Rheumatoid Arthritis Update

February 12, 2018 | By | Reply More

By Amish Dave, MD, MPH
Virginia Mason Medical Center

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a chronic, inflammatory disease of the joints that, according to the Arthritis Foundation, affects more than 1.3 million Americans and as much as 1 percent of the worldwide population.

It is a common autoimmune disorder where someone’s immune system mistakes the linings of their joints as “foreign,” attacking and damaging them resulting in inflammation.

This inflammation typically affects joints on both sides of the body, such as both hands, wrists, knees or feet. This symmetry distinguishes it from other types of arthritis.

Since RA is a systemic disease, it can sometimes affect skin, eyes, lungs, heart, blood or the nervous system.

How does it affect the body?

Immune system cells, including cells called T and B lymphocytes, move from the blood into joints and joint-lining tissue, called synovium. Once they arrive, those immune system cells create inflammation, which wears down cartilage (the cushioning material at the end of bones). As the cartilage wears down, the space between the bones narrows.

As inflammation worsens, the bones can rub against each other creating painful friction and, ultimately, eroding the joint itself. Inflammation of the joint lining creates swelling and causes fluid to build up within the joint.

As the joint space fills with inflammatory cells, these can produce substances that damage the bone. This immune response is what causes joints in RA to become painful, swollen and warm to the touch.

What causes it?

The specific cause of RA is not known and, currently, there is no known cure. The goal of rheumatologists is to put RA into remission.

In rheumatoid arthritis, the immune system is triggered to attack an individual’s joints and, sometimes, other organs.

Some experts suspect a virus or bacteria may change the immune system, causing it to attack the joints. Cigarette use is a known trigger for the disease.

Certain genetic mutations can also make some people more likely to develop RA, which is why it can sometimes run in families.

Whom does it affect?

For unknown reasons, there are higher incidences of RA among Caucasians, Native Americans and women. Women are up to three times more likely to get it than men. Women are also more likely to develop it at a younger age than men, but men may have more severe symptoms. Rheumatoid arthritis generally begins to affect people between the ages of 30 and 60, but patients can be diagnosed at any age.

How is it diagnosed?

There is no single test that shows whether someone has rheumatoid arthritis, but many patients with the disease have concerning antibodies (key element in an adaptive immune system), elevated inflammation tests and, potentially, anemia from chronic inflammation.

Your primary care provider will give you a checkup, ask about symptoms and, possibly, perform X-rays and blood tests before referring you to a rheumatologist, if warranted.

How is it treated?

Treatments include medications, rest, exercise and, in some cases, surgery to correct joint damage. Medication use has to be optimized to take into account a person’s existing medication list, age, liver and kidney function, risk of developing infections, cancer history, and prior RA treatment.

A rheumatologist should ultimately diagnose and manage rheumatoid arthritis. Additionally, RA treatment should take into account a person’s age, overall health, medical history and severity of the disease.

Why are rest and exercise important for RA?

People who suffer from rheumatoid arthritis need to be active but pace themselves. When joint inflammation worsens, it is important to discuss the flare-up with your rheumatologist but also rest and, in severe cases, use an aid, like joint splints or a cane.

When joint inflammation improves, people with RA should engage in regular exercise to maintain joint flexibility and strengthen surrounding muscles. Gentle stretching, swimming and brisk walking can help with chronic pain.

Once inflammation has subsided with treatment and joint pain has improved, I often recommend that patients initially work with a physical therapist.

Lack of rheumatology care in Washington state challenging to patients

Washington is not immune from the national shortage of rheumatologists. In 2017, there were only 35 to 40 rheumatologists practicing full time throughout the entire state. The situation is dire in rural areas.

Currently, my rheumatology practice at Virginia Mason Bainbridge Island Medical Center sees patients from across Kitsap County and the Olympic Peninsula. ‘

This is one of the reasons Virginia Mason’s Rheumatology Program conducts outreach in rural areas like Kitsap and Yakima counties, as well as the Olympic Peninsula.

This shortage often means patients in rural areas have to wait extended periods to see a rheumatologist. As an example, it is not uncommon for people who live in the Tri-Cities area to have to wait 12 months to see a rheumatologist close to home.

So, it should come as no surprise that I often see patients from throughout the Northwest (e.g., Alaska, Idaho, Montana, etc.) in Seattle or on Bainbridge Island.

In response to the shortage, and because of its commitment to convenient access to quality care in a variety of high-demand specialty areas, Virginia Mason has been growing its Rheumatology Program.

Karen Huisinga, MN, ARNP, FNP, joined the Rheumatology Program at Virginia Mason Bainbridge Island Medical Center in May 2017, and rheumatologist Erin Bauer, MD, has been practicing at Virginia Mason Federal Way Medical Center for about 18 months.

Dr Dave Amish Virginia Mason RheumatologistAmish Dave, MD, MPH, practices at Virginia Mason Bainbridge Island Medical Center one day a week and at Virginia Mason Hospital and Seattle Medical Center four days each week. He is ABIM board-certified in rheumatology and internal medicine. Dr. Dave specializes in rheumatoid arthritis, lupus, psoriatic arthritis and vasculitis.

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Category: Arthritis, Bones, Uncategorized

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