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How to Live Well with Rheumatoid Arthritis
Dr. Ananta Subedi discusses the effects of rheumatoid arthritis.
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Learn more about Ananta Subedi, MD
Ananta Subedi, MD
Dr. Ananta Subedi is a board-certified rheumatologist with clinical interests in vasculitis, systemic lupus erythematosus, rheumatoid arthritis and rare auto-inflammatory diseases.Learn more about Ananta Subedi, MD
Transcription:
How to Live Well with Rheumatoid Arthritis
Scott Webb: Rheumatoid arthritis affects 1.5 million Americans and women are three times more likely to develop it than men. And joining me today to help us understand the disease and how we can live well with it is Dr. Ananta Subedi. He's a rheumatologist at Wake Med Health and Hospitals. This is Wake Med Voices, a podcast from Wake Med Health and Hospitals. I'm Scott Webb. So Doctor, thanks so much for being on today. We're talking about rheumatoid arthritis and let's start with, you know, maybe the most obvious question. What is rheumatoid arthritis?
Dr. Subedi: Rheumatoid arthritis is a very common autoimmune disease where our own immune system starts attacking our own tissues. And in particular, the joints and in case of severe untreated rheumatoid arthritis, you could have problems in other areas of your body, like skin, eyes, lungs, and the blood vessels too.
Host: Yeah. So I wanted to ask you about that because I think most people, when they think about rheumatoid arthritis, if they know what it is, or they associate that with our joints but in addition to our joints, it can also affect many other parts of our bodies. Right?
Dr. Subedi: Correct. Absolutely. And in particular, if the disease is not well treated in time, it could cause problem in other organs, including the eyes, skin, lungs, and even the cardiovascular system.
Host: So obviously then early detection, early treatment is important. Do we know what causes the auto immune disease? Do we know what causes rheumatoid arthritis?
Dr. Subedi: So rheumatoid arthritis is a disease of the immune system where the immune system, by different reason, it starts attacking our own tissues. So far, there has been a limited understanding on what is the primary cause for rheumatoid arthritis. Now, so far, we understand there are various genetic risk factors along with multiple environmental risk factors and one of the most important environmental risk factor that we know, that could increase your risk of having rheumatoid arthritis is smoking. So we also know that people who smoke also get more severe form of rheumatoid arthritis that is difficult to control.
Host: That's interesting. And like so many things when it comes to health and wellness, you know, genetics and lifestyle play a big part, obviously. So what are the symptoms of rheumatoid arthritis, whether we're talking about joints or other organs?
Dr. Subedi: As we discussed earlier rheumatoid arthritis cause inflammation, particularly in the small joints, it could be in the hand, or it could be in the feet. Due to inflammation, it causes significant swelling and people feel a lot of morning stiffness that lasts for several hours. So basically joint pain, swelling, and stiffness of the small joints in your hand or the legs.
Host: That's really interesting because I know that I'm 52. And when I wake up in the morning, everything's kind of sore, everything kind of hurts. And then it tends to go away within that, you know, first hour of getting up and getting moving and having some coffee. So how do we know the difference between, you know, just being older, right? Older bodies, older body parts. How do we know the difference between that and rheumatoid arthritis? In other words, how do you diagnose rheumatoid arthritis?
Dr. Subedi: Yeah, you are absolutely right. Most people do feel some joint pain and stiffness in the morning. And as we get older, we do get a form of arthritis called osteoarthritis. That could also cause some of the symptoms similar to rheumatoid arthritis, but patients who have rheumatoid arthritis, they have again, other symptoms that includes significant joint swelling. They also feel a lot of stiffness that lasts for several hours in the daytime, which is not seen commonly with osteoarthritis.
Host: Okay. And then how you, as someone who treats, who specializes in this, how do you diagnose people? How do you diagnose and tell the difference between osteoarthritis let's say and rheumatoid?
Dr. Subedi: That's a very important question. And the reason is the adequate diagnosis and timely diagnosis is very important in rheumatoid arthritis. And one of the key factor, our key way of diagnosing rheumatoid arthritis is a good physical examination by a doctor. And this is supplemented with some blood testing and even x-rays, but one of the most important is a good examination by a physician, either your primary care doctor or more important, maybe a rheumatologist.
Host: And because early detection and diagnosis is so key, it's obviously really important that we get those yearly physicals, right?
Dr. Subedi: Yes, absolutely.
Host: So now once you've diagnosed somebody, you know, as having rheumatoid arthritis, this autoimmune disease, how is it treated? How can people live with something that can be so debilitating?
