Most people with rheumatoid arthritis can live full, active lives despite their disease. But living a good life with RA often means you need to work at managing your disease and get the help you need. Take care to avoid these six common mistakes.
RA Mistake 1: Not Seeing a Rheumatologist
If you’re like most people with RA, the first doctor you saw for your joint symptoms was a primary care physician. But a specialist has more training in treating RA.
Just 20 years ago, RA was often treated with medications that relieved pain but didn’t stop ongoing joint damage. Today, there are many new, effective — and highly complex — treatments for rheumatoid arthritis that do both. It’s important to see a rheumatologist, who has the training and experience to prescribe and monitor those medications.
If you haven’t seen a rheumatologist, your primary care doctor should be able to refer you to one. The American College of Rheumatology (ACR) also lists rheumatologists in your area.
What is a Rheumatologist?
A rheumatologist is a physician who specializes in treatment of arthritis, and other disorders of the joints, muscles, and bones, autoimmune diseases, and soft tissue diseases.
A rheumatologist is usually an internal medicine specialist or pediatrician, with additional specialized rheumatology training to identify and treat the more than 100 different types of arthritis in addition to other autoimmune disorders such as lupus, gout, and osteoporosis.
Mistake 2: Becoming a Couch Potato
When you have joint pain and fatigue, it’s hard to get up and get moving. But regular exercise is one of the best things that you can do for your health. While rest is also important for managing your disease, too much inactivity can make pain, fatigue, and stiffness worse.
Even when your RA is flaring, you can — and should — do gentle range-of-motion exercises. Range-of-motion exercises help maintain joint movement and flexibility by taking joints through their full span of movements. No weights are used.
You may also be able to gently exercise in water during flares.
When your disease is less active, you should be more active. Add exercises to build muscle strength and joint stability and improve aerobic fitness.
Why Are Rest and Exercise Important?
A balance of physical activity and rest periods are important in managing rheumatoid arthritis. Exercise more when your symptoms are minimal, rest more when your symptoms are worse.
Exercise helps maintain joint flexibility and motion. There are therapeutic exercises, such as physical therapy that is prescribed, that can help with strength, flexibility, and range of motion of specific joints or body parts affected by your RA. Many recreational activities such as walking swimming are helpful because allow movement with little to no impact on the joints. Consult your rheumatologist or physical therapist to find out what exercises are right for you.
Just as physical activity is important, so is rest. When you have an RA flare and your symptoms are worse, it is best to rest to help reduce joint inflammation and pain, and to cope with the fatigue that may accompany it.
Talk to your rheumatologist or a physical or occupational therapist about the best and safest exercises for you. Walking can be a good exercise for people with RA, and it doesn’t even require going to a gym! Warm-water aerobic exercise may be another choice to consider — the water gives sore joints some additional support.
Mistake 3: Skipping Doctor Appointments
While you may not feel the need to see your rheumatologist when your RA is less active, keeping your appointments is still important.
During regular visits, your doctor will:
- Monitor the course of your disease
- Determine how well your treatment is working
- Look for harmful side effects
- Adjust your treatment, if necessary
- In addition to seeing your doctor, you also may need periodic lab tests or X-rays. It’s important that keep those appointments, too.
Mistake 4: Not Taking Prescribed Medications
Pain relievers and nonsteroidal anti-inflammatory drugs (NSAIDs) may help your joints feel better. But they do nothing to stop the joint damage that is going on inside. That requires a more powerful disease-modifying antirheumatic drug (DMARD) or biologic response modifier, or both.
Years ago, doctors started RA treatment with aspirin and other pain relievers. If the disease got worse, they then prescribed a DMARD. Today, doctors are likely to prescribe a DMARD or a biologic (or both) early on, particularly for aggressive RA.
In fact, ACR guidelines recommend that all people diagnosed with RA be given a DMARD, regardless of how active or severe their RA is. Studies have shown that starting powerful drugs earlier may be more effective in reducing or preventing joint damage.
If your rheumatologist recommends a DMARD or biologic and you don’t take it, you may be risking serious joint damage that cannot be repaired. If you have active RA and your doctor has not recommended one of these drugs, ask if you need one.
