7 Common Myths and Facts About Rheumatoid Arthritis

From everydayhealth.com

By Matt McMillen

Rheumatoid arthritis (RA) causes pain, stiffness, and swelling in your joints. While those are the most common and obvious symptoms, did you know the impact of RA on your body is much broader?

“RA is a systemic disease that not only affects the joints, but can also affect several other organs, such as the lungs, the eyes, the nerves, the heart, and the skin,” says Nilasha Ghosh, MD, a rheumatologist at the Hospital for Special Surgery in New York City.

RA is the most common type of autoimmune inflammatory arthritis, and it affects about 1.5 million people in the United States. RA is a chronic disease, and though there’s no cure, treatments can quell its inflammation and limit the damage it does.

To help you better understand the disease and how serious it is, our experts dispel some of the most common myths and misconceptions you may have heard about RA.

1. Myth: RA Is the Same as Osteoarthritis (OA)

While both cause joint pain, they’re not the same. “Rheumatoid arthritis is a disorder of the immune system affecting the joints, whereas most cases of osteoarthritis are the result of degenerative disease at the joint,” says Dr. Ghosh.

OA typically develops from wear and tear on your joints as you age. This causes the breakdown of cartilage at the ends of your bones where they attach to your joints. The result: Your bones begin to rub together, causing pain, stiffness, and swelling. Some research shows that people with RA are at a higher risk for OA. But because the diseases are different, their treatments differ as well, says Ghosh. RA treatments suppress or modify the immune system. These are not effective for OA.

2. Myth: RA Only Affects Older People

RA most often starts between ages 30 to 60, though it can occur at any age. Ghosh says the incidence of RA in young adults has been rising, though that increase, she adds, might be because doctors are better able to recognize and diagnose it.

Your age can make a difference in how RA presents. “In young and middle-aged people, let’s say 30 to 50 years old, RA most often develops insidiously and gradually, whereas in older people its onset is acute and sudden most of the time,” says Kezia Daniel, MD, a rheumatologist at Northwell Health’s Phelps Hospital in Sleepy Hollow, New York. Another difference she points to: In young people, RA typically affects small joints, like those in your fingers and toes. Older adults, on the other hand, frequently have pain and swelling in large joints like the shoulders, hips, knees, and neck.

3. Myth: RA Is Just Minor Joint Pain in the Hands or Knees

When you have RA, your immune system mistakenly attacks healthy tissue. These attacks lead to ongoing, damaging inflammation. This can result in much more than joint pain. “Chronic inflammation will erode the cartilage and bone, which can lead to joint damage and deformity,” says Dr. Daniel. And RA inflammation does not only affect your joints. It can harm your skin, eyes, and lungs, says Ghosh. RA, she adds, also contributes to heart disease and, without treatment, boosts the risk of cancer.

Daniel points out that RA also increases your risk of the following:

• Heart attack
• Stroke
• Interstitial lung disease
• Osteoporosis
• Blindness
• Vasculitis
• Infections
• Carpal tunnel syndrome

4. Myth: If You Have RA, You Should Avoid Exercise to Protect Your Joints

Actually, the opposite is true. “Exercise does not make joints affected by rheumatoid arthritis worse,” says Ghosh. “In fact, it is recommended.” Why? Ghosh says that inflammation in your joints can weaken the muscles and tendons that surround it. Exercise, she points out, may help prevent this weakening. Exercise also reduces RA disease activity and lowers inflammation. In other words, you’ll feel better if you exercise. “Many [RA patients] feel less stiff and sometimes have less pain after exercise given that mobility tends to help inflammatory joint pain and swelling,” says Ghosh.

Daniel recommends 15 to 30 minutes of exercise a day at least five days a week. “It will lessen pain and stiffness in your joints and will help keep them lubricated,” she says. She recommends asking your rheumatologist to refer you to a physical therapist who can design a safe and effective exercise routine that meets your specific needs.

If any exercise does cause significant joint pain, says Ghosh, don’t ignore it. “Discuss it with your rheumatologist or a sports medicine doctor to assess if the joint has excess inflammation and what can be done to mitigate that,” she says.