Dr. Subedi: Yeah, I think I emphasize once again that the early diagnosis and early treatment is very important in rheumatoid arthritis. And one of the problems that happens with rheumatoid arthritis is it causes significant joint damage. And if not treated on time, these damage could be permanent causing significant deformities. So one of the key goals in treatment of rheumatoid arthritis is starting treatment sooner rather than later, so that we can prevent joint damage. Now talking more on the treatment plan or treatment options, there are multiple medications that are currently approved for rheumatoid arthritis. Now, as a group, these medications are called disease modifying anti-rheumatic drugs, basically meaning they stay the course of the disease and prevent joint damage. These medications could be taken by mouth. And then the older medication we call a traditional medication like methotrexate, Plaquenil, also called hydroxychloroquine, sulfasalazine are some of the common ones. Now in the last two decades, we have a significant improvement in the treatment of rheumatoid arthritis with a discovery of very good new medication. We call biologics. These are very well tolerated medication and very effective in controlling the disease, leading to a significant improvement in the quality of life, even though with the rheumatoid arthritis.
Host: That's really interesting. And it's, so it sounds to me like you're not just treating the symptoms of rheumatoid arthritis, but really some of these drugs can actually reverse the effects if again, diagnosed and treated early. Right?
Dr. Subedi: Correct. Absolutely. Yeah.
Host: So, doctor, as we wrap up here today, when we think about quality of life, as you said, what's your best advice for people who may believe that they have rheumatoid arthritis or have been diagnosed, what's your best advice for helping them to improve their quality of life and live well with rheumatoid arthritis?
Dr. Subedi: I usually tell my patient that unfortunately, you got the rheumatoid arthritis, but you got it at the right time, meaning we have so many good treatment options, which are relatively safe and very effective. So I'll ask all of my patients if they suspect they have rheumatoid arthritis based on the symptoms that we just heard, please get a care from your primary care doctor and get an early referral to a rheumatologist so that you can discuss about the treatment options so that you don't have to suffer with pain.
Host: That's great and great to know that there are safe and effective treatment options and that people really can live good lives, healthy lives, even though they've been diagnosed with rheumatoid arthritis, as you say. If you've been diagnosed, but you got diagnosed early enough that you can live pretty well, that that they're safe and effective treatment options. And that's really great to know. Well, Dr. Subedi, I thank you so much for your time today, your expertise, your compassion, your care, and you stay well.
Dr. Subedi: Thank you so much for the opportunity.
Host: That's Dr. Ananta Subedi. For more information, please visit wakemed.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Wake Med Voices, a podcast brought to you by Wake Med Health and Hospitals in Raleigh, North Carolina. Thanks for listening.
How to Live Well with Rheumatoid Arthritis
Scott Webb: Rheumatoid arthritis affects 1.5 million Americans and women are three times more likely to develop it than men. And joining me today to help us understand the disease and how we can live well with it is Dr. Ananta Subedi. He's a rheumatologist at Wake Med Health and Hospitals. This is Wake Med Voices, a podcast from Wake Med Health and Hospitals. I'm Scott Webb. So Doctor, thanks so much for being on today. We're talking about rheumatoid arthritis and let's start with, you know, maybe the most obvious question. What is rheumatoid arthritis?
Dr. Subedi: Rheumatoid arthritis is a very common autoimmune disease where our own immune system starts attacking our own tissues. And in particular, the joints and in case of severe untreated rheumatoid arthritis, you could have problems in other areas of your body, like skin, eyes, lungs, and the blood vessels too.
Host: Yeah. So I wanted to ask you about that because I think most people, when they think about rheumatoid arthritis, if they know what it is, or they associate that with our joints but in addition to our joints, it can also affect many other parts of our bodies. Right?
Dr. Subedi: Correct. Absolutely. And in particular, if the disease is not well treated in time, it could cause problem in other organs, including the eyes, skin, lungs, and even the cardiovascular system.
Host: So obviously then early detection, early treatment is important. Do we know what causes the auto immune disease? Do we know what causes rheumatoid arthritis?
Dr. Subedi: So rheumatoid arthritis is a disease of the immune system where the immune system, by different reason, it starts attacking our own tissues. So far, there has been a limited understanding on what is the primary cause for rheumatoid arthritis. Now, so far, we understand there are various genetic risk factors along with multiple environmental risk factors and one of the most important environmental risk factor that we know, that could increase your risk of having rheumatoid arthritis is smoking. So we also know that people who smoke also get more severe form of rheumatoid arthritis that is difficult to control.
Host: That's interesting. And like so many things when it comes to health and wellness, you know, genetics and lifestyle play a big part, obviously. So what are the symptoms of rheumatoid arthritis, whether we're talking about joints or other organs?
