Weapons against RA

Rheumatoid arthritis can be devastating disease. The daily joint stiffness, the frequent, sometimes terrible and disabling pain naturally affect every part of the affected person’s life, from career to parenting to having fun and being sociable.

Fortunately, medical science has made several amazing, breakthrough discoveries over the last twenty years. The result? A double handful of sometimes near-miraculous medications. In addition to a number of non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen, ibuprofen and diclofenac, there are now medications known as disease-modifying anti-rheumatic drugs (DMARDs). These include hydrochloroquine (Plaquenil), methotrexate (the “gold standard” in the treatment of RA) and leflunomide. They slow or inhibit the disease’s progression. Often, DMARDs are used in two- or three-drug “cocktails” that pack a powerful punch.

When NSAIDs and DMARDs are ineffective, a third new group of medications have joined the arsenal. These are called ‘Biologics,” because they inhibit RA’s progression at a biological, cellular level, affecting T-cells, etc. Biologics are taken by injection or infusion.

But pharmaceuticals aren’t the only weapons in the battle against RA. Many people turn to more natural remedies, including acupuncture and massage; herbal remedies such as turmeric, ginger, burdock, white willow bark extract and a myriad of others.

Exercise is also important. Because RA is often so painful and debilitating, gentle exercise, like stretching and light repetitions of range-of-motion exercises—are best. Avoid working flared joints, but don’t neglect the unaffected ones. Swimming is wonderful because water takes the pressure off the joints while moving them against light resistance.

Other exercise includes gentle stretching and weight-bearing activities. Walking, the brisker the better, is excellent. Repetitive motion strengthens the muscles surrounding the joints, which can help to increase your general mobility. It also contributes to a healthy heart, lungs and digestive system, and aids in weight loss or weight maintenance. Both are important in life with RA.

Finally, the things we choose to eat may have beneficial effect on rheumatoid arthritis. While the jury remains out on the debilitating effects of eating plants in the nightshade family—tomatoes, potatoes and eggplant, for instance—a healthy diet is beneficial to anyone, including those who’re battling RA.

Some vitamins found in foods are particularly helpful against RA. Citrus, broccoli and spinach are good sources of Vit. C; whole grains, avocados and nuts are rich in Vit. E. And Vit. B6 can be found in bananas, beans and fish. Vit. D, which helps build bone, can be found in tuna and egg yolks.

Try to follow a low-carbohydrate, high protein diet. Eat plenty of fresh vegetables. Stick to whole grain breads and cereals. Avoid processed and fast-foods. There are many ways to fight RA. Click here for a smart seven-day meal plan from Healthline.com.

Polymyalgia rheumatica: setting the record straight

In my last post, I stated that polymyalgia rheumatica (PMR) is a type of rheumatoid arthritis.

A couple of RheumaBlog’s readers gently questioned this assertion. Since the last thing I want to do is mislead anyone, I decided to dig into the subject more deeply.  Is PMR a type of RA, as I asserted so blithely, backed by the Healthline article I linked to?

Well, um, no. It isn’t.

Here’s what I found out: PMR is a connective tissue disorder, an inflammatory condition that causes painful aching and stiffness in the muscles of the neck and shoulders, the lower back and the upper thighs. Sometimes the aching affects the hands and wrists. PMR can be chronic. It afflicts people aged 50 and older, a few more women than men.

According to Wikipedia, “The pain and stiffness [of PMR] result from the activity of inflammatory cells and proteins that are normally a part of the body’s disease-fighting immune system, and the inflammatory activity seems to be concentrated in tissues surrounding the affected joints.”

Polymyalgia rheumatica can come on quickly. While the pain can be quite intense and disabling, like RA it tends to be worst in the morning and often lessens as the day progresses. Periods of inactivity, such as sitting for more than 20-30 minutes, can aggravate it.

PMR is often associated with a kind of vasculitis (inflammation of the blood vessels) called giant cell arteritis. Some researchers believe PMR’s muscle pain might actually be referred pain from inflammation in the joints, ligaments and bursae of the shoulders and hips.

The American College of Rheumatology’s information sheet on PMR states that non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen “are not effective” in treating PMR. Instead, low-dose corticosteroids, such as prednisone, are generally prescribed. Because PMR can be chronic, patients sometimes need to stay on corticosteroids to keep the condition under control.

The information I found seems pretty clear: polymyalgia rheumatica is not a type of rheumatoid arthritis. But just to make sure, I emailed Dr. Irwin Lim, a rheumatologist and the director of BJC Health in Sydney, Australia. He writes an excellent blog for BJC that’s chock full of information about RA and other autoimmune diseases.

