Rheumatoid Arthritis: Primary care Initiative for improved Diagnosis and outcomes

Understanding Rheumatoid Arthritis: A Patient Primer

What is rheumatoid arthritis (RA)?RAisachronicconditionthatdamages thejointsofthebody.Chronicconditionsarelonglasting(greaterthan3 months),andtheydonotgoawayeasily orquickly.Morethantwiceasmany womenasmengetRA.Althoughit mayoccuratanyage,RAusuallystarts inpatientswhentheyarebetween30 and 60 years old. RA causes ongoing joint damage to many patients. To reduce damage and other complications, RA should be diagnosed and treated early, and optimally it should be managed throughout life. There is no known cure for RA, but effective treatments exist.

EarlysignsofRAinclude:

• Swelling,stiffness,aching,orpainofoneormorejoints

• Morningstiffnessthatlastsforatleast30minutesandoftenforseveralhours

• Difficultygraspingobjectsasstronglyasyouusedto

RAcommonlyaffectsthesmalljointsofthefingers,wrists,andfeet,butitmayalsoaffectotherjoints,includingtheankles,knees,hips,elbows,andshoulders.

• RAisNOTosteoarthritis(OA),a muchmore common condition whichgenerally develops with older age. It ispossible, however, to have both OA andRA together.

What causes RA?• ItisnotknownwhatcausesRA, butitisanautoimmune disease.Inpatients with an autoimmune disease,the immune system attacks one ormore of the body's organs or tissues.Thismeansthatthe bodyattacksitself.

• Normally,thebody’simmune systemfightsoffinfectionscaused byinvading bacteriaandviruses.

• InautoimmunediseaseslikeRA, thebodyattacks normaltissues,suchascellsin thejoints,as if they areforeignmicroorganisms,suchasbacteriaand viruses.

• Genes likely play a part in thedevelopment of RA, but most peoplewho develop RA do not have anyclose relatives with the condition.

Elbow

Hip

Wrist, hand, fingers

Knee

Ankle,foot,toes

Joints affected:

Parts of the body affected by RA

Other organs that may be affected if RA is not treated early:

Eyes:drynessanddamagetodelicatestructures

Lungs:muchgreaterriskofgettingseriousinfectionsandothercomplications

Heart disease:mayoccurabout10yearssoonerthaninpeoplewithoutRA

Stomach:higher riskofbleeding with some medications

Cancer: double the risk of some types of cancer, such as lymphoma. Increased vigilance is advisable.

Early diagnosis and treatment may prevent these complications.

Healthy joint

Damaged joint

Cutawayview

What are the symptoms?

Neck/Spine

Shoulder

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ofcartilageDestruction

Rheumatoid Arthritis: Primary care Initiative for improved Diagnosis and outcomes

What happens when RA causes an autoimmune response?Whenanimmuneresponseistriggered,inflammationoccursintheareasthatareattackedbytheimmunesystem.• Inflammationcausesrednessandwarmth,swelling,stiffness,

andpainintheaffectedjoints.• Iftheautoimmuneresponseisnotslowedorstopped,itcan

permanentlydamagetheaffectedjointsandothertissuesovertime.

Can RA be prevented or cured?Becausewedonotknowwhat causesRA, thereiscurrently no effective way to prevent the disease. Although there is no cure for RA, new drugs can help put the disease into remission(thatis,to“quietdown”thediseasesothatyoufeelbetteranddon’texperiencesystems or complications of RA).

Early diagnosis and early treatment are the best ways to fight RA• A proper diagnosis of RA, made as early as possible, is

the first step in treating the condition.• Treatmentis focused primarily on reducing inflammation and

relieving pain. RA treatment also aims at stopping or slowingdamage to joints and other parts of the body.

How can RA be controlled?TherehasbeengreatimprovementinthedrugsusedtotreatRA.• AclassofdrugsreferredtoasDMARDs (disease-modifying

anti-rheumaticdrugs)actstosloworstop RA from progressingto more advanced stages of the disease.

• ThegraphshowsthatwhenaDMARDisnotused(the linewithsquares),theproblemscausedbyRAincreaserapidly, especiallyinthefirst2years.

• However,whentreatedwithDMARDs(thelinewithdiamonds),thediseaseprogressesmuchmoreslowly,andfewerproblems occur.

70

60

50

40

30

20

10

00 4321 5

Years of Disease

Dise

ase

Prog

ress

Without DMARDs, problems increase rapidly

With DMARDs, fewer problems

Treatment with disease-modifying anti-rheumatic drugs (DMARDs) improves long-term outcomes

I have some pain in my joints. How can I tell if I have RA?Ifyouhavepaininyourjoints,youneedtotellyourhealthcare provider.Heorshewillexamineyouandaskthefollowing questions:– What joints hurt when you get out of bed in the morning?

– Whenisyourpainworst(morning or evening)?

– DoanymembersofyourfamilyhaveRA?– Doyousmoke? (smoking is associated with increased risk of RA)

– Signsthatmaysuggestotherreasonsforyourpain:• Fever Nightsweats or unexpected weight loss•• Rash,tickexposure • Recentcontactwithsickchildren

What happens next?IfyourhealthcareproviderthinksyoumayhaveRA,heorshewilllikely perform some blood tests, and possibly obtain some imaging studies like x-rays. Your provider may also prescribemedicationtoreducethepainandinflammationinthejoints.Heorshewillalsoreferyoutoarheumatologist (adoctorwhospecializesinRAandrelateddiseases).

If therheumatologistconfirmsthediagnosisofRA, he or she will likely prescribe appropriate medications like DMARDs to slow or stop the autoimmune process and joint damage, and he or she may order some additional blood work or x-rays. It is important to realize that no single blood test or x-ray is 100% accurate in making the diagnosis of RA. It very much depends on the clinical opinion of an expert like a rheumatologist.

Learn more about RARheumatoid Arthritis Resources and InformationThe American College of Rheumatology http://www.rheumatology.org/The Arthritis Foundation http://www.arthritis.org/Johns Hopkins Arthritis Centerhttp://www.hopkinsarthritis.org/patient-corner

How long does it take to feel as limber as you are going to feel for the day?–

– Can you:• Turn faucet handles?

Hold a hairbrush/toothbrush?•• Dress/bathe independently?

Depending on the extent of any joint damage caused by RA, you may be referred to a physical or occupational therapist, a podiatrist, or other physican specialist, such as an orthopedic surgeon.Many patients feel frightened and alone when they receive this diagnosis. Learning as much as you can about your disease and the possible treatment options can help you to feel more empowered and in control. Finding encouragement from fellow patients, patient advocacy groups, or other resources can make you feel supported and give you tools and tips for coping.

• Fix your own breakfast?•• Take a cap off a bottle?

Walk outside on flat ground?

– What are the things you cannot do because of your symptoms? – Before today, have you ever had other joint swelling?– How is your energy level?

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