut. “Exercising also decreases inflammation.” One of her patients was a fitness instructor, and when he started teaching classes, he said it helped his RA so much that he was able to reduce his medications.

If you have mobility issues, it’s important to see a physical or occupational therapist who can show you how to do exercises to keep your joints flexible. They can also help you find ways to make daily tasks easier on your joints.

Ultimately, simply moving your body around is the first goal. “It could mean something like sitting on a chair and lifting your arms,” Sammut says. “Everyone has to go at their own rate.” But the more you can safely move your body, the better.

“A person with rheumatoid arthritis has joint pain, and they might try to avoid using that joint because of pain,” Meysami says. “But if they don’t use the joint, they lose it.” Keeping joints strong is critical for controlling RA.

Certain habits can speed up RA progression. Do not smoke. Cigarettes can worsen symptoms and make it harder to stay active. “Smoking increases the risk of getting rheumatoid arthritis by 1.8 times, especially if you smoke more than 20 packs per year,” Meysami says. “Unfortunately, that risk factor remains with the smoker even 10 to 20 years after quitting.”

Smoking also puts you at risk of more severe RA, Sammut says. “Rheumatoid arthritis can be very mild, or can be super aggressive, or anything in between,” she says. “For people who smoke, they’re more prone to having the more aggressive forms.”

Body weight is another factor in RA. Increased body weight puts more physical stress on your joints. For every pound you gain, you add 4 pounds of pressure on your knee with each step you take. This can be particularly dangerous if you do not lead an active lifestyle.

If you have a higher body weight, you need to take extra care to keep your body strong so your joints are not put under stress. But weight loss, even a small amount, will make your journey easier. “There are some studies that show that for people who are overweight, when they lose 10% of their body weight, their pain in their knees gets better by 50%,” Sammut says.

On top of the physical risk of damage, Sammut says that high body fat itself can worsen the damage done by RA. “Adipose tissue, [or] fatty tissue, actually gives off inflammation,” she says. Losing weight is not a silver bullet, but it can go a long way in reducing inflammation and making you feel better overall.

You don’t have to live with chronic pain. “In having rheumatoid arthritis, the goal should be to wake up in the morning and not even think about it,” Sammut says. “Early help is really important.”

RA can be serious, but it is very treatable. By sticking with it, Meysami says, you and your rheumatologist can find a solution together. “It’s just a matter of finding the [treatment] that works for an individual patient.”