5. Myth: Joint Damage From RA Is Inevitable

“Joint damage can be prevented if caught early enough and if treatment regimens can be adhered to,” says Ghosh. That’s because the medications your doctor prescribes will keep RA’s joint-damaging inflammation under control. Daniel stresses the importance of regular follow-up appointments. Your rheumatologist will assess whether your current treatment is adequately managing your RA and preventing its complications. If it’s not, don’t worry. A change in dosage or a switch to another of the many available treatment options should get your disease in check. Your rheumatologist will determine your follow-up schedule, but Daniel says to expect appointments at least every three months.

6. Myth: You Don’t Need Medication Until Your RA Becomes Severe

If you have been diagnosed with RA and have begun to develop symptoms like joint pain, “early treatment is definitely recommended to help prevent joint damage and subsequent worsening of joint damage as time goes on,” says Ghosh. “It may also help prevent systemic complications that can accompany RA, such as cardiovascular disease and cancer risk.” In fact, with treatment, your RA may never become severe, she says.

7. Myth: Medication Is Not Necessary if You No Longer Have RA Symptoms

Right now, RA has no cure. The best that your doctor can do, says Daniel, is get your disease into remission, in which you have little or no active inflammation. “Remission means your medication is successfully doing its job right to suppress the disease,” says Daniel.

Once in remission, your symptoms should ease up significantly. But you likely won’t remain in remission if you stop following your treatment plan. “The majority of patients with rheumatoid arthritis will have a flare or relapse of disease if their medications are stopped, even if they were in clinical remission beforehand,” says Ghosh.

Most of Daniel’s RA patients ask her if they can at least reduce the amount of medication they take when they feel better. Her answer is no. Here’s what she tells them: Many of the medications used for RA require steady, consistent levels in your body to keep your immune system from attacking your joints. “If you take it randomly, the drug levels in your body drop rapidly between doses,” says Daniel. “That puts you at a higher risk for flares.”

The Takeaway

• Misconceptions about rheumatoid arthritis can delay diagnosis and treatment as well as discourage you from making helpful lifestyle changes, such as increasing how much you exercise.
• Following your treatment plan even when you feel better will increase the likelihood that your RA remains under control or in remission. Skipping doses of medications or stopping altogether puts you at risk of a flare, in which your symptoms return.
• RA can develop at any age. If you have symptoms, see a doctor. While the disease can’t be cured, treatments can prevent it from causing serious harm to your joints and other parts of your body.

https://www.everydayhealth.com/rheumatoid-arthritis/common-myths-and-facts-about-ra/

Could Anaemia Be Contributing to Your Psoriatic Arthritis Fatigue?

From health.yahoo.com

By Carmen Chai-Oakley

Fatigue can be one of the most disruptive - yet common - symptoms of psoriatic arthritis (PsA). And it isn't just ordinary tiredness: PsA can cause a lingering physical and mental exhaustion that doesn't disappear after a good night's sleep and can make working, exercising, socializing, and even carrying out everyday tasks more difficult.

There are a few factors at play. Interrupted sleep, symptoms like anxiety, depression, and swollen joints, and certain medications may contribute to fatigue.

But another potential factor is anaemia, a condition in which your body doesn't have enough healthy red blood cells. It can cause symptoms such as tiredness, weakness, and shortness of breath.

Here's how to tell if your fatigue may be anaemia-related - along with how anaemia is diagnosed and treated alongside PsA.

Causes of Anaemia in Psoriatic Arthritis

Anaemia occurs when you don't have enough healthy red blood cells to adequately carry oxygen throughout your body. But there isn't one single reason someone with PsA may develop it, according to Alireza Meysami, MD, the head of rheumatology at Henry Ford Health in Detroit, where he specializes in diagnosing and treating inflammatory arthritis, including PsA.

"Persistent inflammation can increase hepcidin, a liver hormone that traps iron in storage and limits its availability for making red blood cells. This is called anaemia of inflammation," Dr. Meysami says.

This process is also known as anaemia of chronic disease because it can affect people with conditions that cause inflammation, including autoimmune diseases like PsA. With chronic inflammation, your body struggles to use stored iron for red blood cell production.

But PsA-related inflammation isn't the only possibility. Anaemia may be triggered by:

• Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) for joint pain. "NSAIDs may cause gastritis, ulcers, or slow gastrointestinal bleeding," Meysami says. This may lead to iron deficiency anaemia.