I asked Dr. Lim if polymyalgia rheumatica is a “type” of RA. His response (thanks, Dr. Lim!):

Hi Wren,

 Polymyalgia Rheumatica is a different disease. It is not a type of rheumatoid arthritis.

 PMR is related to a vasculitis called Giant Cell Arteritis. It is a steroid-responsive condition and sometimes DMARDs like Methotrexate are used to reduce the reliance on steroid.

 However, rheumatoid arthritis can sometimes mimic PMR. In fact, all connective tissue diseases, if they cause large joint involvement limited to shoulder and pelvic girdle, may look like PMR. So it’s something Rheumatologists are aware of when treating PMR and I routinely measure rheumatoid serology.

 However, true PMR is different from RA with a polymyalgic-type onset (i.e. mimicking PMR).

 Read the American College of Rheumatology’s info sheet on PMR.

My apologies for publishing erroneous information about polymyalgia rheumatica—and thanks to RheumaBlog’s readers who caught the mistake.

The many faces of RA

Back in the olden days (1986), when I was first diagnosed with rheumatoid arthritis, it never occurred to my 31-year-old self that there might be other types of RA than the one I had.

And why should it? I was surprised enough to learn that I had RA at all: a disease that wasn’t caused by some outside marauder, like a virus or bacteria, but by my own autoimmune system mistaking my joints for viruses or bacteria.

All I really understood was that I’d somehow gotten a disease that I’d always associated with old people and the commercials for iron pills and creams for sore joints and muscles I’d seen as a child while watching The Lawrence Welk Show at my grandma’s house.

And, from recent experience, I knew that RA could be extremely painful. Sometimes the affected joints hurt so badly they impaired my ability to work—and everything else. A flared hand could keep me from taking notes and typing, an integral part of my job. A flared shoulder made it really hard to wash and fix my hair and get dressed. And depending on which shoulder  or foot the RA bit into, driving my stick-shift car became a huge challenge, too.

Still, I was lucky. Prior to making a final diagnosis, my doctor ordered a blood test. He was looking for a protein called the Rh factor, a clear indicator of rheumatoid arthritis. He found it. I was seropositive for RA.

My doctor explained the basics: RA strikes at any age. It can be treated, but it’s incurable. RA attacks more than the joints, too, he said. It can damage soft tissues like the heart, the lungs, the eyes and even the veins, and while remissions occur, they’re rare. I’d have RA the rest of my life.

Unfortunately, many people have RA, but don’t show the Rh factor in their blood. They’re seronegative, and it makes diagnosing the disease much more difficult. Because there are so many diseases, syndromes, conditions that can mimic RA (such as fibromyalgia, neuropathy and Lyme disease), doctors sometimes rule RA out if they don’t find the Rh factor in the patient’s blood. It can take a long time to get a diagnosis—and finally, treatment.

Doctors now believe that the earlier in the course of the disease a solid diagnosis can be made, the more likely it will be RA medications—DMARDS in both their original and biologic forms, along with NSAIDs—can slow or even arrest the disease’s progression, preventing as much joint damage and deformation as possible.

There are several other forms of rheumatoid arthritis: ankylosing spondelitis, polymyalgia rheumatica and juvenile idiopathic arthritis.  Click www.healthline.com/health-slideshow/types-rheumatoid-arthritis to learn more about them.

Back on the wagon

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Owie hands. Boring. Aggravating. Again.

Yesterday was a really rough day. I was hurting all over, but the RA was hitting my hands and wrists the hardest. Along with that, the chronic trochenteric bursitis I’ve had for several years now showed up again, making my hips feel like I had spikes in them.
So, I wore my compression gloves all day long. I counted down the hours between painkiller doses and wished, fervently, that they’d work better. I sat with ice-packs jammed against each hip and toddled around like an old lady.

It was no fun, but I’ve had worse flares. For instance, I was able to do most of what I needed to do in spite of the pain yesterday. I even managed to make a fresh salad for lunch by limiting the ingredients to Romaine lettuce, tomatoes and cucumbers because those veggies don’t require much effort to chop. Still, it was a long, miserable day. The RA and bursitis pain was constant and nagging. Ignoring it was a pipe dream. And pain like that simply wears me down.

What brought this nasty flare on? Hmm. The weather was clear and hot. I kept checking the barometric pressure, convinved that it must be rising or falling, prodding my rheuma-dragon and making him restless and irritable. Making him bite. But the barometer was dead-steady. That wasn’t it.

(An aside: I used to just accept that there was no rhyme or reason for flares. They just came and went, random as clouds. Since those early days I’ve learned that there may be triggers for RA flares, such as barometric pressure changes or fatigue, so I tend to look to those before I just give up and blame the pain on fate alone.)

