you according to the Arthritis Foundation about 1.5 million people in the United States have rheumatoid arthritis and nearly three times as many women have the disease as men today on being well dr. chip row from Paris Community Hospital Family Medical Center will be here to talk about ra it's symptoms treatment options and more there's a lot of help for information coming your way so stay right here production of being well is made possible in part by Sarah Bush Lincoln Health System supporting healthy lifestyles eating a heart healthy diet staying active managing stress and regular check-ups are ways of reducing your health risks proper health is important to all at Sarah Bush Lincoln Health System information available at sarahbush.org alphacare specializing in adult care services that range from those recovering from recent hospitalizations to someone attempting to remain independent while coping with a disability chronic illness or age-related infirmity alphacare compassionate professional home care additional funding by Jazzercise of Charleston orthopedic surgeon dr. chip row has brought joints for us today for our discussion about rheumatoid arthritis thanks for coming over Thank You Lori I appreciate being here again been a few sessions since we've had you back but we wanted to talk about rheumatoid arthritis because it does affect several million people it does we hear about our itís in general but there is a difference between our a and the more typical osteoarthritis there is okay the Arthritis plain and simple is just the wearing out of the joint surface the joint surface is covered with cartilage that has very little friction if that cartilage starts to break down then you start to get friction it doesn't function as well in the most common form of arthritis which is wear and tear or osteoarthritis the joint just wares out with time whereas in rheumatoid arthritis their act is an actual active process that destroys the cartilage itself okay and that's mediated through something that we call an autoimmune process where for whatever reasons we don't completely understand our immune system identifies our own cartilage or the linings of our joint the synovium is being abnormal and actively begins to attack it okay and as a consequence it destroys the cartilage okay so can you grab one of our models and actually show like where well what's happening visually this happens to be a model of the knee this would be the right knee if you were to look at the ends of the bones if you were to break the joint apart it would have a nice white shiny smooth surface what gives it that appearance is that layer of what we call articular cartilage with rheumatoid arthritis or degenerative arthritis that cartilage undergoes change and it reaches a point where where the bone is no longer completely covered with that nice smooth shiny white surface it starts become roughened an irregular and that is a source of pain limitation emotion and deterioration of function okay so how does someone know if they have RA versus osteoarthritis well unfortunately it's not a simple yes and no question okay rheumatoid arthritis is what we put into the category of a syndrome meaning that there's not one specific thing that enables us to say you do or you do not have rheumatoid arthritis there are a constellation of about ten factors that we look at morning stiffness swelling of the joint limited range of motion but then we will couple that with laboratory studies the common ones are something called a test for a rheumatoid factor which is positive and about seventy to eighty percent of people with rheumatoid arthritis but there's thirty percent of people or so where the rheumatoid factor is negative more recently they've come up with a test called AC PA which is looking for a different type of antibody and that actually is a little bit more specific for rheumatoid arthritis but then we also look at signs of inflammation such as a sedimentation rate and c-reactive protein and again in everybody who has rheumatoid arthritis all of those factors are not positive so we take those constellation of things and if six or more of them are positive then you're presumed to have rheumatoid arthritis if three of them are positive and the rest of them are negative then we kind of scratch your head and we look for other potential things like lupus or Lyme disease or there's various other types of syndromes that can overlap with rheumatoid arthritis it sounds like it's a little bit of a mysterious kind of disease in some ways it is because we like to think that things are simple but with rheumatoid arthritis there's not a hundred percent genetic relationship so just because you have it doesn't necessarily mean that a child has it okay they say that hereditary is a 50-percent factor in terms of whether you're going to develop rheumatoid arthritis but I mean the statistics day showed that men particularly who are heavy smokers have a three times increased likelihood of developing rheumatoid arthritis then a man who does not smoke so okay there are are so environmental factors and there's always been the debate whether there is some infectious cause such as a virus that that triggers it because we know that people who have epstein-barr virus there's a relationship there with rheumatoid arthritis so you're right it it is mysterious in that we can't really pigeonhole and say that if you're this age you have a parent that has that and if you smoke and you get this infection so it's a little bit of a of a random type thing but once it does affect you it usually stays with you for the rest of your life okay it affects the joints does it affect certain ones more than others most commonly it affects the small joints of the hands in the feet also can affect the cervical spine but you can't affect any joint it can affect the knee joints in the shoulder joints and than the hip joints okay you'd mentioned a few risk factors are there other things that increase someone's risk for developing our a smoking seems to be the biggest one and we mentioned hereditary if you have a family member who's had it that increases your likelihood the the other things in terms of exercise lack of exercise obesity they're really does not seem to be a good correlation okay so if someone thinks hope I might have this what course of action should they take because you're you know there's you know you're a surgeon there's rheumatologist did people typically start with their family practice physician and go from there most often i would say they do see their