Rheumatoid Arthritis Myths

With the abundance of easy-to-find (but not always accurate) information, many people have misconceptions about rheumatoid arthritis (RA). You may have heard that RA is just a normal sign of aging or that it happens because of the wear and tear on your joints. (Both are wrong.) Here, two rheumatologists explain the truth behind some of the most common myths about RA.

Myth 1: Only older people can get RA.

Both adults and children can develop RA, says Max Konig, MD, rheumatologist at Johns Hopkins University School of Medicine in Baltimore. He says that misconception might float because children are often diagnosed with a subtype of juvenile idiopathic arthritis (JIA) rather than RA. Children with this type of JIA – known as polyarticular arthritis, rheumatoid factor positive – have a protein called rheumatoid factor (RF) or anticyclic citrullinated peptide (anti-CCP antibody) that appears in their blood, such as Most people with RA.

RA actually becomes rarer with age, notes Nilanjana Bose, MD, rheumatologist at the Rheumatology Center in Houston. You are more likely to have osteoarthritis than RA as you age, she says.

The majority of people are diagnosed with RA between their 30s and 50s, according to Konig. He says problems in your immune system – like RF and anti-CCP antibodies – can actually show up more than a decade before your symptoms start, indicating that RA can start much earlier than diagnosis.

Myth 2: RA is the same as osteoarthritis.

Osteoarthritis and RA both affect your joints, but Konig says they’re different conditions with different treatment approaches.

RA is an autoimmune disease, which means your immune system sees the normal proteins in your joints and other tissues as a threat and tries to destroy them, he explains.

“It’s kind of like your immune system activates your own body and causes a lot of inflammation,” Bose says. “As a result, you experience joint pain and swelling, and you may also experience other symptoms like weight loss, fever, and fatigue.”

Because it’s a systemic disease – which means it affects your whole body – RA can also involve things like your lungs and heart, Bose says. Lung disease is especially common in people who have RF or anti-CCP antibodies in their blood, known as seropositive rheumatoid arthritis, Konig says.

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He notes that RA can also affect your skin, eyes, and, in rare cases, blood vessels. “You really have to treat RA more aggressively because we’re not just talking about the joints, we’re talking about your whole body,” Bose says.

By comparison, osteoarthritis is limited to your joints. It’s the wear and tear type of arthritis rather than an autoimmune disease because it doesn’t involve the immune system, Konig says. Bose explains that unlike RA, osteoarthritis has no symptoms other than pain, swelling, stiffness, and tenderness.

Myth 3: There is no cure for RA, so you just have to live with it.

In the past, Konig says, people who ended up in hospital with RA were treated with bed rest, cold compresses, massages, and leg elevation. This may have alleviated some of their symptoms, but it didn’t stop the disease from getting worse. Over time, this led to deformed joints and exhausting pain.

Fortunately, this is no longer true. “Over the past 40 years, the treatment for rheumatoid arthritis has changed dramatically,” says Konig. “We now have a plethora of highly effective therapies that can not only reduce or eliminate pain, but also quench joint inflammation and prevent the development of structural bone damage, joint deformities and disability.”

Not only are there many treatment options for RA flare-ups, there are plenty to help manage the condition, Bose says. Your rheumatologist will help you find the best treatment for your needs.

Myth 4: You shouldn’t be exercising when you have RA.

This one might sound believable because you don’t want to put more wear and tear on your joints. But the only time this can be true is if you are having a relapse, when you should cut down on your activity. “We don’t want to stress the joints, so we don’t recommend vigorous exercise at this time,” Bose explains. Otherwise, exercise is an important part of managing RA. It can reduce fatigue and depression, make you stronger and more flexible, and even help prevent disability.

One of the main reasons exercise is crucial is that when you have RA, you have a higher risk of heart disease, Konig notes. Regular exercise can lower your risk. The American Heart Association recommends a minimum of 150 minutes of moderate-intensity aerobic activity or 75 minutes per week.

Make sure you’re doing the right kind of exercise so you don’t over-strain your joints, Bose says, especially if your hips or knees are affected. She recommends low-impact aerobic exercise like swimming, light walking, or using an elliptical or stationary bike. Your rheumatologist or physiotherapist can help you design an exercise program that’s right for you.

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Myth 5: You will definitely get joint damage if you have RA.

There are so many effective treatments, especially when RA is diagnosed and treated early, that joint damage can often be prevented, Bose says. This is why it is so important to act as soon as possible. “The goal is to bring the disease into remission quickly, as significant damage can occur early in the course of the disease,” says Konig.

Everyone’s RA works differently, Konig says, likely due to things like their environment, their genes, and how the disease manifests. Some people have aggressive RA, and even with treatment they can develop joint damage and deformity. But that’s a minority of patients, Bose says.

Myth 6: It doesn’t help RA change their lifestyle.

Beyond exercise, other lifestyle changes can have a big impact, such as quitting. “We know that smoking is a significant risk factor for the development of RA, and smokers tend to have more serious illness,” Konig says. Quitting smoking can improve RA as well as your risk for heart disease.

Eating healthy, exercising regularly, sleeping well, managing stress, and adding body-mind relaxation techniques are all key to helping control pain, fatigue and inflammation and managing RA, says. Bose.

People with RA are at a higher risk of developing certain types of cancer because of chronic inflammation. Lifestyle changes can also help reduce this risk, Bose says.

Myth 7: Once you feel better, you can stop taking your medication.

“The reason you feel better is that you are taking the drug, so when you stop your disease comes back,” Bose explains. RA is a chronic disease. Some people go into remission, but for the most part, “the disease stays at a basic level, burning with good treatment,” she says.

Your rheumatologist wants to give you as little medication as possible. If your disease has been in remission for a long time, they will try to slowly reduce or stop your treatment, Konig says. This process helps some people determine the minimum amount of medicine they need to control their RA. Others are able to stop treatment altogether, at least for a while, he says.

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It is important to note that you should never stop your treatment without talking to your doctor first. On the one hand, these drugs work by weakening your immune system due to its unusual response, Konig explains. If you suddenly stop taking them, there is a high risk that your immune system will decide to act again.

Sometimes people stop taking their medications because they have side effects or don’t like how they feel, Bose notes. If this is the case for you, it’s important to let your rheumatologist know you’re having problems rather than changing or stopping them yourself, she advises. If your next appointment is far away, try sending a message through your online patient portal or call your rheumatologist’s nurse for advice.

Sources

SOURCES:

KidsHealth de Nemours: “Juvenile idiopathic arthritis”.

Max Konig, MD, rheumatologist, Johns Hopkins University School of Medicine, Baltimore.

Special Surgery Hospital: “Understanding the Tests and Laboratory Results for Rheumatoid Arthritis.”

Nilanjana Bose, MD, rheumatologist, Rheumatology Center of Houston.

Mayo Clinic: “Rheumatoid Arthritis: Is Exercise Important?”

American Heart Association: “American Heart Association Recommendations for Physical Activity in Adults and Children”.

Arthritis Foundation: “Rheumatoid Arthritis and Cancer Risk.”


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