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Scott Webb: There are a few types of arthritis and rheumatoid arthritis is an autoimmune condition of the joints that is. And treatable and joining me today to explain rheumatoid arthritis and the latest treatment medications is Dr. Aasim Rehman. He's a rheumatologist with Genesis. This is Sounds of Good Health with Genesis brought to you by Genesis Healthcare System. I'm Scott Webb, Doctor. Thanks so much for your time today. Sadly at 54 years old, I'm familiar with arthritis, but I'm less familiar with rheumatoid arthritis. So great to have your expertise today. What is rheumatoid arthritis?

Dr. Aasim Rehman: Rheumatoid arthritis. As the name says, it's a type of arthritis. Arthritis actually means anytime we have issues with a joint, especially joint pains, that is called arthritis. So it's a very generic term, and there are multiple different types of arthritis. The most common type of arthritis is your regular wear anti arthritis, which is the osteoarthritis. But then another common kind of arthritis is rheumatoid arthritis. Rheumatoid arthritis is a type of autoimmune condition. Autoimmune conditions are conditions in which your own immune system, which is your body's defense mechanism, it starts acting against you. So your body is fighting itself and you can have multiple different autoimmune conditions.

You can have autoimmune conditions of the joints like rheumatoid arthritis of the skin leading to rashes, autoimmune liver problems, autoimmune thyroid problems. So rheumatoid arthritis is an autoimmune condition of the joints in which your immune system is attacking. Essentially the lining of the joints. Mostly the peripheral joints, the hands, the feet, the wrist and ankles are the common targets. It can also affect the larger joints.

Scott Webb: Yeah, and I'm definitely familiar with the wear and tear version of arthritis, but what are the symptoms for rheumatoid? Are they similar? Does it manifest similarly as the wear and tear osteoarthritis?

Dr. Aasim Rehman: Joint pain is a common symptom, osteoarthritis and rheumatoid arthritis, both present with joint pains. But then some of the presentation for osteoarthritis and rheumatoid arthritis is a little different. Rheumatoid arthritis being an autoimmune condition in which inflammation is the primary process. It leads to more swelling in the joints, more stiffness in the joints, some warmth as well, sometimes some redness as well. And the stiffness is significant when you compare that to osteoarthritis, the aches and pains in osteoarthritis are usually worse when you're more active, they're worse at the end of the day.

And you're not as stiff in the morning. You are stiff, but just not for as long. When you compare that with rheumatoid arthritis, you have more symptoms when you are inactive, you tend to get a little bit better when you start moving around and your stiffness lasts longer compared to osteoarthritis.

Scott Webb: Yeah. When we think about rheumatoid and diagnosing it, is it just something when you sort of take a patient history, when you speak with a patient you're able to differentiate between osteo and rheumatoid or there's some actual tests and things involved?

Dr. Aasim Rehman: So history and examination for any medical conditions are better amount. Definitely history and examination give us clues just like I said, they both sometimes present a little differently. So those are important clues to pick from your history. On examination, we can appreciate swelling in the joints tenderness, that can help us. But yes, we do have tests available for rheumatoid arthritis and that help us in diagnosing rheumatoid arthritis. Although there are some cases in which, you can have rheumatoid arthritis, even with negative tests.

And on the flip side, sometimes you do have positive tests for rheumatoid arthritis, but you do not have active inflammation in the joint. So you may have a positive test and not have active rheumatoid arthritis. And that is where your history and examination help us in nailing the diagnosis.

Scott Webb: Yeah, you see why those would be important and wondering, are there things that we do to ourselves? I find when I host these and speak with experts like yourself, that I find that we do a lot of stuff to ourselves, whether that's behavior, lifestyle, choices that we make, but in terms of the risk factor for rheumatoid arthritis. What are they?

