RA Myths and Facts
RA myths and misconceptions: getting the facts
RA is a chronic disease, which means that even with effective treatment a person with RA will continue to have the disease throughout his or her life. However, this does not mean that just because you have RA your chances for leading a normal, happy, and productive life are decreased.
With today’s treatments (disease-modifying drug treatments), most people with RA can slow or prevent damage to their joints, cartilage, and bones, as well as other parts of their bodies affected by the disease. This is why it is important for you to GET THE FACTS about RA. Learn all you can about RA. Separating truth from common myths and misconceptions about the disease will help you understand the many options you have for treatments that will allow you to lead an active and full life.
Here are some common myths and misconceptions about RA, followed by the facts.
MYTH 1: RA is a disease that affects mostly the elderly
Although the incidence (the number of new cases in a given year) of RA increases in men and women until about the eighth decade of life, RA is not a disease of old age.1 For instance, the incidence tends to peak earlier for women than men, at about ages 55 to 64 years for women, compared with 75 to 84 years for men. However, RA can occur at any age and is often diagnosed in the prime of life and even in children younger than 16 years of age.2
MYTH 2: RA is no different from osteoarthritis
RA and osteoarthritis are very different diseases. Both affect the joints and involve pain and disability. However, the two diseases differ in terms of the CAUSE of joint pain. In osteoarthritis, a disease that affects mostly people in their middle and old age, joint pain is caused by wear and tear on aging joints. In RA, which can affect a person at any age, joint pain and damage result from an inflammatory autoimmune process, in which the immune system malfunctions and turns against the body’s own healthy tissue (in RA the joints and related structures) causing inflammation and damage.
MYTH 3: Even with early diagnosis and aggressive treatment, damage and disability is still inevitable with RA
Progress made over the past couple decades has increased our understanding of RA and improved our ability to treat the disease. Just a few decades ago, RA was a disease often associated with progressive disability. However, this is no longer the case for most patients. With the development of disease-modifying anti-rheumatic drugs (DMARDs) and newer biologics, such as TNF-inhibitors or monoclonal antibodies, treatment combinations can be tailored to the needs of individual patients to slow and prevent joint damage and other disease complications. These treatment advances have allowed more and more patients with RA to lead full and normal lives.
MYTH 4: Most people with RA eventually end up in a wheelchair, unable to work, or in a nursing home
The course of RA can be very different from patient to patient and there are patients for whom the disease can be severe and cause a high level of disability. However, with recent advances in treatment, more and more patients are able to lead full and active lives. Somewhat less than 20% of RA patients will achieve clinical remission, with or without treatment. Another 75% of patients can achieve low disease activity with continued treatment.3 When it comes to RA, prognosis (predicting the course the disease will take) depends on disease severity and how successful treatment is. So, talk to your doctor about the many treatment options that are available to you.
MYTH 5: RA can be cleared up by making lifestyle changes or just using pain medications
RA is just one of many forms of arthritis. What they all have in common is pain affecting the joints and related tissues (often pain is associated with joint inflammation). However, RA is different from other types of arthritis, such as osteoarthritis, in that inflammation is caused by an autoimmune process in which the body’s immune system turns against and attacks its own healthy tissues. We don’t understand exactly why this happens. Unlike other forms of arthritis that may respond well to lifestyle changes alone, such as weight loss, dietary changes, or exercise, RA requires special medications proven to control the autoimmune process that is at the heart of the disease. These medications include disease-modifying anti-rheumatic drugs (DMARDs) including newer biologic treatments. It is important to remember that with RA, using pain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), alone will not stop or prevent joint damage from occurring. While these medications may be an important part of your total management strategy, like most RA patients, you will also need to use drugs that are aimed at interrupting the inflammation and damage caused by the autoimmune process.
MYTH 6: RA involves only joint pain and damage
RA may begin with inflammation of the joints that causes pain and damage to joints and related structures (bones and cartilage). However, symptoms and health problems associated with RA are not limited to the joints. RA can affect the entire cardiovascular system including the heart, lungs, and blood vessels throughout the body. This is important to know, because you need to treat the disease to limit the damage and health problems related to RA even if you are in remission and not experiencing pain. Studies have shown that RA can shorten one’s lifespan by an average of ten years.
