Rheumatoid Arthritis Q&A

Dr. Thais Moldovan MD Board Certified Rheumatologist

If you have occasional flare ups of joint pain or your joint pain is chronic, you probably have a lot of questions about rheumatoid arthritis. Dr. Thais Moldovan MD answers the questions she hears most often from patients.

Is my joint pain rheumatoid arthritis (RA)?

First of all, you are smart to ask this question because without prompt treatment of rheumatoid arthritis (RA), initial pain and discomfort can lead to long term joint damage and even damage to major organs including your heart.

If you have joint pain flare ups or chronic joint pain, you should see a rheumatologist to determine if you have RA.

What is rheumatoid arthritis (RA)?

RA is a chronic inflammatory form of joint disease. It is an autoimmune disease meaning that the body’s immune system attacks its own joints causing swelling, pain and redness. Over time, the prolonged periods of inflammation can cause destruction of the joints and deformities.

Who is at risk for rheumatoid arthritis?

The onset of the disease can happen at any age, but RA typically occurs in people between the ages of 30 to 50 years old.

The disease is more common in women. About 70% of people with RA are women.

What are the symptoms of rheumatoid arthritis?

RA symptoms include joint pain, swelling and stiffness as well as fatigue and muscle pain. The symptoms can vary considerably from person to person including the location of the symptoms and the severity.

Typically symptoms of RA progress slowly. Initially, symptoms may flare up and then improve all by itself. Because of this, people often hesitate to call a doctor or rheumatologist. Please note that it is important to treat RA as soon as possible because RA can lead to long term and irreversible joint damage and even damage major organs including your heart.

When you do see a rheumatologist, it is very important to be precise and objective when describing your symptoms to your rheumatologist.

Besides joint pain, what other symptoms are associated with rheumatoid arthritis?

As a systemic disease, RA can affect multiple organs and systems in you body. Patients can experience fever, weight loss, fatigue, malaise, enlarged lymph nodes, carpal tunnel syndrome and in more dramatic cases inflammation of the tissue around the heart (pericarditis), eye inflammation and lung disease.

Which joints are the most commonly affected by rheumatoid arthritis?

Most patients with RA have both wrists and the small joints of the hands and fingers (PIPs and MCPs) involved, and frequently the feet, toes and ankles. That being said, it’s important to keep in mind that any joint in your body can be affected by RA. As the disease progresses, larger joints such as elbows, shoulders, hips and knees can become affected. Interestingly, RA typically develops in the same joints on both sides of your body

What causes rheumatoid arthritis?

Despite ongoing research, the etiology of RA remains unknown. It’s thought to be caused by different factors such as genetics, environment (smoking, silicon, poor dietary habits and others). Some viruses (EBV and Parvo B19) have also been considered as a possible triggers.

Can rheumatoid arthritis be detected with blood work?

There are two antibodies that are present in most patients with RA, they’re called rheumatoid factor and anti-CCP. Unfortunately, some patients who have the disease, do not have the antibodies in the blood.

Usually, your doctor will check two inflammatory markers in the blood, ESR (erythrocyte sedimentation rate) and CRP ( C-reactive protein). When elevated, these numbers indicate that the disease is active. There also other tests, such as VECTRA, that in addition to ESR/CRP will measure other proteins that indicate inflammation.

Can you see the changes of rheumatoid arthritis in a regular Xray?

Sometimes, it’s possible to identify bone destruction by an X-ray of patients with RA. Early diagnosis and treatment are crucial to prevent bone erosions.

What other diseases can look like rheumatoid arthritis?

  • Gout
  • Pseudogout
  • Osteoarthritis
  • Polymyalgia rheumatica
  • Viral infections
  • Thryroid dysfunction
  • Lupus

Is there a cure for rheumatoid arthritis?

While there is no cure for RA, there are many safe and effective options to prevent disease progression and joint destruction. There is a class of medications called DMARDs (disease modifying agents), that are usually used as a first line of defense and depending on your response a biologic medication can be added. These medications are immune modulators that will try to stop your immune system from destroying your joints. Initially you may be placed on oral steroids to calm down the inflammation, until the long-term plan is in place. Discuss your options with your Rheumatologist.

Can my primary physician or internist treat rheumatoid arthritis?

A rheumatologist is typically the most qualified to provide an early and accurate diagnosis of RA and to create an effective treatment plan.

Rheumatologists are internist with specific training and experience in the diagnosis and treatment of musculoskeletal diseases and autoimmune conditions, like RA.

After four years of medical or osteopathic education and three years of residency in internal medicine, a doctor who wants to concentrate on rheumatology needs to complete a two year rheumatology fellowship and pass a test to become board certified.