Dr. Aasim Rehman: Being an autoimmune condition, if you do have a family history of rheumatoid arthritis that would increase your risk of having rheumatoid arthritis, you are just genetically predisposed. We usually talk about, a two hit theory and that essentially means that you have a genetic predisposition to develop a certain condition and then you get another environmental hit and that kind of triggers the disease. So you may have a family in which you have, one parent or a set of parents who have rheumatoid, but not all the children would have rheumatoid arthritis or any other autoimmune condition. And that is where the second hit theory comes in with.

Some of them may get the second hit from the. Now, where do we get that second hit from? We don't know, is it something we eat? Is it something we breath? We are constantly interacting with our environment and what triggers our immune system, which just takes it off. We don't know. But yes, if you have a family history of it, yes, that would increase your risk. And again, there are studies that have shown that people who have been diagnosed with rheumatoid arthritis sometimes, smoking can increase their risk and they do not respond to their medications as well. So that is considered as an environmental hit as well.

Scott Webb: So let's talk about some of the complications that can develop with untreated rheumatoid arthritis.

Dr. Aasim Rehman: Going back to, when I started med schools, we'd see patients with rheumatoid arthritis, with advanced deformities, and now with the newer medications, I think we have come a long way. We don't see all those advanced deformities that we used to see. But again, coming to your questions about the complications with rheumatoid arthritis. Now that we have better medications to help control disease. We are seeing fear and fear complications. But one thing to keep in mind is the rheumatoid arthritis.

Although everyone considers it to be a condition of the joints, but if left untreated and not well controlled, it can spread beyond the joints. It can involve other organs, too. It can involve your skin. It can involve your heart. Kidneys your eyes. So if left untreated, not only would it damage your joints and tendons and ligaments, but it would spread beyond those musculoskeletal organs too, to involve other organs.

Scott Webb: Yeah. So you can see why a early diagnosis, especially if we have a family history. So getting to it early, seeking out treatment. And so as we wrap up here, doctor, what are the treatment options you say that they've come a long way since you were in medical school? So what are the treatments available for rheumatoid arthritis?

Dr. Aasim Rehman: So I'm going to date myself here. And I'd say maybe looking back in the last 30 years, I think we have come a long way. 20, 30 years ago, , if somebody was diagnosed through rheumatoid arthritis, their treatment options were literally really limited., and essentially their choices were mostly back in the day. It was, we used to use gold. It sounds really, funny, but yes, we used to use gold to treat rheumatoid arthritis. And then there were a few that choices like methotrexate and steroids and high dose of aspirin were used, but starting in the mid nineties, we discovered a new class of drugs called Bologic disease modifying antiromatic drugs or BMARDS or DMARDS. And these medications have essentially changed the face of the management of rheumatoid arthritis and other rheumatologic conditions as well. They're called biologic DMARDS for two reasons because they work that way, plus they alter your biologic response.

So that is why they're called biologic DMARDs and these medications, essentially to put it simply block critical steps involved in the process of inflammation. Now there are many, many, many steps involved, many different chemicals involved in inflammation. And as time has gone on in the last two or three decades, we have different steps that we can block safely, that are involved in inflammation. We can block those steps and by doing that, we can control your immune system. Stop your body from attacking itself and in turn, help control the inflammation. And by controlling the inflammation we can control, the pain, the swelling, the stiffness, that is associated over this particular condition.

Scott Webb: It's really amazing. I love medicine and science and just how far things have come I have the, yeah, you have the luxury of hosting these doctor. And so just hearing that managing and living with rheumatoid arthritis has become so much easier, better, not that anybody wants it, but at least if you can't cure something, then you want to be able to manage it and live with. It sounds like you're able to do that and help folks with rheumatoid. So thanks so much. You stay well.

Dr. Aasim Rehman: Thank you. It was a pleasure.

Scott Webb: And for more information, visit genesishcs.org. And thanks for listening to Sounds of Good Health with Genesis, brought to you by Genesis Healthcare System. If you found this podcast to be helpful, please be sure to tell a friend and subscribe, rate and review this podcast and check out the entire podcast library for additional topics of interest. I'm Scott Webb. Stay well.