March is Autoimmune Disease Awareness Month. Each week I will be highlighting a different autoimmune disease and this week it’s Rheumatoid Arthritis. RA is an autoimmune disease that is close to my heart because I’ve been living with it for almost 15 years. Today we are going to talk about what this autoimmune disease is, how it’s diagnosed, what treatments are out there and what diet and lifestyle things you can do to help reduce the symptoms of this disease.
What is RA?
Most people with RA experience pain in the hands, knees, and ankles and it usually affects both sides of the body, which differentiates RA from other forms of arthritis. Approximately 1.5 million people in the U.S. have RA and women are 3x more likely to develop RA than men. Additionally, most women develop RA between the ages of 30 and 60.
The other issue with RA is that it can affect other areas of your body and not just your joints. It can affect your lungs and increase your risk of cardiovascular disease. Because RA affects mobility, it can make it difficult for people to move their bodies, which can lead to weight gain, which places even more stress on the joints.
Getting an RA Diagnosis
Your doctor may also check antibodies to anti-cyclic citrullinated peptide, or anti-CCP. A positive anti-CCP is found in about 60-70 percent of people with RA, but they are also found in people with no RA present. Individuals who have high anti-CCP levels have what is called seropositive RA. Those with low to no anti-CCPs are called seronegative RA. With seronegative RA, it can take longer to get a diagnosis because rheumatologists have to rule out other forms of arthritis such as psoriatic arthritis and gout.
Your rheumatologist may also take x-rays of the affected joints. Imaging will help identify erosions or places where the ends of the bones are starting to wear down. Imaging also helps track the effectiveness of treatments and/or the progression of the disease.
The goal of rheumatoid arthritis treatment is to stop joint destruction, reduce inflammation and achieve the lowest possible disease activity, and, ideally, put the disease into remission. There are 3 main drug classes to help achieve these goals, they are:
- Non-steroidal anti-inflammatory agents (NSAIDs)
- Disease-modifying anti-rheumatic drugs (DMARDs)
NSAIDs are used to reduce acute inflammation but do not protect the joints from ongoing destruction. They are usually used in conjunction with other medications for relieving pain, especially during an active flare. These can be tough on the gastrointestinal tract and should not be used long-term.
Corticosteroids include prednisone, one of the most common anti-inflammatory medications used for rheumatoid arthritis. They are typically used at the onset of diagnosis to quickly reduce inflammation, and with the implementation of DMARDs as a bridge until the latter starts to work. Prednisone should not be used long-term either, as it can deplete calcium in the bones and cause insulin resistance.
DMARDs are the one class of drugs that can change the disease course of RA. There are a number of DMARDs to choose from, and the most commonly used one at the onset of RA is methotrexate. Methotrexate interrupts inflammatory pathways which help reduce inflammation and prevents joint destruction. However, there are a number of side effects with methotrexate, including fatigue, liver toxicity, headaches, and low folate levels.
Diet and Lifestyle
In general, anti-inflammatory diets work the best, which include familiar dietary patterns like mediterranean, vegetarian and vegan. In addition, there is a high probability of food sensitivities in the RA population. Figuring out what you are sensitive to can help lower inflammation and disease activity as well.