The RA Serenity Prayer
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Most of us are familiar with the Serenity Prayer:

God, grant me the serenity to accept the things I cannot change,
The courage to change the things I can,
And the wisdom to know the difference.

Though not a religious person, I have always found that to be a practical and powerful prayer. Living with a condition like rheumatoid arthritis (RA) highlights the significance of this prayer; it takes much serenity to accept life with this challenging disease, it requires courage to attempt changing the course of the condition, and it can often be far more difficult than one might expect to determine which facets of life with RA can and cannot be altered.

On one hand, RA is something that one cannot change in that it is a chronic, degenerative disease without a cure. For some perplexing reason that still eludes researchers, the immune systems of people with RA get confused and instead of solely attacking germs and viruses, they also turn against the body’s own joints, tissues, and organs. Most people’s immune systems can tell the “good guys” from the “bad guys” when determining when to go on the defensive, but that’s not the case for those of us with RA. Therefore, this disease might seem a pretty clear case of a “thing I cannot change.”

Being unable to change the fact that I have RA has indeed required a call for serenity. In the 17 years since my RA diagnosis I have made many a wish that I could change having this disease. I’ve often imagined what life might be like if I didn’t have an autoimmune condition. Even though I’ve been diagnosed for nearly two decades, from time to time I still lack the “serenity” to cease comparing myself to others, as comparison never proves helpful.

Considering your RA when making decisions is key to living better with it

Failing to accept my reality with RA can not only cause unhappiness, it can even increase my pain and inflammation. When I ignore the condition and fail to honor my body’s needs for proper rest, movement, and nutrition, disease activity becomes more severe. There are countless times when I’ve had an “activity hangover” or a full blown flare of symptoms after pushing myself harder than is healthy for my condition. I cannot change the fact that my immune system doesn’t work as it should, and therefore I have to factor RA into decisions large and small, from whether to accept an invitation to what to include on a trip itinerary (or whether to take a trip at all) to what type of job to have. When I haven’t factored RA into decision making, I’ve often paid a price. Therefore, living successfully with this disease has necessitated a certain level of acceptance.

Does accepting RA mean giving up on the quality of life you want?

Yet, pure acceptance of RA can, paradoxically, also diminish one’s quality of life with the disease. While one can’t change whether or not one has the disease, there are factors that can impact disease activity, such as diet, exercise, sufficient rest and adequate sleep (and those of us with chronic conditions often need more sleep than others), stress reduction, and medical treatment. If one just says, “Well, I have RA so I’m just going to be in a lot of pain every day and there’s nothing that I can do about it,” it greatly reduces the likelihood of that person searching for the yoga class, diet, supplement, prescription, etc. that could actually decrease her/his level of pain.

Therefore, there are aspects of RA that one might be able to change, and it does indeed take courage to “change the things I can.” For instance, a person may have tried many RA medications on the market and found them ineffective or causing too many side effects. That person could accept that “there isn’t a medication to help my RA.” However, new medications continue to be developed, and it’s possible that a newly released prescription drug could make a huge difference in that person’s disease activity.

The same goes with diet, exercise, and supplements. A person might try eliminating multiple foods to no avail, but with continued attempts discover a food that does increase RA symptoms. Eliminating that particular food might make life better for that person. Likewise, someone may find most forms of exercise too painful, but after repeated trials may find the exercise regimen, or even the right instructor, that incorporates the necessary level of support and protection into the activity, allowing for enough movement to decrease RA symptoms.

This process of trial and error does indeed require courage, as the disappointment and frustration of trying something new and discovering that it doesn’t help, or may have in fact even made things worse, can be intense. Being disheartened and yet summoning up the hope and determination to try again is nothing short of courageous.

Reflecting on the interplay of accepting the reality of RA while trying to change one’s personal trajectory with the disease, it occurs to me that perhaps an “RA Serenity Prayer” is needed. It might go something like this:

Grant me the serenity to accept I have unique needs because of RA,
The courage to keep searching for what works for me,
And the wisdom to know when to be still and when to push forward.

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