primary care physician and i end up seeing some of them because they get referred to me for pain in their hands or swelling in their hands or arthritis because I probably am work accessible then rheumatologists are today and I will take a history and I'll examine them and I will often initiate the initial laboratory testing and if that's confirmatory or I'm uncertain then I will usually refer them to a Rheumatologist for further evaluation and work okay so as a Rheumatologist that is all they study and deal with this is RA no they they deal with all forms of arthritis but more often they're involved with the inflammatory arthritis but they do also overlap with orthopedic surgeons and care for patients who have osteoarthritis the what are the long terms effect if people don't seek any treatment for it what can happen over the course of time rheumatoid arthritis follows a variable course some people it can be episodic where they'll have a flare up and then things will quiet down and may or may not flare up again that would probably be less likely be rheumatoid arthritis but left untreated the disease typically marches on with protrek progressive destruction of the joints subsequent loss of function certainly deformity people think of people with rheumatoid arthritis is very real yeah big knuckles are kind of deformed hands absolutely the big knuckles and the fingers kind of drifting off to the side is this kind of everybody's picture of rheumatoid arthritis and so there can be progressive loss of function associated with deformity okay you talked about flare-ups and I think anybody that deals with rheumatoid arthritis or Arthur's just talks about flare-ups what are there things that might bring those flare ups on that your patients have told you about again it tends to be more patient dependent but I actually have a daughter who's in her late 20s who does have rheumatoid arthritis and I know while she was in school during the time of finals and that sort of thing it always used to flare up on her so there's always been a feeling that stress fatigue probably as they say cigarette smoking can do it so they're poorly understood factors but they are appreciated as things that if you can moderate you probably experience less severe and less frequent flare-ups so for people who have RA they know what their flare-ups are like but maybe for someone like me that isn't around that or maybe someone who has a loved one explain to us what what a flare-up is like and the level of pain and discomfort that a patient going through it can be quite severe I mean we where we can avoid narcotic medications sometimes it does require a narcotic medication they're typically is a kind of an overwhelming sense of fatigue significant morning stiffness that may take an hour or more to resolve just being able to you know making a full fist with your your hand or do you even be able to walk comfortably on your feet the joints will tip those that are involved will typically become more swollen which can be you know quite visible and they'll often become warm and red so as are there some at-home treatments that people can try first before maybe needing more advanced you know narcotics that you said well probably the first thing most people reach for is one of the anti-inflammatory medication so a leave or Advil or if it's been prescribed your celebrex and those types of medications aspirin was is still frequently used to treat children with rheumatoid arthritis was really one of the original medications used to treat rheumatoid arthritis tylenol can help and can be taken in conjunction with one of the anti-inflammatory medications but if it's persistent and or seems to be getting worse than that would prompt me to recommend that people see their primary care doctor or you know asked to make an appointment with an orthopedic surgeon or a Rheumatologist but usually a Rheumatologist is not necessarily going to see them without a referral okay so will someone after they've had the disease for so many years will they get more flare ups or over as time goes on or not not necessarily and with the newer medications today flare ups have actually become less severe and less frequent and we're seeing much less severe destruction or damage to the joint surfaces that's our goal is to prevent the the functional limitations and the deformity so when people have persistent flare-ups it's the flare-up that eventually is causing the degeneration after a while there is a correlation with the frequency in this end the severity of flare-ups with damage to the joint surface okay I had a question here night should acid I I was doing my research I understand that there's two different types of RA well there's probably many more than the types of RA but just because of laboratory tests and kind of traditionally and it does help us kind of determine prognostic factors is one of the earliest tests for rheumatoid arthritis was something called the rheumatoid factor and still today if you see me or see a rheumatologist or even your primary care doc and they're concerned about it that's probably one of the first tests that they're going to run is a rheumatoid factor and we alluded to that before that the about seventy percent of people with rheumatoid arthritis do have a positive rheumatoid factor there are those that do not have a positive rheumatoid factor we call those people 0 negative now we know that the people who have a positive rheumatoid factor particularly at higher higher levels that there is a correlation there with the severity of the disease and also with the newer test the the antibodies there is a correlation with that in the amount of that so that and just because you may start off as 0 negative a year or so after the diagnosis it then may convert to positive so it's kind of an arbitrary designation but it does help us can it provide people with expectations in terms of the their prognosis so in when you're doing all these diagnostic tests do you use x-rays MRIs CT scans to look at the joint what's the most common problems all of them have their place but for rheumatoid arthritis I would say the most common our plane x rays there are characteristic changes loss of bone density around the the cert the bones next to the joints you can see actually the soft tissue swelling and more advanced rheumatoid arthritis you will actually see loss of the space between the two ends of the bone and there can often will be irregularities and one of the things that helps distinguish osteoarthritis from rheumatoid arthritis is at least by