Rheumatoid arthritis  (RA) affects 1.3 million Americans, representing about 1% of the US population. The Arthritis Foundation estimates that the  global prevalence of RA is 0.5-1%  in developed countries. RA is an  autoimmune disorder and occurs  when your immune system mistakenly attacks one’s own body’s tissues.  This affects the lining of one’s joints, causing a painful swelling that can  eventually result in bone erosion and  joint deformity. Often, there is pain  and swelling of the fingers as well  as prolonged stiffness especially in  the morning. RA develops gradually  over many weeks to months. While it  usually begins between ages 40 and  60, a similar disease can present in  teenage children and is called Juvenile  Rheumatoid Arthritis.

RA is diagnosed with medical  history, physical examination, and  blood testing. Blood testing includes  markers of inflammation (Erythrocyte  sedimentation rate and C reactive  protein) and antibodies (Rheumatoid factor and anti-cyclic citrullinated  peptide antibody). X-rays of hands and  feet can show weak bones with damage,  or erosions in certain areas. One must  see a rheumatologist early to get RA in  good control. 

Treatment of RA has greatly improved  during the last three decades.  Initial treatment of RA includes  pain medications which are not  disease-modifying drugs. Another  method of initial treatment includes steroids taken by mouth to control inflammation in joints in RA. Steroids are associated with many side effects with long-term use, including weak bones (osteoporosis), diabetes, high blood pressure, stomach ulcers,  dead bone (avascular necrosis), increased risks of stroke and  heart disease. Steroids should only be used initially in RA  management for rapid response, but it is advisable to taper  quickly to the lowest effective dose and stop within a few  weeks.  

Rheumatoid arthritis should be managed by disease-modifying  anti-rheumatic drugs (DMARDs) as soon as possible to prevent  irreversible damage. Usually, patients are given DMARDs  like Methotrexate, Hydroxychloroquine, Sulfasalazine and  leflunomide. These medications have been used for many years  to control RA but have not been successful in achieving full  remission (control of disease) in all patients.

The most significant improvement in RA treatment has been  the discovery of biologics. Biologics target certain chemicals  or cells in the immune system which are causing damage to  joints. These medications have made remission (full control of  disease) possible and have made a great impact on improving  quality of life in RA. Physical therapy, occupational therapy,  steroid injections in the joints and weight control can also have a beneficial effect on RA. There is significant interest  about changing diet in RA to see improvement, and studies  have shown improvement with fish oil capsules along with  continued medications.  

The Center of Excellence of Arthritis and Rheumatology  (CEAR) at LSU Health Shreveport has been actively involved  in many research projects involving use of biologics in RA. We  are participating in many ongoing drug trials to discover more  biologics for treatment of this chronic and disabling disease.  Because of a lack of availability of good biologic medications in  the past, RA patients have suffered from chronic deformities  and disabilities. With the advancement of biologics treatment,  the patient has full control of their disease with almost no  irreversible damage to their joints. These are fascinating and  encouraging times for patients and rheumatologists, as this  treatment has had excellent clinical response.  

If you or a loved one is experiencing these joint symptoms,  consult with your doctor as soon as possible, and you may  request a rheumatology referral. An early referral to a  specialist is key to prevent irreversible joint damage and control the disease with prompt management. 

Sarwat Umer, MD, is an Associate Program Director of the Rheumatology Fellowship with the Center of Excellence for Arthritis and Rheumatology and a Professor of medicine and pediatrics at LSU Health Shreveport.