Transcription:
Living with Rheumatoid Arthritis

Melanie Cole (Host):  Rheumatoid arthritis can be one of the most disabling types of arthritis. As an autoimmune disease that affects more than 1.3 million Americans every year, rheumatoid arthritis, or RA, can affect a person’s joints and many other parts of their bodies in different ways. My guest today is Dr. Lauren Kennish. She’s a Summit Medical Group rheumatologist. Welcome to the show, Dr. Kennish. Tell us a little bit about rheumatoid arthritis. What is it and what symptoms might a person have that would send them to the doctor?

Dr. Lauren Kennish (Guest):  Sure. Rheumatoid arthritis is an autoimmune disease. That is when your immune system, which is normally there to fight infections, instead gets an incorrect signal and can attack your own body’s cells, in this case, causing pain and inflammation in the joints. This is a type of inflammatory arthritis. It’s a chronic condition and is also systemic, which means it can affect the whole body and potentially causing lifelong symptoms. This is opposed to osteoarthritis, which is the more common type of arthritis that most people think of, which more affects older adults and is from wear and tear in the joints. With rheumatoid arthritis, it’s actually a younger person’s arthritis. It normally presents around age 30 to 60 and it’s more common in women. People with rheumatoid arthritis presents with pain, swelling, and stiffness, especially in the morning and their pain is worse in the morning in the joints and it affects the smaller joints of the body, such as the knuckles in the hand, the wrist, the feet, elbows, and ankles, and it’s symmetric, on both sides. People have a lot of trouble getting out of bed in the morning, have trouble doing things with their hands like buttoning. It’s very variable. It can be very mild, it can be very severe. The symptoms can be very intermittent or come in flares or wave. Sometimes, you might be feel better; sometimes, you might feel worse. If left untreated, it can only cause a lot of disability. This is the course that we want to prevent and what we can with modern treatment. 

Melanie:  Dr. Kennish, aside from the normal aches and pains that we all suffer every day, how do you diagnose somebody as having rheumatoid arthritis?

Dr. Kennish:  It can be hard to diagnose rheumatoid arthritis. Not one single test to make the diagnosis, so mainly it’s based on the types of symptoms that the person has and what joints are affected with pain, and especially swelling in the joints. A common symptom is stiffness in the morning greater than an hour usually. On exam, the doctor can see red, hot, or swollen joints that are difficult to move. We can do some blood tests to help with the diagnosis. This can be helpful in combination with the types of symptoms. We look for markers of an overactive immune system that can show particular antibodies that are associated with rheumatoid arthritis and markers of inflammation. Sometimes, imaging studies can be helpful as well, like x-rays, MRIs, or ultrasounds and then we try to differentiate rheumatoid arthritis which has different characteristics from other types of arthritis, such as osteoarthritis, as I mentioned. 

Melanie:  What’s the first line of defense? What do you do when you diagnose somebody with RA and you say, “Okay, this is different than osteoarthritis, we’re going to treat it now this way.” What’s your first line of defense? 

Dr. Kennish:  Initially, for quick relief, antiinflammatory can be helpful for symptoms. NSAIDs or things like ibuprofen or steroids or prednisone. These can be very helpful just to control the initial symptoms, but it’s not a good long-term relief because it really just masks the symptoms. The mainstay of treatment is really to get to the root of the problem by suppressing that overactive immune system and then decreasing the inflammation and the symptoms of arthritis. These medications are called disease-modifying agents. There are several medications, both oral and injection, that are very effective to help control the symptoms, but they do require close monitoring. The treatments overall are suppressive treatments. So far, we don’t have a cure for rheumatoid arthritis. Hopefully we’re getting close, but as of now, these treatments need to be taken usually in the long term. The key to treatment and success is to start early within the first few months of symptoms. The sooner you get the symptoms under control, the less likely you are to have damage to the joints. This is what we want to prevent and what we can with treatments we have available. The medications usually start as an oral medication; something such as methotrexate is a common example. There is a couple of other oral medications we can use, sometimes in combination, two or three together, that work in different ways to suppress that overactive immune system and the inflammation. If those don’t work, we can go to stronger types of medications called biologics, and these are usually injection medications that interrupt the inflammatory process at more precise points. In general, they make a bigger impact on the disease. Again, we have a few different types of medications to choose from now in this category; something like Enbrel or Humira are examples. We have also a new medication that is similar to these biologics, but it’s actually a pill version that targets inflammation from within the cell. It’s called Xeljanz. We have a lot of options now which is the important part and that people are able to live normal, active healthy lives without constant pain and swelling in the joints. As I said, the medications need to be taken usually long term and as directed. If you stop the medication, the symptoms may come back. As of now, we just have suppressive therapies, not curative, but hopefully a lot of research is being done and hopefully we’ll have that option in the future.