x-ray is with osteoarthritis you typically see the development of what we call spurs or osteophytes which are they appear on x-rays as bony prominences they tend to be conspicuously absent on the x-rays of patients with rheumatoid arthritis you'll see loss of the joint space without a lot of the bony response to the Arthritis like we see with osteoarthritis now I want to ask about exercise and movement and things like that I me if you have are a prey you may not want to go I would think I want to go you know for a walk or jog or ride bike but can exercise be good or in sometimes bad for ra patients uh it definitely is beneficial okay because it keeps the muscle strong which provides the support for the joint it also serves to keep the surfaces kind of polished and smooth and it also stimulates the body to secrete increase lubricating fluid so it can be beneficial I'm not aware of studies that show that its associated with flare ups but we do recommend in rheumatoid arthritis where they can do lower impact activities such as swimming or riding a bike that's preferential to something like running or jumping or or weight-bearing activities so what about you know weight-bearing activities in terms of like lifting weights and things like that is that good or bad I would say it's good okay but again lightweight tire repetition ok again to try to preserve the function in the range of motion and just that that sense of well-being ok so keep up the exercise absolutely I'll but talk to your doctor first about what might be well and keep your weight down again one means well that is consistent exercise true are there any kinds of dietary things or food things that are good for RA patients or nutritional supplements vitamins there there are a whole whole host of things that are promoted out there but none of them that have been truly proven to have a significant impact ok but for general health eating a good healthy diet is always a good idea absolutely so I know I mean we see it on TV there's ads all the time for new medications are the medications for re getting better and better at helping people oh there's been huge changes within the last probably eight to ten years that have significantly improved the quality of life and people with rheumatoid arthritis is it typically an injection sort of medication I have a friend that has it and that's what she takes yes there there are a couple of medications umbrellas one of them which are used for other autoimmune diseases as well sorry adequate yes arthritis crosses over with rheumatoid arthritis a little bit humera is another one those are both at this point in time by injection I am not aware of any medications that are in that class that art can be taken by mouth at this point I'm kind so in this last minute or so just give us a little bit of advice for someone out there who's living with ra may be having a hard time with it you've probably had patients that are that are doing well what advice would you give to someone to things that the patient can actively moderate is one they're smoking mm-hmm and unfortunately that includes marijuana and 2 is their weight okay and you know seek out a professional that you can establish a good working relationship with because unfortunately unlike a broken leg you're going to be entering into a long-term relationship with the physician who's going to be treating you for rheumatoid arthritis and again the nature of the problem is one that it can flare up without you know predictable problems arising and so you want somebody who will be attentive to you that you can get in touch with relatively easily and is going to be there to optimize your care and you know that's those taking responsibility for yourself exercising not smoking keeping your weight down and then you know developing a good rapport and a long-term relationship with the physician who you trust are going to be the biggest factors with the long-term care of rheumatoid arthritis all right well dr. Rowe our time went so fast thank you so much for for shedding some light on our a and hopefully can help some people out there I hope it does thank you thanks Lori when it comes to prescriptions following your doctor's orders is critical despite that some patients are not adhering to those instructions and that can make feeling better harder Susan Hendricks explains whether you use over-the-counter or prescription medicine it most likely means you're looking for something to make you feel better following instructions for your medication is a big deal if you fear from the plan that you and your physician have come upon an agreed upon then you're not going to get the result that should have been there pharmacist rich Toma Levitch says that applies to most medications in antibiotic therapy the infection may never go away antidepressant therapy you truly never may get to what's called steady state and it may never be truly effective blood pressure medication may truly never work research shows that fifty percent of Americans don't take their medicine as prescribed and the ramifications can be significant non adherence to medication guidelines causes thirty to fifty percent of treatments to fail and 125 thousand deaths annually for anything to truly work the way you want it to you have to give it a true shot you have to give it a chance tomah leverage says if you miss a dose ask for help to get back on track that's what a pharmacist is for a pharmacist is there to answer your questions specifically because it truly depends on the medication for today's health minute I'm Susan Hendricks that's all the time we have for this edition of being well check us out right here on WEEI UTV Tuesday evenings at seven and Wednesday afternoons at twelve thirty or anytime on youtube you'll find new programs there as well as extra program content from some of our guests until next week i'm lori casey for being well production of being well is made possible in part by Sarah Bush Lincoln Health System supporting healthy lifestyles eating a heart healthy diet staying active managing stress and regular check-ups are ways of reducing your health risks proper health is important to all at Sarah Bush Lincoln Health System information available at sarahbush.org alphacare specializing in adult care services that range from those recovering from recent hospitalizations to someone attempting to remain independent while coping with a disability chronic illness or age-related infirmity alphacare compassionate professional home care additional funding by Jazzercise of Charleston you