Pain Before Beauty?

I like to think of myself as a practical person. However, if I’m honest, I sometimes put vanity and ego before practicality, even when it comes to RA.

Rheumatoid arthritis is not pretty. In the figurative sense, it’s a hard disease to live with, often presenting daily challenges. In the literal sense, RA can impact appearance. Even though it’s an “invisible disability,” the condition can show up externally, if you take a close look. Nodules can form near joints. While these lumps under the skin are harmless (unless they’re pressing on a nerve), they are a visible reminder of the disease, and would dash the hopes of any budding hand model. Advanced progression of the disease can lead to “swan neck” deformity of the hands, causing fingers to be crooked by bending at odd angles. Inflammation can be severe enough to cause joints to be noticeably large and puffy. Then there is the aesthetic impact of aids and side effects. Braces and splints can provide needed support to painful joints, but you won’t see them sported by any beauty contestants. Likewise, canes, walkers, and wheelchairs may be necessary in advanced RA or during severe flares. Somehow a cane can be elegantly sported with a tuxedo and a top hat, but it doesn’t have the same effect with an evening dress. Perhaps the most dramatic visible impact of RA is the side effect of long-term corticosteroid use, commonly referred to as “moon face.” When taking drugs such as prednisone for long periods of time, some people develop Cushing syndrome, which causes deposits of fat on the sides of the face, resulting in a much rounder countenance. This can drastically change the appearance of one’s face.

I am lucky. I’m not in a wheelchair, I don’t need walking aids except on rare occasions, and while I’ve had an on-again, off-again relationship with prednisone for 15 years, I’ve never been on it for a long enough stretch to have “moon face.” While my pinkies are crooked, the rest of my fingers remain straight. Yet, in spite of getting off easy when it comes to the most noticeable impacts RA can have on one’s appearance, I still catch myself prioritizing looks over comfort from time to time.

The most blatant example of this is shoes. Day to day, I wear “comfortable” shoes (that is to say they’re as comfortable as any shoes can be on my painful bunions), but when it comes to special occasions, I sometimes sacrifice feeling my best in order to look my best. There are just so many dresses that look odd when paired with flats, and my ego at times insists on looking my most amazing. I don’t completely disregard practicality, as I will stick a pair of flats in the car so that I can change shoes midway through the event should the pain become too great. Still, I recognize my vanity isn’t doing my body any favors on nights like these (or on the following day).

There are also times when I will not use the aids that would help my body feel it’s best. Over the counter pain patches and prescription lidocaine patches can diminish the discomfort in my joints. Yet, I often opt not to use them on visible joints such as wrists or, in the summertime, on knees or elbows. The same goes for the wrist braces I use from time to time. Of course, there are days when the pain is so great that it overrides any concerns of appearance. However, there are days that are somewhere in-between a “good day” and a flare, where I will wait until I get home to don my splints or patches. On such occasions, my motivation generally stems from not wanting to attract extra attention to my disability, especially when I’m at work. Yet there are those days where I’m barely feeling well enough to attend a special event, and I don’t want to accessorize my cocktail dress with a bulky wrist splint or glaring white rectangle of topical analgesic.

There’s the saying, “age before beauty.” While usually used as a bit of a slam when allowing an older person to go ahead in line or through a doorway, I actually find that it applies to my life. The older I get, the less vain I’ve become. I think this is due in part to the natural tendency to become more practical with age. In addition, as it’s been over a decade since I’ve been single there’s the reduced pressure to get completely dolled up when going out for a night on the town. My RA has also played a part. There are times when my arthritis screams so loud that it shuts out all other voices, including that sometimes-vain voice of my ego. On these occasions, I do prioritize pain over beauty. Still, every once in a while, I catch myself pushing practicality aside, choosing to nurse my vanity rather than my RA.