Symptoms of rheumatoid arthritis (RA) are difficult to live with, but fortunately, treatment is available to alleviate symptoms and, most importantly, protect the joints from the damaging effects of RA. However, sometimes patients choose not to treat their RA for a variety of reasons. Rheumatologist Paul Sutej, MD, discusses the most common questions he hears from his patients about treating RA, and why it’s so crucial to treat the disease. 1. Q: What is rheumatoid arthritis? A: Rheumatoid arthritis is the name for a group of inflammatory arthritis processes that are usually pretty progressive and pretty destructive. Inflammatory means the joints are hot, swollen and red. RA can cause symptoms in small and large joints like pain, swelling, stiffness, loss of function, redness, and tenderness. Sometimes you might experience symptoms that aren’t joint-related, like lethargy, fever, weight loss, or night sweats. 2. Q: Does RA affect everyone the same way? A: The only thing we can predict about immune-based diseases like RA is that they’re unpredictable. They just do whatever they want. Patients will ask why it affects one joint and not the other–we don’t know. They’ll ask why their RA is intermittent while their friend’s is continuous. Again, we don’t know why. But we do know that if RA is untreated, the joints become more and more swollen and ultimately will be severely damaged, causing people to lose function. 3. Q: What happens if you don’t treat RA? A: My first impression of RA was in my first clinic, probably in 1985 or 1986. There were a bunch of women sitting in wheelchairs with distorted, disturbed, destroyed joints, with no ability to function. That’s what the disease looked like 30 years ago. It doesn’t look like that now, because we’ve made important and quite dramatic advances in treatment. But if you don’t treat RA, you end up like those women. That’s the natural progression of RA: to destroy joints irreparably. And most of the damage in the disease occurs early, so you can’t afford to wait to begin treatment. It’s a bit like driving down the highway without a safety belt, drunk-- you’re risking a lot. 4. Q: Why do some patients choose not to treat RA? A: Today, we have such an opportunity through medical therapies to control the natural path of the disease. What many patients don’t understand is that, while there are side effects to some of the medications, the benefits far outweigh the risks. Not all patients experience side effects and not all side effects are intolerable. When patients don’t trust their doctor, when they read on the Internet about side effects and choose not to follow their treatment strategy, that’s a great sadness. When I diagnose patients with RA, I know they are shocked and fearful, but I try to emphasize the opportunity available to them. You make a choice as a patient: you’re either the victim or the survivor. Not choosing to be treated is almost like choosing to be a victim. 5. Q: What’s the hardest part of treating RA for you? A: Probably the hardest part is trying to treat patients with very fixed ideas: somebody who’s been influenced by family members, who is allowing previous bad experiences to cloud their decision-making. The hardest part is trying to get a patient to get out of his own way, to sit and watch somebody make bad choices.