1. Rheumatoid Arthritis Is Not Osteoarthritis
Osteoarthritis affects more than 32.5 million adults in the United States, according to the Centers for Disease Control and Prevention (CDC). It is the most common type of arthritis; it’s the type that your grandparents have, most likely. It is known as degenerative arthritis and is also called wear-and-tear arthritis, aptly named because the cartilage that lines your joints wears down. The risk of developing osteoarthritis increases with age.
Rheumatoid arthritis is an autoimmune, inflammatory, systemic disease. In RA, your immune system attacks healthy cells in your body by mistake, resulting in inflammation, pain, and swelling in affected body parts. Typically, with rheumatoid arthritis, the pattern of affected joints occurs symmetrically (in the same joint on both sides of the body).
RELATED: Signs and Symptoms of Rheumatoid Arthritis
2. Rheumatoid Arthritis Is Systemic, Not Solely a Joint Disease
With rheumatoid arthritis the organs of the body, such as the heart, lungs, and eyes, may also be affected. Because “arthritis” is part of the name, it is misleading, confusing, and somewhat suggestive that RA only affects the joints. Not so.
While the joints are certainly affected by RA, the pulmonary, cardiovascular, and neurological manifestations are significant aspects of the disease that must be managed. Potential complications of RA include an increased risk of infection and osteoporosis. According to an article published in the June 2020 issue of the Journal of Clinical Medicine, systemic involvement occurs in about 40 percent of RA patients.
RELATED: How RA Can Affect Your Whole Body
3. It’s Nearly Impossible to Explain the Variability of RA Symptoms and Disease Activity
It is hard enough to get people to understand that RA is a chronic disease and it’s not going away. It is even more difficult to explain that RA is characterized by variable symptoms — fluctuations that can occur without notice, which may be intense and of unpredictable duration. Pain levels can spike for what seems like no reason, and the fluctuation may occur not only from week to week, but also day to day or even hour to hour. The variability and unpredictability of RA is difficult for patients to accept and understand. That is also true of family and friends. One day you can’t get out of bed and the next day you’re able to go to the gym. It may almost seem as though you are faking it, and many RA patients have been accused of just that.
RELATED: 12 Things You Only Understand if You Have Rheumatoid Arthritis
4. Diet, Exercise, and Supplements Do Not Cure Rheumatoid Arthritis
If you have RA, it is a sure bet that someone at some point will suggest that changing your diet or exercising more will cure your RA. People also like to pitch supplements as the solution. Decades ago, DMSO (dimethyl sulfoxide) was a popular folk remedy for RA. Milk thistle, turmeric, vitamin D, and countless other supplements and products have gotten their 15 minutes of fame. Let’s not forget a gluten-free diet, too.
Regular exercise is definitely helpful for managing RA symptoms. And, there are foods that are considered anti-inflammatory. Helpful, maybe. But, there is no cure for RA.
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Managing and treating RA usually involves using drugs, DMARDs (disease-modifying antirheumatic drugs) and biologic DMARDs, which slow disease progression and prevent joint deformity. Other medication may be used to help control inflammation and reduce pain. The goal of treatment is to manage the disease. There is no single treatment plan that works for everyone with RA. A period of trial-and-error is necessary to find the most effective combination of medicines, as well as self-management techniques (reducing stress, using joint protection techniques, massage, and more).
5. Fatigue Is as Daunting as Rheumatoid Arthritis Pain
Most people are aware that RA is a chronic pain condition. Pain management and how to cope with pain become the focus after an RA diagnosis. Most people don’t realize that, with RA, fatigue is as big a problem as pain. Research published in the journal RMD Open Rheumatic and Musculoskeletal Diseases suggests that fatigue in RA is a persistent problem and an unmet need. Even with improved treatment strategies, fatigue persists.
RELATED: Chronic Fatigue From RA – 6 Ways to Regain Energy
6. Morning Stiffness Is a Recognized Characteristic of RA — You’re Not Being Lazy
I know a lot of people who have a hard time getting up when the alarm clock goes off. That’s people without RA as well as people with RA. For people without RA, it is mostly a consequence of not enough sleep. For people with RA, it can be due to morning stiffness. While the exact cause of morning stiffness in RA is not known, it does seem to be associated with inflammation.
Morning stiffness leaves you feeling like you can’t get up; flattened, as if hit by a truck. The joint stiffness and body aches are intense and cruel and typically last more than an hour. So, if you have RA, you aren't just trying to grab a few extra winks, or being lazy — your body isn’t cooperating.
RELATED: How to Deal With Morning Stiffness — Tips From People Living With RA
7. Work Disability Is Common With Rheumatoid Arthritis
According to the CDC, RA can make work difficult. In fact, adults with RA are less likely to be employed than those who do not have RA, research shows. As the disease progresses and worsens, many people with RA find they cannot work at the level they once did. Work loss among people with RA is highest among people whose jobs are physically demanding, and less so among those with jobs that are less physical or where they have influence over the job pace and job activities.
While some studies suggest work disability rates with RA are somewhat variable, prospective studies show that the rate is about 30 to 40 percent five years after diagnosis, according to research published in the journal Annals of the Rheumatic Diseases.
It has been theorized that better treatment options, such as biologic drugs, would have a positive impact on RA and lower work disability rates. While there may be improvement in individual cases, the research cited above suggests that overall work disability remains an economic burden with RA.
It can be difficult to determine when it is the right time to stop working, but you must consider your physical limitations and the demands of your current job, as well as the demands of any type of work. Social Security Disability defines disability for their purposes of determination as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment that has lasted or is expected to last for 12 months or result in death.
RELATED: Rheumatoid Arthritis and Disability Applications: What to Know
8. Are Rheumatoid Arthritis Patients Immunocompromised? What Does That Even Mean?
"Immunocompromised" is a scary word, and a complicated one. It is also very misunderstood. I have heard people with rheumatoid arthritis or other autoimmune diseases say they have “no immune system." That is an inaccurate statement. In fact, "immunocompromised" means a “weakened immune system.” People who are immunocompromised have a reduced ability to fight off infections or certain other conditions. It is also said that immunocompromised patients have an increased risk of developing an infection. (The words "immunocompromised" and "immunosuppressed" are often used interchangeably.)
With RA, the disease state itself is associated with being immunocompromised. With autoimmunity, the body attacks healthy immune cells, thus lowering immunity. Also, the treatments for RA are designed to dampen the overactive immune state of RA. But, remember, lower immunity is not no immunity. Think of it as lower defenses against infection.
You may also hear about a consequence of being immunocompromised: poor response to vaccines. Potentially, immunocompromised patients may not achieve the full effect from vaccinations.
RELATED: 5 Things People With RA Need to Know About COVID-19 Vaccines
