Condition: Rheumatoid Arthritis
Brief Overview: Rheumatoid arthritis (RA) is a chronic autoimmune disease causing inflammation, pain, and damage in joints, often symmetrically. It can also involve systemic symptoms and organ complications.
Prevalence: Affects approximately 1% of the global population, with a higher prevalence in women.
Etiology: The exact cause is unknown but involves an autoimmune response against synovial tissues, influenced by genetic predisposition and environmental triggers.
Risk Factors:
• Female sex
• Family history of RA
• Smoking
• Obesity
• Age (most commonly between 30-60 years)
Commonly Associated Conditions:
• Cardiovascular disease
• Osteoporosis
• Sjögren’s syndrome
• Depression and anxiety
Common Medications:
• Disease-modifying antirheumatic drugs (DMARDs)
• Biologic agents (e.g., TNF inhibitors)
• NSAIDs
• Corticosteroids
Common Labs, Imaging, and Tests:
• Rheumatoid factor (RF)
• Anti-cyclic citrullinated peptide (anti-CCP) antibodies
• Erythrocyte sedimentation rate (ESR)
• C-reactive protein (CRP)
• X-rays, MRI, or ultrasound for joint damage
Common Symptoms:
• Joint pain and swelling
• Morning stiffness lasting more than an hour
• Fatigue
• Symmetrical joint involvement
Common Treatments:
• DMARDs and biologics to control disease progression
• Physical therapy and exercise
• Pain management strategies
Physical Findings:
• Swelling and tenderness in joints
• Deformities (e.g., ulnar deviation, Boutonnière deformity)
• Warmth over joints
Potential Complications and Contraindications:
• Joint deformities and loss of function
• Increased risk of infections due to immunosuppressive therapy
• Contraindications for biologics in severe infections
General Health and Lifestyle Guidance:
• Engage in regular low-impact exercise
• Maintain a healthy diet rich in anti-inflammatory foods
• Avoid smoking
• Stress management
Suggested Questions to Ask Patients:
• Have you experienced prolonged joint stiffness in the morning?
• Are any of your joints red or swollen?
• Have you been sick recently? (They need to tell their doctor if they are sick as some of their medications might need to be held)
Suggested Talking Points:
• Explain the importance of keeping appointments and interacting with their doctor to discuss pain levels, fatigue levels, and any sicknesses.
• Highlight the role of lifestyle changes in complementing medication. These would include eating whole foods, avoiding sugar, eating protein and vegetables, eating cruciferous vegetables, getting sleep and rest, controlling stress, and exercising within the patient’s capabilities without causing pain. Avoiding processed foods, alcohol, and smoking.
• Discuss options for managing flare-ups such as rest, sleep, contacting their doctor, Epsom salt baths, heating pad, drinking bone broth, and eating foods high in omega 3 such as salmon.