Preventing Joint Damage in Rheumatoid Arthritis
Rheumatoid arthritis (RA) is an inflammatory condition that is progressive and destructive without necessary treatment. If untreated, the constant inflammation affecting the joints will cause irreparable damage.
Often, my patients will ask me what they can do to protect their joints from this damage. I tell them there’s no miracle diet or set of exercises that can shield their joints. The best thing they can do is to commit to their pharmacological treatment plan and develop a strong relationship with their physician.
RA is an autoimmune disease, which means the immune system has lost what’s called self-tolerance, the ability to recognize its own tissues. The immune system in a healthy person fights off infections, viruses, parasites, bacteria, fungus, cancer and other threats by sending chemical messengers to attack the various intruders. This attack creates inflammation.
With RA, it’s almost as if the immune system senses an intruder, switches on, fights and kills the intruder–but then doesn’t switch off. It keeps fighting, only now it’s fighting the body’s own tissues, creating inflammation that persists and eventually causes severe damage. For RA, the immune system fights and inflames the joints; for other autoimmune diseases, it fights other parts of the body.
We don’t yet know what causes the immune system to get out of whack. Experts believe there may be a certain set of genes that predispose people to developing RA. And there may be some catalyst that comes along and provokes the immune system to act in this self-destructive way. For many years, it was thought that the catalyst may be something environmental–perhaps a virus–but after years of unrelenting clinical research, we haven’t been able to prove this theory.
At the end of the day, we don’t know precisely which gene predisposes people to RA, and we don’t know what provokes it to cause the immune system to break down its recognition of self and cause destruction. We do know, however, how to use pharmacological therapies to protect joints from this destruction.
We’ve developed medications called disease-modifying antirheumatic drugs (DMARDs). They suppress immune system activity, decrease inflammation, and thus preserve the structure and function of the joints. Typically, I’ll start patients on a DMARD called methotrexate. It may take 3 to 4 months for the full effects of methotrexate to appear, but if a patient is still experiencing serious RA symptoms after six months, I’ll either add to or replace methotrexate with a type of DMARD called a biologic. Biologics target and block specific molecules in the body that help produce inflammation. By keeping inflammation down, biologics preserve the joints.
The best way to protect your joints from the damaging impact of RA is to control the disease with these effective treatments. The best way to do that is to partner with an experienced, knowledgeable physician whom you trust. As a physician, I’ve spent years reading editorials, conversing with my colleagues, and researching the best path forward for these diseases. Your physician will constantly monitor your symptoms and adjust your treatment strategy when necessary, so it’s key to develop a good relationship. My patients protect their joints by providing me with details I need to prescribe appropriate treatments, by staying in touch and committed to the strategy I outline, and by being open-minded if I determine I need to make a change.
Sometimes my patients are frustrated with their situation and they want a quicker fix; they don’t want to wait three months to get better. They’ll turn to the alternative medicine industry, most of which is scientifically proven not to be effective. They’ll try drugs and diets that are untested and unproven, thinking if it’s “natural,” it’s safe. I understand that my patients are fearful, and I understand why they want to explore, but there are real risks with pursuing this path.
The truth is, to follow an anti-inflammatory diet that actually makes a difference, you’d have to undergo extraordinary measures for very little impact. It’s incredibly difficult to manufacture drugs that control the immune system, so how on earth are you going to find foods that do so? I tell my patients they can explore these strategies, but as an adjunct therapy to their medications—not a replacement. If you don’t stick with your prescribed treatment strategy, you’re not reducing inflammation in your joints, and you’re going to experience damage.
The whole purpose of treatment is to control the disease, to maximize your function, and to prevent symptoms from interfering with your lifelong goals and activities--all in a safe manner. That’s how we protect your joints.
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