Dr. John Wade, MD, FRCPC, Rheumatologist, talks about the steps a patient should take when deciding to stop taking Leflunomide.

What is Local Rheumatologist

A local rheumatologist is a physician who is trained in treating patients who have diseases of the joints, bones and muscles. There are certain diseases that cause a person’s immune system to attack their own body. Patients with different types of arthritis and diseases such as gout and fibromyalgia work with a rheumatologist. If your local family physician thinks you may benefit from working with a local rheumatologist, they may refer you. It’s important to see a local rheumatologist as soon as possible, as many diseases can cause permanent joint damage over time. If you have a family history of diseases such as arthritis, talk to your local family physician.

Rheumatoid arthritis (RA) is a chronic condition that causes pain, swelling, and stiffness in the joints. Affecting about 1% of the population, it is one of the most common types of inflammatory arthritis. RA  is a systemic rheumatic disease, which means that it can affect the entire body.

Rheumatoid Arthritis Causes

Rheumatoid arthritis is a long-term autoimmune disease. Although the reason why is not well understood, a variety of factors may be involved including genetics, hormones and environmental factors.

RA occurs when the body’s immune system attacks its own healthy tissues and cells. As a result, patients may experience fatigue in addition to joint pain, swelling and stiffness.

The Importance of Early Treatment 

It's essential that rheumatoid arthritis is treated as early as possible to prevent further joint damage. Not only can early treatment prevent crippling pain, it can also reduce the risk of other medical conditions associated with chronic inflammation, such as heart disease.

Fortunately, with proper treatment, many patients with rheumatoid arthritis are able to live healthy and active lives.

Who Gets Rheumatoid Arthritis?

Rheumatoid arthritis is three times more common in women than in men. People generally notice the first signs and symptoms of RA between the ages of 25 and 50.

Rheumatoid Arthritis Diagnosis

Rheumatoid arthritis is usually diagnosed by a rheumatologist, a doctor who specializes in autoimmune diseases and arthritis.

To diagnose RA, a physician will take a complete medical history and perform a physical examination. In most cases, they will also order blood tests and x-rays to help confirm the diagnosis.

Common Tests to Diagnose Rheumatoid Arthritis

There is no single test that can diagnose rheumatoid arthritis. Also, some patients may have normal results from certain blood tests, even though they have RA. That's why rheumatologists consider various factors when diagnosing a patient with rheumatoid arthritis.

Blood Tests

Rheumatoid arthritis is an inflammatory disease, so blood tests often show abnormal results. Common tests that detect inflammation include a Complete Blood Count (CBC), C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR).

A local rheumatologist will also look for a type of autoantibody called Rheumatoid Factor (RF). This antibody, which targets the body’s own tissues, is elevated in 80% of people with RA. However, a positive test can be from another cause, and a patient who tests negative can still have rheumatoid arthritis.

ANother autoantibody that can be detected in the blood is the Anti-Cyclic Citrullinated Peptide Antibody. The anti-CCP test looks for anti-citrullinated protein antibodies (ACPAs), which target the body’s own tissues. This autoantibody is present in 60-70% of people who develop RA.

However, like with the Rheumatoid Factor test, a patient can test positive due to another cause, and someone who tests negative can still have rheumatoid arthritis.

Scans

X-rays can show damage to the joints from rheumatoid arthritis. They can also help physicians track the progression of RA over time. Rheumatoid Arthritis Patient Communication System

Rheumatoid Arthritis Symptoms

Pain, Swelling & Stiffness

Rheumatoid arthritis causes pain and swelling in the joints, resulting in stiffness. At its onset, RA usually affects only a few joints. It may start in the knees, hands, wrists or feet and slowly begin to affect other joints. In some patients, rheumatoid arthritis seems to move from joint to joint. Many people say their rheumatoid arthritis symptoms are worse in the morning.

Rarely, RA symptoms appear suddenly. A person may go to bed feeling fine, but find it difficult to get out of bed in the morning.