So, the barometer was out. What else could have caused me to flare? Well, I took my uncle to the VA medical center to see his doctor and have some tests done the day before yesterday. I wore myself out. Could that be it?
Maybe, but with the exception of hefting unc’s wheelchair into and out of my car’s trunk a couple of times, most of the day was spent wheeling him from clinic to clinic, waiting through appointments, and driving there and back again. And then back home. It wasn’t exactly strenuous, though it did end up being a full, 8-hour day. Now that I look at it all written down like this, I’m not really surprised that I was pretty much whupped by the time I got home.
I went to bed about an hour early and fell asleep the moment I laid down. But I woke several times during the night. And when dawn arrived, my hands were stiff and throbbing, and the bursitis was shooting darts through both hips.

So, maybe I can blame Uncle’s Doctor Day for yesterday’s flare. But I can’t just quit helping him to avoid rousing the dragon. Beyond that fact that I love my uncle, helping him means that I help my sweet aunt (whom I love even more), too. She also has tronchanteric bursitis, she’s 79 years old, and caring for him has just about run her ragged. I can’t leave her without help.

Today, the bursitis pain is there but mild, thank goodness. And my hands are somewhat better. I’m glad the concentrated rest helped, but I’m not totally convinced that getting so tired the other day was the sole reason this flare happened.

There are other culprits.

Number One: I stopped being mindful about my nutrition and calories some time back. Like I’ve done time and time before, I was pleased with what I weighed and how I looked and felt, so I started cheating. I hate to admit this, because it’s just an excuse, but my mom is one of those lucky people who can eat anything she wants and never gain weight. She loves sweets and potato chips and fast food and keeps them on hand all the time. I got tired of always denying myself those goodies, and I got lazy, too. It’s a lot easier to eat like she does than make myself special meals (she doesn’t like what I eat when I’m being good to myself). It’s just plain hard to resist the constant temptation those cookies and bags of candy in the cupboard present me with, not to mention the ease of KFC and Carl’s Jr.

The result? I’ve once again regained the weight I worked so hard to lose—plus a little more for good measure. And while I don’t know what my blood-sugar levels are at the moment, I’m sure they’re high. I imagine the lipids and cholesterol levels don’t look very good, either. My blood pressure has been up a bit for awhile now, though my doc hasn’t suggested medication for it yet. And I know I’m once again looking squarely at the dreaded Metabolic Syndrome—excess fat around the mid-section, a proven cause of heart trouble (which RA can cause, as well)—complete with pre-diabetes, at least. Type 2 is waving coyly from the wings.
Crud. I’m frustrated—no, angry—with myself for being such a weakling, such a slacker. Sure, I know I’m not alone. Plenty of Americans are obese, their health compromised by their penchant for French fries and Keebler’s cookies, McMuffins and candy bars instead of nutritious breakfasts and lunches, and chips and microwave popcorn after dinner from Pizza Hut, munched in front of the TV at night. Still, being one of the crowd isn’t much to be proud of, is it.
So, today marks my first day back on the Real Food wagon. I know that the poor diet I’ve allowed myself to eat, and the excess poundage it packed back onto my smallish, five-foot-four-inch frame, has only made the rheuma-dragon stronger, meaner and harder to fight off. Yesterday’s flare was just a taste of what lies ahead unless I take action. Now.

Getting it all back under control is fairly simple (though much harder to do than it is to say): just cut out the processed foods; the junk and fast foods; the flour-and-simple-carbohydrate-based white foods; and of course, nix anything with sugar or high-fructose corn syrup in it. Eat whole grains only, but limit even those to as little as possible. Eat lots of green veggies—the darker green the better—along with veggies in most of the other colors, too. Severely limit dairy foods. Eat fruit,

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A good meal for RA, and easy to make.

but watch the sugar content. Since I like meat and don’t really want to give it up completely, I’ll limit it to fish and chicken breasts, which I like best anyway. And I think I’ll try chef Mark Bittman’s suggestion and only eat meat after 5 p.m. and choose one day a week to go completely meatless. It can only help.

The Number Two Culprit: I stopped even trying to exercise. Along with that, I spend a big chunk of each day planted squarely on my broadening behind. So I’ve got to get my body moving again. I’ll start out with a short walk early each morning, adding more time and distance as my body strengthens. I’ll do some gentle stretching and resistance exercise each day as well, including the ones I learned at physical therapy for the bursitis. Maybe it will help that, at least. And if I’m careful, it shouldn’t aggravate the RA much, if any. In fact, I keep reading that exercise helps RA, even if it’s just to strengthen the muscles that support the joints. That hasn’t really been my experience, but I tend to give up exercising easily if I start to flare. This time I’ll squash my inner-wimp and try to stick with it.
Diet and exercise really do have a beneficial affect on rheumatoid arthritis (and its co-morbidities, like bursitis). I’m only human—I’m good at denial and prefer the easy path to the hard. But I’d also like to live a long and productive life with a minimal amount of illness and disability. I know how. It’s time to get busy again.

