Chances are you’ve at least heard the term “rheumatoid arthritis,” particularly if you’ve watched a fair amount of TV in the last few years. The second word in that two-word term is fairly easy to understand – nearly all of us know an older relative who has had arthritis at some point in his or her life. This generally is known as osteoarthritis, the most-common type. The “rheumatoid” part, though, is more complex and less widely known, although it’s becoming more and more common. Rheumatoid arthritis is an autoimmune disease that can lead to joint pain, swelling and deformities of the hands, wrists, elbows, shoulders, hips, knees, ankles and feet. It starts when the body’s immune system, which normally attacks viruses, bacteria and other material from the environment, turns against a patient’s joints, causing pain, swelling and morning stiffness at the onset. About 30 percent of people with rheumatoid arthritis have a family member who has it, as well.
Blount Memorial rheumatologist Dr. Brett Smith says rheumatoid arthritis can affect people of all ages, including children, adolescents, young adults and the elderly. “Rheumatoid arthritis, also known as RA, tends to affect women more than men,” Smith said. “In fact, we often see two or three females for every one male affected. It’s a disease that can present differently in different patients, so it's important to see a rheumatologist, who specializes in patients with arthritis and autoimmune diseases, to help establish if a patient's symptoms are related to RA. With our expertise and experience, rheumatologists are able to diagnose the disease, treat it and care for people throughout their lives to reduce the symptoms and risks of complications,” he explained.
Smith says there are signs to look for before consulting with your doctor. “Pain, morning stiffness and joint swelling are the primary warning signs that something is not right, and that a patient should be evaluated by a rheumatologist,” he said. “Also, if a patient's mother or father has RA, he or she also may need to be evaluated. The most-important part of diagnosing RA is talking with patients about their symptoms and performing a good physical exam. Approximately 85 percent of patients with RA have positive blood tests for the disease. While the blood tests are not all we need to diagnose RA, they certainly can help. X-rays also can be helpful in finding specific changes in a patient’s joints that show evidence of RA,” he explained. “It’s important to understand that rheumatoid arthritis is not just a localized inflammation. This is an inflammation that involves the entire body, particularly the cardiovascular system and bones. After years of experiencing RA, we begin to have to focus on a patient's risk for high blood pressure, cholesterol problems, risk of osteoporosis and potential heart attacks. RA also can affect the eyes, lungs and nervous system, and carries a 250 percent risk of lymphoma when compared to someone who does not have RA,” he added.
While there is no cure for rheumatoid arthritis, Smith says there are treatments available that can be effective. “Thirty years ago, treatments were limited to steroids and a few other medications,” he said. “Now, we have nearly 20 medications available for patients that can reduce pain and swelling, and improve their quality of life. Treatment options include pills and injections that can be taken at home, as well as intravenous medicines. The frequency of these medications varies from daily, weekly or even to once every few months. Currently, there is no cure for RA, but symptoms can be managed with medications that suppress part of the immune system. Typically, patients will notice a significant difference in pain and stiffness within the first eight weeks of treatment. Within a few months, the swelling improves, and patients sometimes can nearly get back to their normal state of health. Some patients require six months of treatment before we can get them into remission, but will still notice symptom improvement during that time. A large number of patients are able to return to family activities, employment and hobbies with minimal difficulty,” he explained.
“Typically, patients need months to years of treatment to put the disease into remission,” Smith said. “However, once it’s in remission, patients usually can live relatively normal lives. Some patients can even enjoy a few years without medications after two years of remission before the disease has a chance of becoming active, again,” he added.
Dr. Smith sees patients in his office at East Tennessee Medical Group, located at 266 Joule St. in Alcoa. In addition to specializing in ultrasound-guided procedures, Smith also is the only pediatric rheumatologist currently serving Blount County.