Mistake 5: Skipping Medication When You Feel Good
You may be tempted to skip your medications on days when you’re feeling better. But failing to take your medications could cause the pain — or even your rheumatoid arthritis — to get worse.
If you take medication for pain and inflammation, you should take it consistently. Missing a dose could cause the pain to return, and it may be more difficult to relieve. The same is true for joint inflammation. It’s better to keep it under control than allow it to flare and try to get it under control again.
To control your RA, some medications need to stay in your bloodstream at therapeutic levels. If you miss a dose of medication, you should take it as soon as you remember (but don’t take a double dose). If you miss a dose often — even if you are feeling better at the time — blood levels of the drug may drop and could cause a flare of your RA.
What Is the Difference Between Normal, Healthy Joints and Arthritic Joints?
Arthritis refers to more than 100 conditions that affect the musculoskeletal system, specifically, the joints. The joints are the parts of the body where bones connect. When arthritis is present, the joints may become inflamed, stiff, red, and painful. Rheumatoid arthritis is one type of arthritis classified as ‘systemic,’ meaning it can affect the entire body. Damage from RA may occur in tissues surrounding the joints including the tendons, ligaments, and muscles. In some patients, symptoms may extend to the skin and eyes, and internal organs including the liver, kidneys, heart, and lungs.
What does a Rheumatoid Arthritis flare feel like?
The thing to understand about inflammatory arthritis pain is that it’s always there. It’s not like muscle pain that happens when you use the muscle, or a broken bone that hurts when you use the limb. Arthritis pain is constant. There’s no comfy position to get into so that it doesn’t hurt.
Some people have pain every day. Sometimes it’s mild, sometimes not so much. No matter what, I try to put a smile on my face and deal with it. Why? Because there isn’t really a choice.
To some people,it would be in a permanent flare. It is thought that most people with RA have a baseline level of pain. For some, this is pain free. For some, this is mild, occasional aches. For some, this is daily aches and pains, from mild to moderate to severe.
Severe pain all day every day is what I would call perma-flare, and there are people who are forced to go through life this way.
Mistake 6: Accepting Depression
Living with RA isn’t easy. It can be painful and unpredictable and make it hard to do the things you enjoy. It’s understandable that you may become sad at times, but you don’t have to accept depression as a part of your disease.
Ask your doctor to refer you to a mental health professional who works with people with chronic diseases. Counseling may help you develop better skills for coping with RA. Attending a support group, such as those offered by the Arthritis Foundation, may also help.
If you still experience feelings of depression, let your doctor know. Some people with rheumatoid arthritis benefit from taking antidepressants. Simply accepting depression can take the joy out of life and make it more difficult to manage your disease.
So what does a rheumatoid arthritis flare feel like?
Rheumatoid Arthritis guy put it like this:
Imagine having all your joints slowly pulled apart. Now, imagine not having to imagine it. This is rheumatoid arthritis. —RA Guy
I think that sounds pretty accurate.
Flares hurt a lot.
There is dull but strong pain in wrists and ankles. The lower back feels like someone is twisting a knife in it. Knees ache, and then suddenly feel like someone has stabbed a screwdriver into them. The ribs squeeze the lungs, so that it’s hard to breathe. It feels like having a heart attack, or someone is crushing the chest. There is no way to sit, no way to lie down, there is no position that eases the rib pain. There is no way a person can wear a bra!
Inflammatory arthritis pain is constant. It doesn’t quit. It wears you down. I think the constant pain is the cause most of the fatigue I experience…most of my brain is trying to block out severe pain and keep functioning. That’s exhausting.
So what can be done?
- Prednisone burst.
- Heat packs.
- Topical creams and gels.
- Hot showers.
- Extra nsaids,
A true full body mega flare? Nothing, really, can be done. Nothing touches it. You just have to hope it doesn’t last long. Mine are improving. Lately they only last 24 hours or so. Recently they were lasting 4 days or so. The longest one lasted 4 months. This is child’s play to what I’ve read some people experience. Some people are in full body mega flare all the time.
I don’t know how they cope. They have to, I guess. Because there isn’t really a choice.
Sources: arthriticchick.com ; WebMD; medicinenet.com