Here are some important statistics to be aware of:
- Unless treated aggressively, RA can affect your ability to work. Within 2 years after diagnosis, up to one third of patients may be unable to work. Within 10 years after diagnosis, half of patients may be unable to work.3
- Damage to bones and cartilage can occur rapidly, within 1 year of diagnosis for 80% of patients.3
- Physical, emotional, and social impacts associated with RA contribute to overall poor quality of life.3
- The impact of RA is not limited to joint pain and related physical disability. RA can increase risk for significant systemic complications, including lung disease, cardiovascular disease, osteoporosis, and infection.3
- RA is associated with increased risk of death from cardiovascular disease: 1.5 times more than in the general population (those without RA).3
MYTH 7: RA is caused by unhealthy eating, excess weight gain, and stress
RA is similar to other autoimmune diseases, such as psoriasis, psoriatic arthritis, and Crohn’s disease, in that we do not understand exactly why some people get it and others don’t. However, we are pretty sure that RA does not result from any single lifestyle factor, such as stress, excess weight gain, or unhealthy eating. So, it is important to understand that just by losing weight, or reducing stress, or eating more healthy, you probably can’t expect that RA will disappear. (However, all of these healthy choices can be important keys in helping you manage RA.)
We think that RA occurs in people who have certain inherited genes that make them susceptible to the disease. However, genes alone do not cause the disease. We think that there is probably some sort of other non-genetic trigger, such as an exposure to something in the environment, the presence of an infectious agent (a virus or bacteria), or some factor related to our bodies, such as hormone levels, that plays a role in causing the disease. Interestingly, just as we know that certain types of genes increase the chances of developing RA, we also know that cigarette smoking also increases a person’s chances of developing the disease.
MYTH 8: Treatments for RA are almost as dangerous as the disease itself
This is a particularly dangerous myth, as dangerous as it is untrue. Over the past decades, very effective drug treatments have been developed for RA. These include disease-modifying anti-rheumatic drugs (DMARDs) including newer biologics (eg. TNF-inhibitors). While it is true that any medication can cause side effects, and some of them serious, the potential benefits of available RA drugs far outweigh the risks associated with those drugs. The proof of this is in the simple fact that decades ago, before the availability of drugs that slow and prevent RA joint damage, it was relatively common to see someone with RA who had accumulated significant joint and bone damage leading to considerable deformity. Now, decades after the advent of drugs that can modify or alter the course of RA, it is far less common to see such damage and deformity.
Having said this, there are certain side effects associated with DMARDs and biologic treatments (as well as glucocorticoids used to control acute inflammation) that you should be aware of. Many of the serious side effects associated with these drugs are related to how the drugs work to provide benefits in RA. DMARDs and biologics work in RA by dampening an out-of-control immune response. In doing this, many of these drugs can decrease normal immune function, leading to increased risk for infection and development of certain cancers. However, serious side effects associated with different RA drugs affect only a minority of patients. Speak with your doctor about the risks associated with the RA medications you take or are thinking of taking.
MYTH 9: Diagnosis of RA can be made using simple blood tests and x-ray
Diagnosis of RA is based primarily on clinical assessment, including the patient’s medical history and a physical examination, including assessment of joint involvement and disease activity. Although blood tests, including measurement of several substances that may be present in the blood of patients with RA such as rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and anti-cyclic citrullinated peptide (anti-CCP) antibody, as well as x-ray results, can be useful when making a diagnosis, these cannot be used alone to confirm the diagnosis of RA.
MYTH 10: Treatment with DMARDs is not necessary in the early stages of RA
Ideas about the treatment of RA have changed dramatically since the introduction of DMARDs and newer biologic treatments. Results of clinical trials have demonstrated that these drugs can slow or prevent damage to joints and other related structures. Remember that damage to joints, bone, and cartilage can happen very soon after diagnosis. Such damage is detectable in 80% of patients just 1 year after diagnosis. While many in the treatment community once tended to use NSAIDs early in the course of the disease and only add other drugs, such as DMARDs, as RA progressed, it is now standard practice, in early RA with a certain level of disease activity, to start DMARDs soon after diagnosis to prevent or minimize joint and other tissue damage. Additionally, combinations of newer treatments are now available that provide even greater control of the inflammatory process that is so destructive in RA.3,4
MYTH 11: Exercise can be dangerous for patients with RA because inflamed joints require rest.
The truth about exercise and RA is that a regular routine of exercise, including gentle stretching, should be an important part of your daily routine. Talk to your doctor and your physical therapist about what is an appropriate exercise routine for you and when you may need to rest particular joints or tissues to prevent damage. The flip side of the exercise question is that inactivity can be particularly dangerous for someone with RA. Inactivity and immobility can rob your muscles of the strength they need to keep joints stable and may increase risk for joint damage and deformity. Not only will exercise help you keep your joints healthy, it will also provide benefits for your overall physical and mental health.