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The AMA’s What Doctors Wish Patients Knew™ series provides physicians with a platform to share what they want patients to understand about today’s health care headlines.
For this installment, two physicians took time to discuss what patients need to know about managing rheumatoid arthritis. They are:
- Shawn Baca, MD, a rheumatologist at Rheumatology Associates of South Florida and clinical associate professor at Florida Atlantic University Schmidt School of Medicine. He also represents the Florida Medical Association in the AMA House of Delegates.
- Amish J. Dave, MD, a rheumatologist at Virginia Mason Medical Center in Seattle who also serves in the House of Delegates, representing the Washington State Medical Association. He is also a member of the AMA Ambassador Program.
It is a chronic condition
Rheumatoid arthritis “doesn’t necessarily go away and a lot of people think that if they do everything right, they can just push it into remission and they don’t have to worry about it,” Dr. Dave said. But “this is a chronic condition. You can get it to a good place, but you won’t cure it.”
“The chances of going into remission are very low, probably less than 5%,” Dr. Baca said, noting that “I have only a few patients who have been in remission over my 30 years of practice. But a majority of patients when they start medication, they end up being on some type of therapy for most of their lives.”
“There are people who can come off their medication and go into remission for long periods of time, even years, but it flares up again,” Dr. Dave said. “We think of this in the same way we think of Crohn’s or ulcerative colitis. Relapsing rheumatoid arthritis tends to be that way too.
“The single best thing you can do is have a good relationship with a thoughtful rheumatologist who’s following you over time and recognizing that there will be good months and bad months is important, and that medications can fail,” he added. “It means that being flexible and needing to switch to a new medication might be important for you.”
Symptoms must be present for months
“Rheumatoid arthritis often tends to be symmetric synovitis, or inflammation of joints. So, often both hands, both wrists, both feet, both ankles have inflammation in the joints, but can affect other joints too within the body depending on that particular individual,” Dr. Dave said. “But the classic person with rheumatoid arthritis has symmetric joint inflammation with more than an hour of morning stiffness.”
“Presentation would be somebody who’s young—20s to 40s—and then there’s a second bump somewhere around the 60s. So, we see it in basically young and older age groups,” Dr. Baca said. Rheumatoid arthritis “usually presents with swelling across the hands and wrists and is symmetric. It should almost always be symmetric hands, wrists, knees, feet, shoulders.
“About the only places that rheumatoid does not attack is the base of the thumbs or the lower back,” he added, noting “most of the joints are basically prey to it including the temporomandibular joints—TMJs—and cricoarytenoid joint, your voice box, can actually be affected by RA.”
“Usually, the symptoms have to be present for at least three months for it to be considered because there are other types of arthritis that can be viral, or following an infection,” Dr. Baca said. “But the difference is that those things will go away whereas RA will never go away.”
