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Rheumatoid Arthritis

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease in which certain cells of the immune system malfunction and attack healthy joints. RA can induce inflammation in the lining (synovium) of any joint, and most often involves the joints of the hands and feet. Patients with RA may experience joint pain, stiffness and swelling, which often results in joint damage and subsequent disability. RA is a systemic condition that can affect more than just the joints and may involve other organs of the body such as the heart, lungs, skin and eyes. The chronic systemic inflammation caused by RA can also lead to fatigue and increase the risk for heart disease and stroke. Treatment of RA is aimed at controlling the inflammation that causes joint pain and joint damage and getting the RA into remission. The earlier RA is treated the better the chance of preventing permanent joint damage and disability.

RA affects more than 1.3 million Americans and is more prevalent in females than males (about 70 to 75% percent of people with RA are women). The disease most often occurs between the ages 40 and 60, however RA can develop in even young children and the elderly.

Causes of Rheumatoid Arthritis

The exact cause of RA is not known, but certain factors, including genetics and environmental influences may contribute to the development of the disease.

Symptoms of Rheumatoid Arthritis

The joints most commonly affected by RA are in the small joint in the hands and feet, although virtually any joint in the body can be affected. The disease typically causes inflammation symmetrically in the body, meaning the same joints are affected on both sides of the body. Signs and symptoms of RA may begin suddenly or gradually and can include:

  • Pain in joints
  • Swelling over joints
  • Stiffness in the morning
  • Redness of the joints
  • A feeling of warmth around affected joints
  • Decreased movement
  • Loss of energy
  • Low grade fever
How Is Rheumatoid Arthritis Diagnosed?

RA may be very difficult to diagnose because symptoms may be subtle and go undetected on X-rays or blood tests. Our Rheumatologists will take a comprehensive medical history; perform a complete full body physical exam and order appropriate imaging and laboratory tests to help arrive at a diagnosis.

Treatment for Rheumatoid Arthritis

Our Rheumatologists are experts in the diagnosis and management of RA. They will design a comprehensive personalized care plan that is right for you (See RA Care program). They base their decision on a thorough evaluation and assessment of many factors and conditions. These include, but are not limited to:

  • Your age
  • Your overall health
  • Your medical history
  • The extent of the condition
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion and preference

The goal of our Rheumatologists is to get your RA in remission. The earlier the treatment is started the better the outcome.

Treatment options may include:

  • Medications: Arthritis Medications fall into 2 major categories
  • Medications that control symptoms
  • Non-steroidal anti-inflammatory medications (NSAIDS) such as Ibuprofen (Motrin and Advil), Naproxen (Aleve), and Celecoxib (Celebrex)
  • Corticosteroids such as prednisone (may have some disease-modifying effect)
  • Medications that slow disease activity are termed Disease Modifying Anti-Rheumatic Drugs (DMARDs)
  • Traditional Oral DMARDs such as Methotrexate, Leflunomide, Sulfasalazine, and Plaquenil
  • Biologics- These drugs are often used when the traditional oral DMARDS fail to control RA adequately
  • Biologics- These drugs are often used when the traditional oral DMARDS fail to control RA adequately . These include abatacept (Orencia) adalimumab (Humira), certolizumab pegol (Cimzia), etanercept (Enbrel), infliximab (Remicade), golimumab (Simponi and Simponi Aria), rituximab (Rituxan), tocilizumab (Actemra), and sarilumab (Kevzara)
  • Jak Inhibitors – Xeljanz (tofacitinib citrate), Olumiant(baricitinib), Rinvoq (upadacitinib)
  • Splints: Splints may be used to help protect and support joints
  • Chiropractic and Exercise Therapy: Many different therapeutic modalities may be used to help decrease pain, maintain muscle strength and increase the flexibility of affected joints.
  • Alternative and Complementary options: These include nutrition and acupuncture
  • Surgery. Surgical options may be used in conjunction with medical therapies if needed
How is the treatment of RA at GCSP different?

The physicians at GCSP are Board Certified Rheumatologists who are experts in the diagnosis of RA and its treatment. They work closely with other staff members such as Physician Assistants, Nurse Practitioners, Medical Assistants, and Infusion Nurses that are dedicated to helping you manage your RA. As no single treatment plan will work for everyone, they will individualize a plan to help put your RA into remission and meet your goals.

Our physicians go beyond the traditional methods of assessing and monitoring your RA. Although traditional methods may be used, including x-rays, non-radiation imaging studies such as a MRI and Ultrasound can be done to help establish the diagnosis and monitor treatment and progression of the disease. GCSP utilizes an ultrasound disease monitoring program to monitor our Rheumatoid Arthritis patients. Ultrasound is more sensitive than X-rays and MRI and lower cost than an MRI. Advanced laboratory testing may also be performed such as the VECTRA Rheumatoid Arthritis disease activity test that measures 12 protein biomarkers to help assess your current level of disease activity objectively.

Advanced nutritional and laboratory testing is available at certain locations to help identify factors that may contribute to immune dysfunction or promote a proinflammatory state in the body.

GCSP Rheumatologists have a thorough knowledge of all the FDA-approved medications that treat pain and prevent joint damage resulting from RA. These may include medications that are taken by mouth, self-injected or administered through an intravenous (IV) infusion. It is critical to have an expert in RA monitor you for possible medication side effects and effectiveness.

If IV infusion medications are needed, the GCSP RA Care Team is able to administer these to you at our on-site infusion centers under the watchful eye of a physician and infusion nurse. This is more convenient and cost-effective than a hospital based infusion center.

Non-medication treatment options are also available and may include physical therapy and chiropractic care to maintain muscle strength and flexibility. Nutrition, wellness, and stress reduction counseling may also be prescribed as well as appropriate supplements and anti-inflammatory diets to help manage inflammation naturally. Alternative and complementary treatment approaches such as acupuncture or stimulation therapy to help manage pain may also be recommended.

GCSP is committed to remaining on the cutting edge of RA management. With the application of our comprehensive treatment plans and RA management tools, we maintain our commitment to providing the very best and state-of-the-art RA care available to help our patients lead a healthy, pain free, and functional life.