Rheumatoid Arthritis: 6 Things to Know

Rheumatoid arthritis used to alter patients' everyday lives. "Now it’s hard to recognize a person with rheumatoid arthritis walking down the street,” says Joan Bathon, MD, director of the rheumatology division at Columbia University's Vagelos College of Physicians and Surgeons and an expert in rheumatoid arthritis.

“When I diagnose a patient with RA, one of the first things I say to that patient is please don’t worry,” adds Bathon, professor of medicine at Columbia. “Rheumatoid arthritis is treatable, it’s not going to ruin your life, and we can make you feel better and get you back to your normal life.”

We spoke with Bathon about what’s important to know about rheumatoid arthritis:

Rheumatoid arthritis is an autoimmune disease.

RA is an autoimmune disease in which the body attacks its own tissues. RA causes swelling, warmth, pain, and stiffness in the joints—most commonly in the hands and wrists but it can involve nearly all joints. This chronic inflammation will eventually damage and destroy  joints if it is not controlled rapidly and effectively with medications. It is disabling only if it is not brought under control quickly, and that control must be maintained long term.

More women than men get RA.

Women get RA twice as frequently as men, and most commonly it starts in middle age, between ages 40 and 60. However, it can occur in the very young and in the very old as well.

The cause of RA is unknown.

We don’t know exactly what causes rheumatoid arthritis. There is a strong genetic factor—that is, in some cases, parents can pass the genetic risk (or trait) down to their children. However, genetics aren’t the only explanation, as many people who develop RA have no relatives with it. We know that smoking can add to the risk for developing RA.

Therapies prevent damage to the joints.

RA medications have anti-inflammatory properties. They resolve the inflammation in the joints and, in so doing, prevent damage to the joints. They are much more potent and effective than medications such as ibuprofen or naproxen and more effective than low dose prednisone.

The usual first medication is methotrexate. This drug works as an anti-cancer medication in very large doses, but rheumatoid arthritis responds well to very low doses of methotrexate so we use low doses in RA. It has been around for 60 years and is very safe, so it is the first-line treatment for RA.

If there isn’t a good enough response to methotrexate, then a second medication is added. This could be another oral medication such as sulfasalazine or leflunomide.

Or it could be a targeted therapy—that is, one that is directed against a very specific molecule or cell type. There are quite a few of these now available that have been approved by the FDA and are very effective in treating RA. Which one is recommended will depend on how severe your RA is, your overall health, your laboratory data, and sometimes which one(s) your insurance company will pay for. 

In general, targeted therapies are much more expensive than methotrexate but are needed in about 50% of patients with RA. Some of these medications include Enbrel, Humira, Actemra, Rituxan, and others.

There is no evidence that “anti-inflammatory” diets help.

To date, despite all the press about "anti-inflammatory" diets, there are no convincing data that a specific diet will cure or substantially reduce inflammation in RA.  Most rheumatologists recommend following a healthy diet, such as the Mediterranean diet, and avoiding fad diets.

We do know that stopping smoking and reducing your weight (if you are overweight or obese) can help to reduce the inflammation in the joints and help the medications work better.

The prognosis is excellent.

We have a large number of well-proven, effective treatments for RA. If the diagnosis is made, and treatment implemented, early in the disease process, we can get it under good control. However, it is a chronic illness, so it does require long-term treatment and routine monitoring with a rheumatologist.

Occasional adjustments in medications often have to be made—for example, if the inflammation breaks through the current treatment regimen, or if side effects to a medication develop.

People with rheumatoid arthritis are usually able to resume most or all of their pre-RA activities once the inflammation is controlled.