Rheumatoid arthritis (RA) is probably not what you think it is.
It is not the same as osteoarthritis.
It is not caused by the normal wear and tear of joints.
It is not just about the joints.
If you’re someone who suffers from the disease, then you know how frustrating it is to explain all this to someone who doesn’t have RA.
Signs of rheumatoid arthritis aren’t obvious. RA patients don’t walk around with joints or organs glowing red from pain; nor do they have a visible cloud over their heads to indicate the heaviness of fatigue that they feel every day. However, it must be said, RA is a disease that is both subtle and conspicuous.
By this, we mean that because symptoms aren’t readily visible, it’s easy for others to dismiss the condition. By the time symptoms become more apparent, whether it’s because swelling or deformation begins to show or you begin to speak up about it, people around you now don’t know what to do.
The unpredictable nature of RA is what makes it so hard to explain to others. There are days when you wake up feeling normal and healthy, only to end up feeling like you will need a wheelchair by midday. Some days, the only indication of your condition is a compression sleeve on a telltale joint—when really, chest pains caused by RA are making it difficult to breathe and function. Sometimes, just when it looks like you’ll get through the day unscathed, fatigue suddenly hits you like a Mack truck, only to have sleep completely evade you by the time you get to bed. There are times when you look perfectly fine, except you can’t hold a pen and write because your hands are so stiff and swollen. Or you might even feel good enough to exercise, but somehow can’t climb a flight of stairs or reach over your head.
RA is an autoimmune disease—largely misunderstood and often dismissed—which is why so many struggle in silence not knowing how to communicate and articulate the challenges of living with this condition.
As a patient, it’s likely that you’ve already made the effort to educate yourself about what this disease is. So, let’s cast the net a little wider, educate others around us as well, and see how we can explain RA to people who don’t have it.
RA Is Not Osteoarthritis (OA)
Image Source: Everyday Health
What is the difference between osteoarthritis vs rheumatoid arthritis?
The most confusing thing about RA is that it has the word “arthritis” in its name.
Many RA patients feel that it’s limiting, and confusing, and this adds to why people find it hard to distinguish between OA and RA. There are similarities between both, but they are very different diseases.
OA is the most common form of arthritis, typically caused by wear and tear of joints, often due to age or injury. Like RA, it can cause a significant amount of pain and disability. But the main difference is that OA is not an autoimmune condition, which means the treatment and disease progression of OA are very different from RA.
There are more than a hundred types of arthritis. OA is one of them, and RA is another. The term “arthritis” in this context is simply a catchall reference for painful inflammation and stiffness in the joints—that’s why they’re lumped together in the “arthritis” category. Because RA symptoms start with joints, it got stuck with the name. But make no mistake, rheumatoid arthritis affects more than just joints.
RA Is an Autoimmune Disease
Image Source: VeryWellHealth
Perhaps the easiest way to say it to make others understand RA is by putting the spotlight on the fact that it’s an autoimmune disease.
A healthy immune system is in charge of protecting the body and works by fighting off foreign invaders—viruses for example, or bacteria. If you have an autoimmune disease, your immune system is basically in hyperdrive and starts attacking its own tissues, as if it were a foreign invader.
When you have RA, the immune system begins to target the synovium, a membrane that lines the interior of the joint capsule to help protect the cartilage and cushion the bones. This then prompts a complex inflammatory process that leads to RA symptoms such as joint swelling and pain.
Now, because RA is a systemic disease (meaning it affects the entire body and isn’t isolated to just one body part or organ) it can also affect the skin, eyes, lungs, heart, kidneys, nerve tissue, salivary glands, bone marrow, and blood vessels.
RA Is Not Just Joint Pain
Image Source: Creaky Joints
Having established that RA is a systemic disease that affects the whole body, it almost goes without saying that RA is not just limited to joint pain.
It’s one of the biggest misconceptions about RA—which again, goes back to having the term “arthritis” in its name. Arthritis, regardless of what kind, is almost always associated with joint pain. But when it comes to RA, pain isn’t always the most challenging symptom that patients have to deal with.
For many, pain is something that they can get used to. Often, an RA patient’s baseline for pain significantly shifts as they learn to manage their disease. On bad days, pain is something you power through. On even worse days, pain is something that you take time to rest and recover from. Swelling and stiffness can be managed by arthritis aids and tools such as joint supports and compression gear. Fatigue however can be overwhelming and debilitating.
According to a study, 65% of patients with RA suffer from severe fatigue, and along with it comes cognitive dysfunction, memory issues, and general malaise, which can affect their ability to go to work or school or complete their daily tasks. It can be difficult to maintain your old lifestyle if you suffer from this kind of debilitating fatigue and it makes even the most mundane, ordinary tasks nearly impossible to complete.
RA Requires Complex Medications to Treat
Image Source: Creaky Joints
Did you know that chemotherapy is used to treat RA?
Treatment for rheumatoid arthritis isn’t simple.
The first line of medication given to patients after they have been diagnosed is called methotrexate—a type of chemotherapy. When given to RA patients in much smaller doses, it can treat some types of inflammatory arthritis. Categorically, when used in this context, they are referred to as disease-modifying antirheumatic drugs (DMARDs)
Using methotrexate for rheumatoid arthritis doesn’t cause the same intense side effects that it causes when it’s administered in significantly higher doses in cancer patients. But despite the lower dose, it can still have difficult side effects such as hair loss, nausea, weight loss, and GI issues. It’s also been known to cause bone marrow suppression and requires patients to pay close attention to their liver for possible side effects.
Unfortunately, not everyone responds well to DMARDs, which means other treatment options have to be explored. This is where biologics come in—a newer and more targeted category of disease-modifying drugs used to treat RA. Even if you do find success with methotrexate, patients still often have to find the perfect dosage needed to control RA and slow progression, while managing side effects. This is why RA patients are also strongly encouraged to maintain a healthy lifestyle.
RA Risks Are Scary and Intense
Image Source: Path Labs
Managing rheumatoid arthritis is not simply a matter of drinking your pills or getting a shot and going about your day. It’s not just about doing more yoga to find inner peace. It can’t be managed just by meditation or rest. It also, (right now, at least) can’t be cured.
The disease itself combined with the medications used to prevent disease progression significantly heightens the risk of osteoporosis—a disease that weakens bones to a point that they become so brittle and weak.
Because the primary medication being used is designed to suppress your immune system, it tends to weaken the immune system which makes you very vulnerable to infections.
RA increases the risk of blocked arteries which makes patients more prone to heart attacks.
Chronic inflammation can also lead to scarring of lung tissues, as well as a higher risk of lymphoma, diabetes, heart disease, and obesity.
Showing Your Support
Education is one of the best ways you can help show your support if someone in your life is living with RA. Share this if you thought this article was helpful or leave a comment below if you have any questions or comments about this post.