This autoimmune condition can strike as early as your 20s or 30s. Here’s what you need to know.
Most people think of arthritis as an older person’s ailment, with painful joints that limit your movement. But for some people, arthritis is an autoimmune condition that launches a full-body attack, and it can strike as early as your 20s and 30s. These people have rheumatoid arthritis (RA), a condition that occurs when antibodies in the immune system (which normally work to fend off germs) attack the lining of your joints, causing pain, swelling, and warmth, and limiting your mobility.
Research shows that the number of women with RA is on the rise. A Mayo Clinic study in 2010 found that the rate of RA in women over the age of 18 increased 30% between 1995 and 2007. It’s estimated that the number of Americans with RA is now 1.5 million.
No one knows exactly why RA is on the rise, but vitamin D deficiency has emerged as a possible culprit, says Cynthia Crowson, a biostatistician and RA researcher at the Mayo Clinic and coauthor of the study. Inadequate amounts of vitamin D have been linked to a higher incidence of autoimmune disease. Women have also been slow to give up cigarette smoking, a known risk factor for RA. It’s possible, too, that decreases in the amount of estrogen in newer oral contraceptives—as opposed to those in previous generations—may explain the increase. “Women with a family history of RA should not smoke and should talk with their doctor about testing for vitamin D deficiency,” Crowson says.
Telltale Clues That It’s RA
It isn’t always easy to distinguish RA from other conditions like osteoarthritis, the most common form of arthritis and the kind that can worsen with age. Both cause stiff, achy joints and morning stiffness. In OA, the stiffness goes away after 15 to 20 minutes and worsens with activity. But in RA, the stiffness lasts longer, can linger for hours, and improves with activity.
If you have RA, your painful joints will be red and warm. And unlike OA, which affects primarily the hips and knees, RA tends to attack the hands and feet. RA may cause fever and flulike symptoms, too. The disease tends to alternate between periods of remission (when you have no or few symptoms) and flares (when the disease is active).
Choose the Right Doctor
If your morning stiffness lingers more than 30 minutes, and your swollen joints are red and warm, ask your primary care doctor for a referral to see a rheumatologist, a doctor who specializes in the treatment of connective tissue diseases like RA. You may be especially vulnerable if you have a family history of autoimmune disease. The rheumatologist will diagnose you based on the symptoms you report, a physical exam, and family history. Your doctor may also do x-rays, ultrasounds, or MRIs to examine the extent of bone damage.
Blood tests can help confirm a diagnosis. The ESR—or “sed rate”—test (ESR stands for erythrocyte sedimentation rate) is often used in combination with C-reactive protein (CRP) test, according to the Arthritis Foundation. Both are markers of inflammation, and high levels combined with other RA symptoms can help doctors make a diagnosis. Other tests include rheumatoid factor (RF)—an antibody that turns up in about 80% of RA sufferers—and an anti-CCP test that measures antibodies to cyclic citrulline-containing peptides, a marker that is produced in 60 to 70% of people who have RA.
Why Early Detection Matters
Getting diagnosed as early as possible is critical to managing RA. Left untreated, RA puts you at risk of permanent joint damage. The good news is, the right medications can slow, and even stop, the pain and progression. “The downward spiral that was once inevitable, in terms of work limitations, chronic pain, and eventual surgery, has completely changed,” says Patience White, MD, vice president for public health for the Arthritis Foundation. “If you get diagnosed early and get on treatment, you have a better chance of remission.”
The first drugs patients try will be ones they can buy at the local pharmacy without a prescription, such as ibuprofen. If these fail to manage symptoms, prescription strength pain relievers will be next; during an acute attack of symptoms, doctors may try a steroid such as prednisone.
To prevent the progression of the disease, doctors use disease-modifying antirheumatic drugs, which suppress the immune system. A newer class of biologic drugs can actually target the parts of the immune system responsible for joint and tissue damage. These medications disrupt the inflammatory process and relieve pain and fatigue. “Starting these drugs sooner is always better, but they work later, too,” says Robert Bunning, MD, a rheumatologist and associate medical director of National Rehabilitation Hospital in Washington, DC.
