Rheumatoid Arthritis: What You Need to Know and Why Conventional Treatments May Not Be the Answer

Have you or a family member been recently diagnosed with rheumatoid arthritis? Do you suspect you might have this disabling condition? Here are the essentials about rheumatoid arthritis. While there are many treatments that have emerged in the last few decades to successfully treat rheumatoid arthritis, they’re not without significant risk. Fortunately, there is a new branch of medicine that can provide more natural relief from rheumatoid arthritis in a less dangerous way.

Rheumatoid arthritis is a more comprehensive condition than many others that carry the name “arthritis.” It’s actually an autoimmune disorder that causes chronic inflammation when your body’s immune system attacks your own tissue. This inflammation may not be limited to just your joints; rheumatoid arthritis can affect your eyes, nerves, skin, lungs, kidneys, and cardiovascular system.

Doctors aren’t really sure what causes rheumatoid arthritis, often abbreviated RA. However, they do know that there are risk factors that predispose people to develop this condition:

• Being female
• Being middle-aged (or older)
• A family history of RA
• Smoking
• Obesity

It may be that RA is triggered in people prone to it by environmental factors, as well as by infection with certain viruses or bacteria.

Often, the symptoms of rheumatoid arthritis come and go in cycles known as “flares.” Typical symptoms include:

• Sore joints that may also be warm or swollen
• Joint stiffness and immobility, especially in the morning
• Extreme fatigue
• Fever
• Loss of appetite
• Symptoms spreading from smaller to larger joints over time
• Deformed joints and nodules
• Carpal tunnel syndrome
• Osteoporosis
• Problems with other body systems (dry eyes, hardening of the arteries, lung disease, lymphoma, etc.)

Early RA can look like other forms of arthritis as well as other conditions. When diagnosing rheumatoid arthritis, doctors usually look at a combination of factors, including:

• Swollen, red, hot joints
• Imaging to detect changes in joint structure and early deformity
• MRI and ultrasound tests to look for the effects of RA in the body outside of the joints
• High ESR (AKA “sed rate”) via a blood test
• High C-reactive protein (CRP) levels, also determined by a blood test
• RA factor on a blood test
• Anti-cyclic citrullinated peptide (anti-CCP) antibody testing, another type of blood test

There is no cure for rheumatoid arthritis, so treatment is focused on three primary areas. The goal is to mitigate symptoms and reduce pain, as well as slow the progression of RA.

Over-the-counter and prescription drugs include:

• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin and Advil) and naproxen (Aleve)
• Steroids, such as prednisone
• Disease-modifying antirheumatic drugs (DMARDs), including methotrexate (Trexall and Otrexup), leflunomide (Arava), hydroxychloroquine (Plaquenil), and sulfasalazine (Azulfidine)
• Biologic agents (second-generation DMARDs), such as abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), sarilumab (Kevzara), and tocilizumab (Actemra)
• Targeted synthetic DMARDs, which are more powerful, like baricitinib (Olumiant), tofacitinib (Xeljanz), and upadacitinib (Rinvoq)

Therapy is largely aimed at making daily living easier and more tolerable. Patients learn how to perform everyday tasks with less irritation to their joints. They also learn how to use assistive devices that have been specially designed to be employed by people with RA. These can include tools for preparing food in the kitchen and handy inventions that make getting dressed or manipulating small items less cumbersome.

There are four kinds of surgery typically recommended for people with RA:

• Synovectomy – removes the inflamed lining of a joint (synovium) to relieve pain and improve range of motion
• Tendon repair – fixes loose or ruptured tendons, which attach muscles to your bones
• Joint fusion – to stabilize or realign a joint and alleviate pain
• Total joint replacement – removes the damaged part of a joint and replaces it with a prosthetic version

Although physical and occupational therapy pose no risks to RA patients, medications and surgery can be quite dangerous. The newer prescription drugs used to combat rheumatoid arthritis suppress the immune system because that’s what’s attacking the body. However, this leaves people taking these medications open to all kinds of infections. Other side effects include liver damage, increased risk of blood clots, cardiovascular problems, and cancer.

Even over-the-counter NSAIDs have risks associated with them. They can drive up your blood pressure as well as increase your chances of having a heart attack or stroke.

Any kind of surgery, including for RA, is inherently hazardous. You can have a reaction to the anesthesia, or you can develop post-operative blood clots and infections. Some people have nerve damage after surgery, which can be a new cause of pain.

After joint replacement, which requires a long downtime, you have to undergo a serious recovery period involving physical therapy and limitations to your activities. And even with insurance, RA drugs and surgery may not be completely covered due to copayments, deductibles, formulary rules about what’s reimbursed, and extra fees rejected by the insurance company.