It can be difficult to define rheumatoid arthritis (RA). It’s somewhat of an artificial name, as it’s likely not one disease, but many. (Over the years, medical experts have given diseases clear names, but these strictly defined terms are man-made concepts. In reality, diseases vary in how they manifest from person to person, and we’re learning new information every day about how they work.) For the most part, RA is the name for a group of inflammatory arthritis processes. There are a few more basics that we understand about RA. If a patient accepts these building blocks of RA, he or she will be better equipped to control the condition. RA is an autoimmune disease. Autoimmune diseases occur when the immune system is, to put it simply, out of whack. Think of what the immune system does: It protects you from developing infections, viruses, parasites, bacteria, fungus, cancers and other threats. It does this by detecting intruders and sending chemical messengers to fight them off; this fight causes inflammation. A healthy immune system has the ability to recognize that there’s a difference between these intruders and your own body tissues. We call this self-tolerance. For people with RA, the immune system’s ability to recognize self appears to be a little fractured. Instead of protecting the body from invaders, it turns on it, producing chemical messengers to fight and causing inflammation even when there’s nothing to fight. If you have RA, your immune system fights the tissues in your joints and causes inflammation that can be destructive without pharmacological therapies. RA is a progressive disease. What’s predictable about immune-based diseases is their unpredictable behavior. Patients will ask me why their RA affects one joint and not another–I don’t know why. They’ll ask why it’s intermittent in some people and continuous in others–again, I don’t know. What we do know about the course of the disease is that it’s progressive. If untreated, the joints become more and more swollen, and ultimately will become irreparably damaged, causing pain, deformity, and loss of function. RA can be treated effectively. When I first began working with RA patients 30 years ago, they were all in wheelchairs with terribly destroyed joints. That’s what the disease looked like back then. It doesn’t look like that now. We’ve made important and dramatic advances in treatment and we have opportunities now through drugs to control the natural path of the disease. And the earlier you start treating it, the better your outcome will be. I’ll start patients on a course of corticosteroids, like prednisone, to bring inflammation down and ease their symptoms quickly. At the same time, I’ll start them on a drug called methotrexate that brings down inflammation and protects joints. Methotrexate tends to take about three months to work, so after a couple months, I’ll take them off the steroids and check in with them to see if their symptoms are better on the methotrexate alone. If they need further treatment beyond methotrexate, I’ll prescribe a type of medication called a biologic, which prevents inflammation from occurring at the molecular level. With this strategy, the majority of my patients gain control of the disease and prevent the irreparable damage from affecting their joints and hindering their function. And if something isn’t working, we’ll try something else. I partner with my patients to educate them about the disease, manage expectations, and adjust medications as necessary so that RA doesn’t control their lives.