Because these drugs are so powerful, they can have serious side effects. Methotrexate, for instance, requires careful monitoring of your liver. The biologics may raise your risk of infections. Biologics may also cause a slight increase in the risk of cancer. But according to White, simply having RA puts you at increased risk of cancer, and the benefits of these medications are well worth the risk. “The benefit is it can almost stop the disease that disables you, while the risk of cancer is very small,” she says.
The Power of Exercise
Regular physical activity is critical to well-being in people with RA. “When you are in remission, it is important to participate in aerobic exercise and strengthening exercises to promote cardiovascular health and regain muscle strength,” says Maura Iversen, chairman of the department of physical therapy at Northeastern University’s Bouve College of Health Sciences. Exercise also helps improve mobility, reduce stress, and prevent weight gain. Being overweight can worsen your RA pain.
When you’re having a flare-up, it’s best to limit your exercise to gentle range-of-motion exercises, and to walk and maintain your usual activities of daily living, Dr. Iversen says. “Tai chi in particular allows you to focus on the movement and the smoothness of the movement,” she says. One study found that doing tai chi twice a week strengthened leg muscles in participants with RA. Exercising in a warm pool can also help by relaxing the muscles and reducing pain and stiffness.
MORE: 5 Pain-Relieving Yoga Poses
Stress and Diet
Having a chronic illness like RA is tough enough. Any additional stress is likely to worsen your pain, says Harry D. Fischer, MD, a rheumatologist in New York City and coauthor of What to Do When the Doctor Says It’s Rheumatoid Arthritis. To reduce your stress, set reasonable goals and clear priorities. Ask others for help. Make time to relax with deep breathing, meditation, or massage.
Many people believe that nightshade vegetables like tomatoes, eggplant, and potatoes worsen RA, but there’s no scientific evidence for that. While there is no specific diet for RA, it is important to eat lots of fruits, vegetables, and freshwater fish. Plant-based foods contain antioxidants and phytochemicals that inhibit enzymes that promote inflammation. Cold-water fish such as salmon, mackerel, and herring contain omega-3 fatty acids that can lessen inflammation.
It’s also important to eat foods rich in calcium, White says. Dairy products such as yogurt, fat-free milk, and low-fat cheese as well as calcium-fortified foods such as orange juice will help keep bones strong.
Some experts believe that fish oil and vitamin D may help lessen inflammation. Fish oil can reduce C-reactive proteins and other inflammatory substances, research suggests. And a long-term study of 120,000 women published in Annals of Rheumatic Diseases in 2013 found that regular exposure to sunlight, which helps the body produce vitamin D, reduced the risk of RA by 21%; previous studies have found that vitamin D deficiency is common in women with RA. But according to White, supplements have little impact on the inflammatory process in RA and pale in comparison to medications.
RA and the Rest of Your Body
RA is a systemic disease that raises your risk of other inflammatory conditions such as cardiovascular disease, vasculitis (inflammation of the blood vessels), and pleurisy (inflammation in the lining of the lungs). It also puts you at risk of Sjögren’s syndrome, an autoimmune condition characterized by dry eyes and dry mouth. Some people may experience inflammatory eye diseases such as scleritis and uveitis. Recent research found that people who have RA are at greater risk of chronic obstructive pulmonary disease (COPD), too.
Cutting Your Risk
RA is highly influenced by your genetics. If you have family members with other autoimmune conditions such as lupus, type 1 diabetes, or celiac disease, you are more likely to develop RA. The disease is also more common in women—70% of sufferers are female.
Although genetics are tough to overcome, there are ways to minimize risk. “We know that if you’re a smoker and have a family history of RA, you’re much more likely to get it,” White says. The combination of smoking and a high-sodium diet can more than double RA risk, according to a 2014 study in Rheumatology. Obesity is also a concern: A report from the same year in Autoimmunity Reviews revealed that compounds secreted by body fat can trigger autoimmune responses; the review also confirmed that obesity leads to vitamin D deficiency. In other words, controlling your weight, eating a nutritious diet, and avoiding cigarettes may help you avoid RA. And get outside and get a little sun every now and then.