NOTE: Andrew, who writes the blog Living With RA has written a three-part series of posts about RA and Metabolic Syndrome. They’re excellent: meticulously researched and written so that they’re easily understandable for the non-medical-type person, which most of us are. He’s also a very good writer, so do take a look at http://livingwithra.wordpress.com/2013/06/27/metabolic-syndrome-and-ra-increased-cardiovascular-and-diabetes-risks/

A busy summertime

You know how it is when you’re busy but the things you’re doing don’t really rate a blog post?

That’s how it’s been for me this summer. Still, I’m going to try to break the silence right now.

First, my mom. She’s doing well. So well, in fact, that she’s finally made up her mind about selling her condo. It’s a decision that she’s been mulling for a long time. The Great Recession was the main factor in waiting, but her health also came into play when it went south on her. Now, though, she’s greatly improved—and so is the local real estate market, thank goodness. So this condominium, which is gobbling up her nest egg like some voracious, never-satisfied beast, is now up for sale.

Preparing to sell has meant a lot of activity around here. Lots of cleaning of

Packing has been interesting with three cats obsessed with boxes...
Packing has been interesting with three cats obsessed with boxes…

closets. Lots of deciding what to keep and what to toss, what to donate to hospice or maybe try to sell. It’s meant perusing real estate websites for decent condo/apartment rentals in the area where she’d like to live. It’s meant doing a fair amount of deep cleaning, and, as of last Monday when the place was listed, of keeping the house absolutely pristine all the time, just in case random realtors drop by with prospective buyers.

Remember, my mom is half Finnish. Genetically prone to neatnik-ness and trained from infancy to react with horrified dismay to dust or clutter, showing her house means that it must constantly resemble a glossy photo spread in House Beautiful magazine. Mom totally resents Nature because She keeps carelessly dropping dead leaves on the back patio and making it look “messy.”

And putting her home up for sale means that I frequently need to buck her up when she starts feeling overwhelmed or low about moving. She and my dad chose this place together back in 2003. They loved it. He died, unexpectedly, in 2005. There are memories permeating the walls here, and at 81 years old, mom’s a bit apprehensive about starting over again somewhere else.

Me, too. When she moves, I’ll have to move with her and be even further away from my own home. I wish she’d come live with me there, but she hates the climate in the mountains. The winters are too cold. Even the summers feel uncomfortably cool to her. Then there’s the fact that the Finnish neatnik-ness didn’t rub off on me so much. My house will never make the pages of House Beautiful. Mom would never be happy there.

Still, she’s become too frail and forgetful to live alone. She has enough money to live comfortably, but certainly not enough to pay the outrageous price of assisted living in a retirement community. We checked. Wow.

So, I’ll stay with her.

Then there’s my uncle. He now has a studio apartment in an assisted living facility. During the last month and a half, I was either visiting him in the rehab facility following his hospitalization or helping my aunt move his things to his new home. I’ve also been taking him to medical appointments and for lab visits—it looks like he’ll be having parathyroid surgery soon. Since all of this has been taking place down in the Sacramento area, I’ve been doing a fair amount of commuting back and forth.

I’ve also been doing some freelance writing, which has been very satisfying. I hope to continue it, too, as it’s work I can always do from home.

And my own health? My old rheuma-dragon continues gnawing on the joints in my hands, causing constant low-level pain and swelling. “Low-level” is key, though. It hasn’t kept me from functioning at all.

During the last couple of days the pain has intensified enough, though, to slow me down markedly. Along with that, the bursitis in my hips, which had finally eased off, is back again.

Although I don’t feel especially stressed, I know that it can trigger RA flares, so I’m trying to stay calm, cool and collected, eat carefully and get plenty of sleep. So far, so good. Barometric pressure can also affect the dragon. The barometer has been all over the place lately, rising and falling like a roller-coaster from one day to the next—even from one hour to the next. The upside of this particular ride is that the temperature, which is usually very hot this time of year in California, has actually been rather comfortable. A gift, and I’m grateful.

I just have to remind myself that there’s always a price.

RA top 20Oh! I was just notified that RheumaBlog, despite my neglect, has been chosen as one of Healthline’s Top 20 Rheumatoid Arthritis Blogs for 2013. I’m blown away and honored, all at the same time! I’d like to offer my congratulations to the other 19 RA blogs that were chosen, too. Visit them all—they’re worth your time and attention. I’m proud of us all!