Signs, Symptoms, and Treatments of RA
What is RA?
RA is an Inflammation disorder
Arthr means joints and itis is inflammation. Rheumatoid Arthritis is a chronic inflammatory disorder that mostly effects the joints but can also involve other organ systems like the skin or lungs as well. A healthy joint typically has two bones covered with articular cartilage at the ends.
Wear and tear of the Articular cartilage
Articular cartilage is a type of connective tissue that acts as a protective cushion. It is a lubricated surface for bones to smoothly grind against.
Genetics vs. Environmental
Is RA genetic or environmental? Rheumatoid Arthritis is an autoimmune process that is usually triggered by a genetic factor and the environment. For example, a person with a certain gene for a immune protein like Human Leukocyte Antigen or (HLA-DR1 & HLA-DR4) might develop Rheumatoid Arthritis after getting exposed to something in the environment like cigarette smoke or specific pathogens.
There are patients that have a typical presentation where the onset can be relatively abrupt. Explosive where one is fine a week ago, and within a week struggling with activities of daily living. Pain, stiffness, swelling in the wrist, knees, shoulders even ankles and feet. Fatigue and stiffness can be prominent part of the presentation.
The gradual onset
Patients with Rheumatoid Arthritis typically start noticing symptoms that are very gradual in onset. It’s not an explosive onset where one day they have multiple tenders swollen joints and they cannot move. It can happen but very unusual. What most patients realize is that they are not able to get out of bed like they did before. They feel stiff, hard to roll to the side of the bed, they struggle to go to bathroom and feel like their joint is not well oiled. People describe it as feeling like a tin man.
A sense of stiffness of the joints actually gets better with activity and movement. Patients may feel better have a hot shower. Don’t think too much about it and kind of go on until they realize that they are experiencing this day in and day out.
Pain and Swelling
Other symptoms are painful joints and swelling. Many woman may say that they cannot wear their ring anymore because it is tight on the finger especially in the morning. It gets loose by the dinner time. The symptoms of Rheumatoid Arthritis are worst in the morning then improves as the day go on. Feel an immediate improvement after a hot shower or light activity and stretch.
Lack of sleep inflammation
When a patient has Inflammation flare up they can have sleep disturbances and not sleep well. Feeling Flu like symptoms is also described by those with the condition. All of these can be the beginning presentation of Rheumatoid Arthritis.
Once our patients are in remission the patients are doing well. On a daily basis, they may have minimal symptoms and minimal stiffness. Typically not struggling with the disease. Often during the patients are doing well, they may experience increased disease activity called a Flare.
Increased disease activity
A flare is described in different ways by different patients. What they are experiencing are increased disease activity. That can be manifested as worsened fatigue and stiffness in the morning or throughout the day. Increased joint pain, swelling, and difficulty doing daily tasks. Energy drop, low grade fever and flu like feeling are all descriptions of flare ups. During a flare up, patients complain about Fragmented sleep or poor sleep. They tell us they don’t sleep well during Flare ups.
Triggers of Flare
This can be triggered by some change in medications or medication non-compliance. It can also be triggered by increased stress in people’s lives. Sometimes physical stress or trauma can cause the increased disease activity. Stress is the one thing that we often hear the most.
Is flare up a part of living with RA?
It is part of it and unpredictable as well. It comes from nowhere and can be frustrating for patients. Once patients with RA learn to live with the flare, patients can often self-manage many of these things. They can sometimes predict that because they are going through a difficult time.
Bonzai Regen Pain Program
The goal of Bonzai Regen pain management program will always be to decrease and stop flare ups for our patients. If a patient is experiencing many flares in a short period of time, this is a good time for us to sit down and evaluate the medication and determine to increase or decrease medications. Even though our patients to live with flares, we can reduce the intensity and frequency of flares.
The flares can punctuate the disease and there is a specific way we take care of the reaction. We can often increase some of the medications such as steroid anti-inflammatory medications. We can also give a shot course of prednisone. We ask patient to rest more during the flare. To pace out their life, prioritize their activities and do less to handle the flare better.