Rheumatoid arthritis (RA) is an autoimmune disorder, which means it occurs when the immune system malfunctions. When you get an infection, your immune system mounts an attack to destroy the infection, causing inflammation. With RA, the immune system thinks there’s an infection, so it springs into action. The problem is, there’s no infection and the resulting inflammation can become a chronic presence. This inflammation, typically appearing for RA patients in the joints, can lead to joint pain, swelling, and permanent damage. I entered the field of rheumatology almost 50 years ago, when we were just beginning to understand how the immune system worked and how its features affected RA. It was an exciting time to be treating patients and contributing to research to get a deeper comprehension of the condition, and my excitement for the field has persisted over the decades. Researchers have learned a lot in the last 50 years about RA and how best to treat it, and I’ve personally learned a lot through working with patients. Here’s what the last five decades have taught me about managing RA: 1. Seek out care from a specialist. Rheumatologists are physicians who have been specially trained to treat conditions affecting the joints and muscles. I’ve always recommended that patients see a rheumatologist for RA, not to self-serve our profession, but because we as rheumatologists know more about RA and similar diseases; it’s all we think about and we’re committed to staying up to date on new research and treatments. Our knowledge and skills pertaining to joint and muscle diseases distinguish us and allow us to provide better, more personalized treatment to each patient. 2. The earlier you begin treating RA, the better. Medications to treat RA can minimize inflammation, relieve pain, alleviate swelling, and prevent further damage to joints, but patients can lose these benefits if they wait too long to start treatment, or stop treatment after a while. One of the problems with rheumatoid arthritis is that when damage occurs in the joints, that damage is irreversible. Once you have a damaged joint with cartilage loss and bone loss, you can recover from it but you won’t ever go back to normal. There’s urgency involved here; we want to get things under control relatively quickly and keep it that way. 3. Find a rheumatologist who listens. Rheumatology is a listening profession; we have to listen to patients to understand how they’re doing, because their ability to take the medicines we prescribe is central to their success. If your rheumatologist doesn’t have the time or inclination to listen to you and make changes based on your concerns, then it’s time to find a better one. George Bernard Shaw once said, “the single biggest problem in communication is the illusion that it has taken place.” I take this concept to heart when it comes to communicating with my patients; I view the treatment process not as a speech, but a dialogue. I make sure they understand what I’m telling them, and I make sure I understand what they’re reporting to me. Managing RA is a team sport: as a patient, you’re the player, and I’m the coach. We have to work together, and it’s really important that patients understand this and feel comfortable placing their trust in me in order to have the best results. 4. Work together with your rheumatologist to find the right treatment. We’re currently in a new era of medicine focused on patient-centered care, rather than the old-fashioned “doctor knows best” model. I’ve heard the analogy that in patient-centered care, the patient is the pilot flying the airplane, and the physician is the ground crew helping with takeoff and landing. As a rheumatologist, I can prescribe the medication, but you as the patient are the one who has to take it. If you’re having trouble with side effects or other obstacles, talk to your doctor honestly about your concerns. It’s my job to give patients confidence that the medications are safe and effective; while they’re not perfect, and sometimes have serious side effects, it’s also important to keep in mind that RA is serious, too. Because we are fortunate to have many effective treatment options available today, it’s very likely we’ll be able to find a medicine or combination of medicines that are tolerable and helpful for each patient. 5. Managing RA isn’t only about medications—it’s also about living a healthy life. Staying in control of your RA means committing to your prescribed medications and forming a strong relationship with your doctor, but living a healthy overall life is important as well. While there’s no specific diet for RA, we recommend following a healthy diet with lots of fruits, vegetables, and lean meats, with less emphasis on sugars and processed foods. Alcohol should be used sparingly, as it can affect a common RA drug called methotrexate. I also strongly advise against smoking—we’ve known for a long time that cigarette smoke is very bad for arthritis and rheumatoid arthritis in particular. Smoking causes a chemical process that leads to dysfunction in the immune system, which is already working incorrectly in RA patients. Every rheumatologist on the planet would advocate stopping smoking because of the clear association between RA onset and severity and smoking. I also encourage my patients to exercise as much as they can tolerate. I wouldn’t want someone with RA to be running marathons, but walking, swimming, and stretching can be very beneficial. RA is a chronic, long-term disease, but if you live a healthy lifestyle, take your medications, and communicate regularly with your doctor, you can live a very full life.