Melanie:  Dr. Kennish, what do you tell patients when they hear on TV, Trexall and Humira and Remicade and these sorts of medications, all the side effects that those commercials list. When they ask you about those and the fear of taking some of these medications, what do you tell them? 

Dr. Kennish:  Yes. You see a lot of commercials on TV nowadays for these medications may have to list all the potential side effects, and of course, we go over with each patient the potential side effects. Again, these are only potential. Most people do very well with these medications and if they do get any side effects, mostly it’s mild, something like stomach upset or rash or allergic reaction. The [main] potential side effects with all these medications are infection because they do suppress your immune system. The important thing is just to know the potential side effects and we go through that with all the patients and then get medical attention if you think anything is going on. We keep a close eye on our patients, doing routine blood tests every few months and follow-up visits to make sure that we’re not seeing any signs of side effects. If we do, the medication can always be reduced on the dose or potentially changed to something else that they may tolerate better. 

Melanie:  Now tell us about living with RA, managing the symptoms that you’re describing. How important do you think things like sleep and exercise, which can be good and bad in some respect for rheumatoid arthritis? Speak about living with and managing all of these symptoms. 

Dr. Kennish:  Yes, as I mentioned, it is a chronic disease, so people do have to live with it and hopefully these medications can make the symptoms more tolerable, but there’s a lot of things that people can do to help their day-to-day activities and make them more manageable. Definitely, exercise is probably one of the most important parts of therapy and we try to use a combination of medication therapy, as I discussed, and non-medication therapy. Exercise is definitely important for the non-medication therapy. It’s tailored to the person’s functional abilities. If they’re able to exercise on their own, we recommend things, lower impact like walking, biking, elliptical machines, and stretching and strengthening exercises like yoga and Pilates. If they’re not able to exercise on their own, physical therapy can be very helpful, targeting certain joints that are bothersome. Then there are things you can do at home for pain relief like heat to aching joints, topical pain creams. There are also alternative measures that sometimes can be tried like acupuncture. This may help for pain. It’s definitely important to maintain a healthy lifestyle. Not smoking is very important because smoking has definitely been shown to increase the incidents of rheumatoid arthritis and make it worse in someone who already has rheumatoid arthritis. Also, as you mentioned, sleep is important. Fatigue can be an important symptom of rheumatoid arthritis. As I mentioned, it’s a systemic disease. You get a lot of other potential side effects, and fatigue is a main one with rheumatoid arthritis. Making sure you get enough sleep and know your limitations, taking naps during the day if you have to. Try not to do too much all at once and kind of know what you can tolerate and when you need to rest. Also, reducing stress has been shown to help disease. Stress can sometimes flare symptoms, so trying to have ways to reduce stress like exercise, like a good social support, that’s important as well. A lot of people ask about what foods can they eat that may make rheumatoid arthritis better or worse. There’s no particular food that has been shown definitely to make symptoms go away or definitely make symptoms worse. It can be different in each patient. In general, we recommend eating healthy diet, low fat, low cholesterol, high in fruits, vegetables, antioxidants, something like a Mediterranean diet. Fish oil actually has been shown to have some antiinflammatory properties and help potentially reduce some of the symptoms in rheumatoid arthritis, again, in combination with medication therapy. Eating salmon a few times a week or taking a fish oil supplement may be beneficial as well. Then there are other things that have been shown to have some antiinflammatory properties like ginger, turmeric. Again, these are all healthy diet components so they may help improve some symptoms and they probably won’t hurt, but again, in combination with making sure the disease is under control. Usually with medications, these things can be helpful in addition. 

Melanie:  It’s really great information. In just the last minute, Dr. Kennish, your best advice for living with rheumatoid arthritis. 

Dr. Kennish:  Definitely to follow up with a rheumatologist regularly, making sure the disease is under control with some type of medication therapy. That’s really key to long-term success. It’s making sure symptoms are at a minimum. Then just trying to follow a healthy lifestyle, again, exercise is important, eating right and just letting the doctor know if you think there’s any issues with the medication or if your symptoms are getting worse, although we have so many medication options nowadays that we can try something else if your current regimen is not working. 

Melanie:  Thank you very much. You’re listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening and have a great day.