• Iron deficiency from menstrual or gastrointestinal blood loss

• Iron deficiency from poor absorption or nutritional deficiencies

• Methotrexate. While methotrexate is commonly prescribed to treat PsA, anaemia is a potential side effect. "Methotrexate interferes with folate metabolism and, rarely, may suppress the bone marrow, which is why we prescribe folic acid and monitor blood counts," Meysami says.

Methotrexate itself can also cause fatigue in some people, even when it hasn't caused anaemia, says Neal Birnbaum, MD, a rheumatologist and past president of the American College of Rheumatology who's been practicing for 48 years in San Francisco.

Ultimately, anaemia can be "multifactorial," Dr. Birnbaum says. It shouldn't automatically be attributed to arthritis, he says. Comorbidities can contribute to anaemia, too, including kidney or thyroid disease.

Signs and Symptoms of Anaemia-Related Fatigue

It's not always straightforward to figure out whether fatigue is coming from PsA or anaemia, because there can be overlap.

"[PsA] patients often describe feeling completely drained, physically heavy, or mentally foggy, even after sleeping. Some have to choose between working, exercising, caring for their family, or participating in social activities because they do not have enough energy for everything," Meysami says.

Anaemia can cause fatigue and weakness, too. But some additional symptoms may make anaemia worth investigating, including:

• Shortness of breath

• Pallor (skin that's paler than usual)

• Dizziness, lightheadedness

• Headaches

• Heart palpitations

• Chest pain

• Cold hands and feet

Still, symptoms alone can't determine whether you're anaemic. Blood tests are needed for a diagnosis.

If your fatigue appears as your haemoglobin level falls and improves after the anaemia is corrected, that's a clue that anaemia was contributing to the exhaustion, Birnbaum says.

But even then, it may just be one factor among several. Sometimes, factors like chronic pain, poor sleep, anxiety and depression, thyroid disease, or fibromyalgia may be causing fatigue, Meysami says. "Steroids may cause insomnia while antihistamines and some pain or anxiety medications may cause daytime sleepiness," he says.

How Anaemia Is Diagnosed

Maria Kray/iStock

If persistent fatigue is interfering with your everyday life, talk to your rheumatologist or primary care doctor about whether testing for anaemia makes sense, Birnbaum says.

Your doctor may conduct a complete blood count test to start, which focuses on red blood cells, including their size and shape, Birnbaum says.

If anaemia is present, additional testing may include further blood testing for reactive proteins, ferritin, iron, transferrin saturation, reticulocyte count, vitamin B12, folate, and kidney and thyroid function, Meysami says.

"Depending on the patient, evaluation for menstrual or gastrointestinal blood loss may also be necessary," Meysami says.

Treating Anaemia When You Have Psoriatic Arthritis

Treatment depends on why you're anaemic.

If anaemia is related to inflammation from PsA, getting the disease under better control may help with both the anaemia and the fatigue. "If you have effective treatment, if the skin and joints are under control, then the anaemia is going to improve," Birnbaum says.

But controlling PsA won't resolve every form of anaemia. Blood loss, iron deficiency, vitamin deficiencies, kidney disease, or medication-related problems need their own treatment, Meysami says.

If testing confirms iron deficiency, treatment may include oral or intravenous iron, while folate or vitamin B12 can be replaced if a deficiency is found.

Your rheumatologist will also review your medical history, prescribed medications, and other factors, such as NSAID use, potential gastrointestinal bleeding, sleep problems, and chronic pain, Meysami says.

"Do not accept severe fatigue as something you simply have to live with because you have PsA. Fatigue is real, can be disabling, and deserves a proper evaluation," Meysami says.

The Takeaway

• Fatigue is a common symptom for people with psoriatic arthritis (PsA) and several potential factors can be at play, including inflammation, chronic pain, disrupted sleep, certain medications, or anaemia.

• Anaemia in PsA can stem from chronic inflammation, which causes the body to struggle to use stored iron for red blood cell production, or from factors like iron loss from bleeding, nutrient deficiencies, or medication side effects.

• Blood tests are needed to confirm whether anaemia is contributing to fatigue, and treatment ultimately depends on the cause, ranging from better management of PsA inflammation to iron and vitamin replacement.

https://health.yahoo.com/conditions/anemia/articles/could-anemia-contributing-psoriatic-arthritis-050000943.html