Dr. Subedi: As we discussed earlier rheumatoid arthritis cause inflammation, particularly in the small joints, it could be in the hand, or it could be in the feet. Due to inflammation, it causes significant swelling and people feel a lot of morning stiffness that lasts for several hours. So basically joint pain, swelling, and stiffness of the small joints in your hand or the legs.
Host: That's really interesting because I know that I'm 52. And when I wake up in the morning, everything's kind of sore, everything kind of hurts. And then it tends to go away within that, you know, first hour of getting up and getting moving and having some coffee. So how do we know the difference between, you know, just being older, right? Older bodies, older body parts. How do we know the difference between that and rheumatoid arthritis? In other words, how do you diagnose rheumatoid arthritis?
Dr. Subedi: Yeah, you are absolutely right. Most people do feel some joint pain and stiffness in the morning. And as we get older, we do get a form of arthritis called osteoarthritis. That could also cause some of the symptoms similar to rheumatoid arthritis, but patients who have rheumatoid arthritis, they have again, other symptoms that includes significant joint swelling. They also feel a lot of stiffness that lasts for several hours in the daytime, which is not seen commonly with osteoarthritis.
Host: Okay. And then how you, as someone who treats, who specializes in this, how do you diagnose people? How do you diagnose and tell the difference between osteoarthritis let's say and rheumatoid?
Dr. Subedi: That's a very important question. And the reason is the adequate diagnosis and timely diagnosis is very important in rheumatoid arthritis. And one of the key factor, our key way of diagnosing rheumatoid arthritis is a good physical examination by a doctor. And this is supplemented with some blood testing and even x-rays, but one of the most important is a good examination by a physician, either your primary care doctor or more important, maybe a rheumatologist.
Host: And because early detection and diagnosis is so key, it's obviously really important that we get those yearly physicals, right?
Dr. Subedi: Yes, absolutely.
Host: So now once you've diagnosed somebody, you know, as having rheumatoid arthritis, this autoimmune disease, how is it treated? How can people live with something that can be so debilitating?
Dr. Subedi: Yeah, I think I emphasize once again that the early diagnosis and early treatment is very important in rheumatoid arthritis. And one of the problems that happens with rheumatoid arthritis is it causes significant joint damage. And if not treated on time, these damage could be permanent causing significant deformities. So one of the key goals in treatment of rheumatoid arthritis is starting treatment sooner rather than later, so that we can prevent joint damage. Now talking more on the treatment plan or treatment options, there are multiple medications that are currently approved for rheumatoid arthritis. Now, as a group, these medications are called disease modifying anti-rheumatic drugs, basically meaning they stay the course of the disease and prevent joint damage. These medications could be taken by mouth. And then the older medication we call a traditional medication like methotrexate, Plaquenil, also called hydroxychloroquine, sulfasalazine are some of the common ones. Now in the last two decades, we have a significant improvement in the treatment of rheumatoid arthritis with a discovery of very good new medication. We call biologics. These are very well tolerated medication and very effective in controlling the disease, leading to a significant improvement in the quality of life, even though with the rheumatoid arthritis.
Host: That's really interesting. And it's, so it sounds to me like you're not just treating the symptoms of rheumatoid arthritis, but really some of these drugs can actually reverse the effects if again, diagnosed and treated early. Right?
Dr. Subedi: Correct. Absolutely. Yeah.
Host: So, doctor, as we wrap up here today, when we think about quality of life, as you said, what's your best advice for people who may believe that they have rheumatoid arthritis or have been diagnosed, what's your best advice for helping them to improve their quality of life and live well with rheumatoid arthritis?
Dr. Subedi: I usually tell my patient that unfortunately, you got the rheumatoid arthritis, but you got it at the right time, meaning we have so many good treatment options, which are relatively safe and very effective. So I'll ask all of my patients if they suspect they have rheumatoid arthritis based on the symptoms that we just heard, please get a care from your primary care doctor and get an early referral to a rheumatologist so that you can discuss about the treatment options so that you don't have to suffer with pain.
Host: That's great and great to know that there are safe and effective treatment options and that people really can live good lives, healthy lives, even though they've been diagnosed with rheumatoid arthritis, as you say. If you've been diagnosed, but you got diagnosed early enough that you can live pretty well, that that they're safe and effective treatment options. And that's really great to know. Well, Dr. Subedi, I thank you so much for your time today, your expertise, your compassion, your care, and you stay well.
Dr. Subedi: Thank you so much for the opportunity.
Host: That's Dr. Ananta Subedi. For more information, please visit wakemed.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Wake Med Voices, a podcast brought to you by Wake Med Health and Hospitals in Raleigh, North Carolina. Thanks for listening.