Flare-ups are common in autoimmune disorders. If you have rheumatoid arthritis, there might be times when your symptoms flare and are more severe.

Fatigue

People with RA commonly feel tired, because their body’s immune system is attacking its own tissues and joints.

Other Symptoms

Over time, rheumatoid arthritis can affect other tissues and organs throughout the body, including the:

  • Eyes
  • Heart
  • Kidneys
  • Skin
  • Lungs
  • Nerves
  • Blood vessels
  • Glands

Depending on the part of the body that's affected, patients may experience a range of symptoms. 

Treatments for Rheumatoid Arthritis

The earlier RA is treated the better the outcome—even a few months can make a difference. Research shows that if rheumatoid arthritis is diagnosed and treated early, patients are more likely to go into remission.

It's important for patients to attend their rheumatologist appointments and maintain a healthy lifestyle. Smoking is especially known to worsen RA symptoms and make it much more difficult to treat.

Because rheumatoid arthritis is linked to heart disease, patients also need to keep their blood pressure and cholesterol at healthy levels. If you have diabetes, it's important to keep your blood sugar under control.

Medications that Treat Rheumatoid Arthritis

There are two broad groups of medications for RA: one that helps control the symptoms and one that prevents long-term joint damage. Make sure to tell your doctor about your alcohol intake and any other medications, supplements or alternative therapies you take to avoid negative interactions.

Disease Modifying Anti-Rheumatic Drugs (DMARDs)

DMARDs are generally used to treat anyone with rheumatoid arthritis, and are often prescribed in combination with other medications.

Methotrexate is the most common Disease Modifying Anti-Rheumatic Drug. It may be given once a week as tablets or as an injection under the skin. In most patients, the injection works better than the tablets and may have fewer side effects.

Other types of DMARDs include:

  • Sulfasalazine
  • Hydroxychloroquine (Plaquenil)
  • Gold (Myochrisine)
  • Leflunomide (Arava)

Rheumatologists often prescribe a triple therapy combination of Methotrexate, Hydroxychloroquine and Sulfasalazine.

Non-Steroidal Anti-Inflammatory Drugs

Also known as NSAIDs, these medications reduce joint inflammation and reduce pain, but do not prevent the progression of rheumatoid arthritis. With 20 different anti-inflammatory medications available, you can always try a different NSAID if one doesn't work for you.

Analgesic Medications

Analgesic medications are used to control pain, but they don't prevent further joint damage. Analgesics range from over-the-counter acetaminophen to stronger pain narcotics like morphine.

Corticosteroids (Prednisone)

Some patients find relief from inflammation, pain and stiffness by using prednisone. However, because it can have side effects when used long-term, doctors generally prescribe it in high doses for short periods of time.

Cortisone injections are another option for some people with rheumatoid arthritis.

Advanced Therapeutics

If your joint pain and stiffness isn't well-controlled by anti-inflammatory medications and Disease Modifying Anti-Rheumatic Drugs, your rheumatologist may prescribe advanced therapeutics.

These medications are made up of biologic medications and small molecules. They're given by an injection under the skin or by an intravenous infusion.

There are a number of effective Anti-Tumor Necrosis Factor biologics available, including:

  • Humira (adalimumab)
  • Remicade/Inflectra/Remsima (infliximab)
  • Cimzia (certolizumab)
  • Enbrel/Brenzys/Erelzi (etanercept)
  • Simponi (golimumab)

There are other biologics that target aspects of the inflammatory response, including Kevzara (sarilumab) and Actemra (tocilizumab), which block an important signalling protien involved in inflammation called Interleukin-6.

Or, you may benefit from alternative therapies such as:

  • Rituxan (rituximab), which targets a marker on the surface of immune cells
  • Orencia (abatacept), a medication that interrupts communication between immune cells

Surgery for Rheumatoid Arthritis

If you have severe rheumatoid arthritis, your joints may become so badly damaged that they no longer function. In this case, surgery may help reduce pain, restore function and improve mobility.

Surgery for RA typically involves replacing a damaged joint with an artificial joint.

 

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