Rheumatoid Arthritis (RA)

Rheumatoid Arthritis (RA), according to an article in WebMD (5/2018), isn’t our grandparents’ arthritis. This form of arthritis is based in our autoimmune system.

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 Inflammation is the driving force behind many major disorders and rheumatoid arthritis is only one of them.  In a publication by the Arthritis Foundation (Vol.10, Issue 2),  RA Today – The theory is that when a person is genetically predisposed to develop RA, and when the inflammation from that disease flares, the increased inflammation is equivalent to a single match igniting lots of other fires in our body.

Systemic inflammation usually begins when our immune system pumps out inflammatory proteins (cytokines) when not needed.  Normally, our body releases a type of cytokines called TNF (tissue-necrotic factor).  TNF is released when our body is hurt or we have an infection.  TNF acts as a “troop leader” that recruits other cytokines into action.  This recruitment leads to an inflammation cascade that helps to fight off serious infections.   However, when TNF is called out without reason, the inflammation becomes destructive.

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 The article in RA Today states that rheumatoid arthritis occurs when immune cells invade our joints and start churning out TNF.  This invasion not only destroys the joints but other parts of our bodies as well, such as connective tissue i.e. muscles, tendons and ligaments around the joints.  This may be why people who have rheumatoid arthritis are also diagnosed with fibromyalgia.  TNF is mainly produced in fat cells. Yes, fat cells.  Now we all have another reason to maintain a healthy weight and live a healthy lifestyle.

There’s discussion around the issue of what causes RA.  Newer studies point to disruptions in the microbes – bacteria, yeasts and fungi – that play critical roles in regulating the immune system.  Other researchers document a genetic component; that is if your parent or grandparent had RA you have a greater chance of being diagnosed with RA.  Still other studies point to stress being the main culprit targeting and disrupting the immune system. Whatever the cause, RA is variable because it’s autoimmune.  Meaning that symptoms can “come and go” and it can be diagnosed in both children and adults.  One thing is certain, RA can affect every organ of the body – eyes, mouth, skin, heart, kidneys, lungs, etc.  The most debilitating symptom is fatigue.  Up to 98% of people with RA report that they suffer from this “RA fatigue.”

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 Sleeping will not satisfy this fatigue although rest will help you stay healthier.  This type of fatigue can be relieved, in part, by medication because the medication brings down the inflammation.   If you’re diagnosed with RA there are some steps that you can take to foster better health for yourself.  The first is to maintain contact with good medical providers who are involved in your care.  This is a vital step.  Getting evidence-based, medically-accepted care early in your treatment process is important in managing your care.  Another wise step is to stop smoking or using tobacco products if you are currently doing so.  Also maintaining a healthy weight by eating a balanced diet and exercising to tolerance is helpful. Research shows that people with RA who are obese are more likely to develop type 2 diabetes.

New drugs are also on the horizon.  Disease-modifying antirheumatic drugs (DMARDs) are effective but must be used under the direction of a medical provider.  Some new biologics have been shown to be extremely effective in reducing inflammation, halting joint destruction and easing pain.  The number of patients undergoing joint replacements in the last two decades for RA has decreased dramatically.

Arthritis Today states in an article entitled “Chronic Pain & The Brain” (Sept/Oct 2018) that patients with RA show the same brain changes for heightened pain sensitivity as people diagnosed with fibromyalgia.  Both patients have the same “pro-pain” changes.  This change occurs in the central nervous system (CNS) – the brain and spinal cord – where pain signals are processed.  This accounts for the fact that many people with RA have pain even when their inflammation is well controlled with medication.

Dr. M. Elaine Husni, director of the Arthritis Center at Cleveland Clinic, says: The earlier you start treatment, the better the response.

 

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