5 Questions People With Rheumatoid Arthritis Should Ask Their Doctors

From self.com

Asking questions is one of the best things you can do

Learning you have rheumatoid arthritis can be scary, stressful, and overwhelming. If the illness is completely new to you, we wouldn’t be surprised if you have a million questions running through your mind after a rheumatoid arthritis diagnosis. Instead of keeping your questions to yourself, don’t be shy about asking questions directly to your doctor.

Remember, your rheumatologist is an expert in this—it’s literally their job description to be one—and they have a wealth of information to help you understand and manage your condition, both now and in the future. Here are some questions you may want to ask your doctor after a rheumatoid arthritis diagnosis.

1. How advanced is my rheumatoid arthritis?

With rheumatoid arthritis, your body’s immune system mistakenly mounts a defence against your synovium, which is the incredibly important lining of the membranes that encase your joints, the Mayo Clinic explains. When your synovium becomes inflamed due to your immune system’s attack, this lining gets thicker, which can damage your cartilage and bones. This process is what leads to hallmark rheumatoid arthritis symptoms like painful, swollen joints, joint stiffness, fatigue, fever, and more.

The severity of your rheumatoid arthritis when you’re diagnosed plays a critical role in figuring out your best course of treatment, Kevin Byram, M.D., assistant professor of medicine in the division of rheumatology and immunology and associate director of the rheumatology training program at Vanderbilt University Medical Centre, tells SELF.

In the early stages, rheumatoid arthritis is often limited to the smaller joints. But as it progresses and becomes moderate or severe, it can have a more widespread impact on the body. “Many times we'll know early on if somebody has really aggressive disease and might require some of the more advanced treatments,” Dr. Byram says.

                                                                 bortonia / Getty Images

2. What are my treatment options?

When treating rheumatoid arthritis, your doctor’s goal is to get you to a place where you’re experiencing as few symptoms as possible. With the right treatment, you might even achieve remission, which basically means your symptoms are so tame (or not even present at all) that rheumatoid arthritis isn’t affecting your day-to-day life.

The standard first treatment for many people with early rheumatoid arthritis is a drug called methotrexate, which is available as a pill or an injection. Methotrexate is from a class of drugs called conventional disease-modifying anti-rheumatic drugs, or conventional DMARDs, according to the American College of Rheumatology. If blood tests and X-rays show developments like highly elevated inflammatory markers and advanced bone erosion, your physician may choose an alternative rather than start you on methotrexate. Or, if methotrexate or other conventional DMARDS don’t bring your illness under control, your physician may suggest other treatments including biologics, JAK inhibitors, and steroids.

When searching for a treatment that works, many different factors come into play, including the severity of your illness, treatment recommendations from the American College of Rheumatology, your response to different medications, existing and potential side effects, and your insurance coverage.

It may take trying a few different medications before finding one that’s effective, but the good news is that there are enough medication options available that if a treatment isn’t working, alternatives are probably available.

3. What side effects can I expect from treatment?

Rheumatoid arthritis treatment side effects vary depending on the type of drug you’re taking: You can experience anything from stomach irritation and nausea to visual disturbances and more, according to the Mayo Clinic. One key potential side effect to note is the increased risk of infection that comes with some rheumatoid arthritis treatment.

If you’ve experienced a lot of infections in the past, this will probably be a consideration when determining which treatment is best for you. “Overall, the medications that treat rheumatoid arthritis are aimed to bring down the inflammation that's overactive in the body,” Elizabeth Schulman, M.D., rheumatologist at Hospital for Special Surgery, tells SELF. “So with that comes, oftentimes, an increased risk for infections.”

Often the infections are mild and the benefits of decreased pain and increased function are worth the risk, but for some people the immunosuppression can be problematic and the infections can be more severe, making this an important consideration, Dr. Byram says. “This was important before COVID-19, but even more in the forefront now,” he says.

4. How often do I need to check in with my doctor?

After a rheumatoid arthritis diagnosis, you can expect that your doctor will want to see you every few months for blood work and to talk about your symptoms. This may seem like a lot at first, but rheumatoid arthritis is a chronic disease, and these frequent check-ins give your doctor a chance to re-evaluate your condition—making sure your medication is working and that side effects are minimal or manageable. This also allows them to include you in treatment decisions.

“An overarching principle in the treatment of rheumatoid arthritis is that this is really a shared decision making between the patient and the physician,” Dr. Schulman says. It’s important to make sure that the treatment feels comfortable to you and that you understand the physician is going to do their best to minimize all possible side effects, she adds.

Even if you reach a state of remission, you can still expect regular visits, Dr. Byram says. It’s possible to have relapses from remission for various reasons, including because your medication stops working or certain lifestyle factors, so it’s still good to have frequent check-ins with your doctor.

5. What lifestyle modifications do I need to make?

Along with starting medication, a number of lifestyle modifications, including stress management, prioritizing your mental health, making sure you’re getting enough sleep each night, exercising, and other healthy habits are all important in managing your rheumatoid arthritis.

And about that exercise bit, since there’s a lot of confusion: Many people with newly diagnosed rheumatoid arthritis are unsure if they should exercise, but Dr. Schulman says you absolutely should consider it. Depending on how advanced your disease is, you may need to work with a physical therapist or trainer to find a program that works for you, “but we highly recommend a routine exercise program, both for cardiovascular health and joint health, and for mental health,” she says.

Gentle, regular exercise may actually help increase your strength and flexibility and specifically make your muscle and joint function better, the Mayo Clinic says, which can be key for people with rheumatoid arthritis. But it’s really important to exercise safely—in general, and especially when you have a condition like rheumatoid arthritis—so be sure to ask your doctor specific questions about your exercise plan if you think that insight would be helpful.

https://www.self.com/story/rheumatoid-arthritis-diagnosis-questions