One of the hardest things I have to do as an orthopedic doctor is tell a patient that he or she has rheumatoid arthritis (RA). When people see me for pain, it is sometimes difficult for them to explain exactly what is happening to them. Some describe their symptoms as "mystery" pain because it's hard for them to pin point the exact location. One day they wake up with sore feet, another day their hands might hurt or they have pain in different joints in their body.
There are several possibilities that could cause this kind of pain from overexertion to various forms of arthritis. In order to make a true diagnosis a series tests are given to narrow down the findings. A blood test that reads negative for the rheumatoid factor is not always accurate. You may test positive on the blood work yet have no symptoms. It is estimated that around 10% of the population who actually have RA do not test positive.
The most common reaction from patients who hear they have RA is usually relief followed by fear and anger. They are relieved because now they can face their health issue, fear because they know not what to expect, and anger because it is happening to them. After the initial shock wears off, the question becomes, "How do I live with RA?"
Someone suffering with RA will most likely feel pain, fatigue, and joint stiffness. I recommend working with a team of health professionals, who may include a physical therapist, counselor, and rheumatologist, to develop a plan to help manage their symptoms. A typical plan includes education about the disease, exercise, diet changes, assistive devices, and other supports to help you stay active. Most people will have to make lifestyle changes to accommodate their condition but it does not mean you can't live a full and satisfying life.
Lifestyle Changes Help Ease Pain
Most people with RA find they have to slow down and get enough sleep or symptoms get worse. Here are a few things you can do to manage your stress, reduce your pain and lessen the exhaustion that accompanies RA.
Fatigue: Pace yourself throughout the day to allow for rest periods, and try not to get overtired.
Depending upon your symptoms, you may need to rest your joints for longer periods of time or at intervals, 15 minutes or so several times a day.
Give yourself permission to give up some mundane tasks and do the things that really must get done or you things you want to do.
Be careful not to rest too much because it can lead to more stiffness and underused muscles. Keeping your range of motion going at a comfortable pace will help prevent stiffness.
Relieve Joint Pain: Be kind to your body and protect your joints by taking the time to follow these helpful suggestions:
Take warm showers or baths after long periods of sitting or sleeping
Soak hands in warm wax baths
Sleep under a warm electric blanket
Use special kitchen tools or door knobs to reduce strain on joints
Use splints, canes, or walkers to reduce pain and improve mobility
Keep Moving: Although this may be difficult, activity will actually help maintain strength, flexibility, and overall health. Consider the following:
Exercise by stretching, strengthening, and conditioning. Weight-bearing and strength training are recommended for people with RA.
Physical therapy for specific joint problems as prescribed by your doctor
Swimming is good for conditioning lower extremities such as knees, ankles, or feet
Bicycling and walking are beneficial for joint problems that do not effect lower extremities
Tai Chi is a form of movement therapy that involves gentle stretches combined with deep breathing. Studies have found tai chi to reduce pain from RA but be careful not to do any moves that cause pain.
Diet: A healthy, balanced diet that is low in saturated fat, cholesterol, and salt and high in fiber and complex carbohydrates such as whole grains, beans, fruits, and vegetables is best. Be sure to watch your weight as being overweight can worsen the symptoms of RA.
Study Links Smoking & Vitamin D to RA in Women
A study conducted at the Mayo Clinic College of Medicine in Rochester, MN led by Dr. Sherine E. Gabriel
used data from records that tracked anyone who sought medical care for the past several decades. In rheumatoid arthritis, or RA, a person's immune system attacks the joints, leading to inflammation, pain, stiffness and in some cases erosion of the bone and joint deformity.
The researchers found that the actual percentage of women with RA increased in incidence of 2.5% between 1995 and 2007. The reason for the increase was deemed more environmental than genetic. Smoking is one of the few confirmed risk factors for the disease and women are slower in quitting than men. In addition, oral contraceptives contain far less estrogen than they used to so may offer less protection against RA which the hormone is known to do.
Another factor is vitamin D deficiency, which has been linked to RA, and is particularly low in women. Researchers feel that this study is likely to reflect that of the U.S. female population. The findings send two very strong messages to women; don't smoke and get checked for vitamin D deficiency!
Take Control of RA
Don't let RA take control of you and your life. Learn as much as you can about the disease and research the side effects of the medication prescribed. Each person is unique and how RA affects your body may be very different from someone else. Studies show that people who take an active role in the management of RA experience less pain and see their doctor less often.
There are some common alternative treatments that can be added to your diet in supplement form that have shown promise for reducing the symptoms of RA. Always check with your doctor before adding anything new as there may be side effects.
Plant oils - Seeds of evening primrose, borage and black currant contain a type of fatty acid that seems to help with morning stiffness.
Omega-3 fatty acids (fish oil) - Helps to reduce inflammation and has been shown to slightly reduce swelling.
Calcium and vitamin D - Protects bones against Osteoporosis
I recommend joining a support group for those afflicted with RA or become involved with the Arthritis Foundation. There are resources available to you that will provide emotional support and help you cope with the stress of pain. Connect with others and keep your family informed as to how you are feeling. They may be reluctant to ask you about your pain.
Eat a balanced diet, exercise, get plenty of rest, don't smoke and most importantly take time for yourself. Allow yourself the space you need to reflect on your feelings, go for a walk, listen to music, or write in a journal. Rheumatoid arthritis does not have to ruin the quality of your life. Make the lifestyle changes today that will help make your tomorrow a better day!
Mark Bromson, M.D.