Your Health

Early treatment key to controlling rheumatoid arthritis

Elderly woman showing her hand to the camera
Photo of Dr. David Robinson DR. DAVID ROBINSON
Winnipeg Regional Health Authority
Published Friday, June 23, 2017

It all started with her wrist.

Three months after her baby was born, Emily noticed some pain and swelling. Within a couple of weeks it had spread to involve her other wrist, her knees, elbows, and the knuckles in both hands.

She was having trouble getting dressed. She could barely change diapers. After a visit to her doctor and a couple of blood tests, she was told she likely had rheumatoid arthritis, or RA.

Emily was scared. Her aunt had RA and she was in a wheelchair and had severely crippled hands. Would this be Emily's fate? How would she care for her baby?

As a rheumatologist, this is a story that unfolds all too often in my office.

RA affects one in every 100 Canadians from their early teens to their eighties, which means chances are that you know someone who has RA. Twice as many women as men are affected by this disease, and women are also at higher risk for a period of time one year after delivering a baby.

Unlike the more common osteoarthritis (or wear-and-tear arthritis), RA is an autoimmune disease. The body's immune system - which is supposed to fight off colds and infections, becomes confused and begins to attack the lining of joints.

This inflammation causes swelling, pain and stiffness that can last for hours in the morning. RA can affect every joint in the body (except strangely the lower back). Left untreated, the joints are destroyed over a period of months to years causing early disability and premature death.

RA can also affect more than joints. Inflammation can occur in the blood, eyes, lungs, and skin, causing severe damage. Patients can have crippling fatigue and even weight loss. RA is a major risk factor for osteoporosis and early heart disease. Unfortunately, there is no known cure.

What causes RA? We don't really know, but people with family members who have RA are at higher risk, as are smokers. There may also be higher risk in those with gum disease.

Your doctor will diagnose RA based on your symptoms and a physical exam. Bloodwork will show signs of widespread inflammation, and most people with RA will have antibodies in their blood that can be measured. While very helpful, the antibodies can also occur in healthy people without arthritis, so care must be taken when looking at those results. X-rays, ultrasounds and MRIs can also help confirm the diagnosis in some cases. While your family doctor may make the diagnosis, most people with RA are referred to rheumatologists for specialized care.

So what will happen to Emily? Fortunately for her, we have made great strides in treating RA over the last 20 years. As basic science research has revealed the molecules involved in inflammation pathways, over a dozen new therapies targeted towards these molecules have been developed. As well, we have become much better at using older drugs in new ways.

Early diagnosis and treatment are the key. If treatment is started early, the disease is much more likely to come into remission, less likely to cause damage, and need fewer medications. Even the risk for heart disease is lowered.

A patient like Emily who presents today with new-onset RA should be placed on medications right away with a goal to completely erase her pain, swelling and stiffness and prevent damage from ever occurring. With early treatment and a little luck, hopefully, the only reminder of her disease will be taking medications. Twenty years ago, there was a 30-bed ward at the Health Sciences Centre for patients with RA. Today those patients no longer need to be admitted to hospitals - they are mostly busy working.

What's next? Research, including some done at our unit led by Dr. Hani El-Gabalawy, one of Canada's leading experts on RA and the Scientific Director of the Institute of Musculoskeletal Health and Arthritis at the University of Manitoba, is finding markers that predict who will get this disease before the symptoms start. If treating RA is easier if it's done early on, then, hopefully, treating people at high risk for a brief period of time may prevent the disease from ever starting.

If a day comes when you find yourself feeling unwell, and you find you have a swollen joint or two, it's time to seek an appointment with your health-care provider. The earlier the better.

Dr. David Robinson is a rheumatologist who works in the Rheumatology Clinic at Health Sciences Centre Winnipeg.

This article was originally published in the Winnipeg Free Press on Friday, June 23, 2017

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