Jan 17, 2019
Humans have walked the Earth for nearly six million years, so you can be sure arthritis isn’t anything new. Even our earliest ancestors suffered through their fair share of stiff, aching joints. The struggle to remain flexible and mobile can become more difficult as we age—and some form of joint disease is usually the culprit, especially arthritis.
Not all arthritis is the same.
There are more than 100 different types of arthritis. All together, they affect about 50 million adults in the United States—making it the leading form of disability.
“Osteoarthritis is the most common form of disease,” says Ho “Bing” Oei, MD, a board-certified rheumatologist at the USMD Las Colinas Clinic. “It occurs when the cartilage that cushions the bones in your joints thins out and eventually leaves bone rubbing bone. Roughly 30 million people suffer from osteoarthritis in the United States. Some individuals with osteoarthritis will get knee or hip replacements.”
Rheumatoid arthritis—commonly known as RA—is very different.
Rather than experiencing grinding bone-on-bone pain that becomes worse with continued movement, individuals who suffer from RA usually experience swelling and stiffness in their joints—most often in the hands and feet. Symptoms are usually worse in the morning or following long periods of being sedentary. “The stiffness gets better as you move around,” Dr. Oei adds. “Eventually, patients may notice swollen, spongy joints that are tender to push on as the disease continue to progress.”
Unlike osteoarthritis caused by degradation of the cartilage between the bones of your joints, rheumatoid arthritis is a systemic, multi-organ autoimmune disease. “Your immune system becomes confused. Instead of defending your body against bacteria and viruses, it attacks your body—particularly your joints, but it can also attack your lungs, heart, eyes, and other organs.”
The trigger effect: genetics versus environment.
Scientists aren’t exactly sure what triggers rheumatoid arthritis, but they have clues.
“We know genetics are involved. Individuals with certain genes can have an increased risk for RA,” Dr. Oei says. “People of Caucasian and Native American ethnicity are more likely to suffer from the disease. Women are affected by rheumatoid arthritis at a rate of two to three times that of men. Although patients who do have genes that can increase their risk for rheumatoid arthritis may not necessarily get the disease.”
There are also certain environmental triggers that are highly associated with rheumatoid arthritis. Lifestyle choices can open the door to RA. Smoking is a big one. “If you are a smoker who also happens to have a high risk RA gene, your risk for developing rheumatoid arthritis is greater than 50 percent,” Dr. Oei advises.
Researchers are also exploring the connection between RA and specific gut bacteria.
Early detection is important.
With so much information still unknown about RA, early detection is especially important. “While there is no cure for RA, treatment can control it. In some cases, treatment can put it into a remission state if it’s diagnosed and treated early,” says Dr. Oei. “Otherwise, RA can turn into a wildfire and ravage the body.”
Some people with RA will just have joint involvement, but a significant number of individuals will experience organ damage if it goes untreated. “About 20 to 40 percent of RA patients will experience lung damage. We’ve also seen heart damage in about 30 percent of RA sufferers, including RA in their cardiac lining.”
Rheumatoid arthritis also increases the risk for cancer of some sort 3.5 times that of the general population—with blood, skin, and lung cancers having higher rates. People with RA can have their life span shortened by five to 10 years.
“That’s why it’s important to be aggressive in treating the disease,” Dr. Oei says. “In studies, we’re finding that the earlier and more aggressive you are in treating RA, the more likely you’ll be able to control it and put it into remission. If you have a family history of RA or any autoimmune disease you should pay more attention to your joints and any profound stiffness in the morning. Unfortunately, by the time a patient sees a rheumatologist, they’ve often lost a lot of time in treating it.”
Don’t blow off symptoms.
“If you have inflammatory joint pain that gets worse with rest, but better as you move throughout the day, have a conversation with your primary care physician,” Dr. Oei advises. “Your care provider may order some initial blood tests. The tests check for inflammation in the blood. Certain antibodies are associated with RA. If these antibodies are elevated and you have swollen joints, then that indicates you have a higher risk for RA and your primary care provider will likely refer you to a rheumatologist.”
If you notice an unusual rash or feel ill accompanied with joint pain not attributed to anything else, get it checked out. Although RA has been diagnosed in people as young as their teens, it most commonly shows up in individuals 40 to 50 years old, and then in seniors 70 and older.
Good treatments are available.
Unlike nearly two decades ago, it’s rare to see someone today who can’t use their joints because they’ve become painfully deformed by RA.
“Twenty years ago, we didn’t have a whole lot of stuff to work with,” says Dr. Oei. “Over the past 20 years, we’ve discovered different pathways in the immune system. These discoveries have resulted in new medications.”
The first biologic RA medication came out in 1999 and blocked tumor necrosis factor pathways. Since then, other pathways have been discovered, offering more treatment options—which is good since every individual’s body chemistry is unique. While a biologic like Humira is an effective treatment for many, it may not work for everyone.
“RA’s not like a single disease where everything is the same,” Dr. Oei explains. “Different individuals have different pathways that are susceptible to attack. Not every medicine works on all individuals.”
Methotrexate is often the starting point. “If patients do not respond to that, then we move on to the biologic agents,” says Dr. Oei. “RA sufferers have to be patient. We may have to try several medications to find the right pathway that needs to be blocked in that individual, but it’s very rare that we don’t find something that works for someone. There’s no cure for RA, but we can certainly control it and try to put it in a remission state—which is good news for individuals diagnosed with rheumatoid arthritis.
Do you suffer from joint swelling, pain and stiffness? Dr. Oei is here to help. Read more about him, or call 972.556.1616 to schedule an appointment.