RA and weight loss: giving it a kick-start

Six-thirty a.m. I sit up, struggle from under the covers and roll out of bed. I hobble, my joints stiff and achy, to the bathroom. During morning ablutions, I gaze at my knuckles. They’re only a little swollen this morning, I note. I flex my hands. Only a little stiff and a little sore, too. This is nice.

As I get dressed, I look at my body in the full-length mirror (that evil thing!). I make a face at my wide hips. I know I haven’t gained any weight! In fact, since the middle of August, I’ve lost eight whole pounds. Maybe, I grumble, my hips look extra-wide this morning because they’re swollen. My here-again, gone-again hip bursitis is definitely here again this morning. Still, those teensy bursae over my hip-joints probably aren’t swollen enough to make my already-wide hips look even wider. I can thank my Scandinavian ancestors and 30 years worth of chronic cookie-binges for that.

THE ABOVE BEHAVIOR does not strengthen joint-supporting muscles or rev up weight loss.

THE ABOVE BEHAVIOR does not strengthen joint-supporting muscles or rev up weight loss.

Mondays are my weigh-in days, so with my breath held I step onto the bathroom scale. To my disappointment it shows the same weight as Monday a week ago. I sigh again. OK, Saturday night I splurged and had fish and chips instead of salad for dinner when Mom and I went out. But I only ate half the meal—and I’d been mindful and disciplined all week up to that point. The fish and chips undoubtedly put me over my daily calorie-quota, but I’d gone right back to it Sunday.

Waiting for my breakfast egg to boil, I think about exercise. Because exercise

BROWN BASMATI RICE and a quick stir fry of tomatoes, zucchini, yellow crookneck squash, onion, garlic and chunks of chicken breast is a healthy, low calorie meal. Fruit is good for you, too.

BROWN BASMATI RICE and a quick stir fry of tomatoes, zucchini, yellow crookneck squash, onion and garlic make a healthy, low calorie meal. Season to taste. And fruit is good for you, too.

can jar the body into burning off fat and help sink the number on the scale. I know this.

But of all the things I’ve done to improve my health over the years—including tossing out the smokes—exercise has always been the hardest. Like others who battle rheumatoid arthritis, it seems like a lot of the time I’m just plain too sore and achy to exercise. And when I’m not, I’m afraid to rock the boat. If I exercise, I convince myself, I’ll just bring on a new flare. It’s a catch-22.

But I know better. I only trigger new flares when my enthusiasm overflows my good sense. If I stick to gentle exercise, like stretching, using resistance bands and walking—not too far, at first—I’m fine. When I do that each day, exercise jump-starts my weight loss. I know, because I’ve done it.

There are lots of RA-friendly types of exercise that not only increase muscle strength (which helps to support the joints), but also promote heart health, safe weight loss, balance and even mental health. Click this slide-show at Healthline.com: http://www.healthline.com/health-slideshow/8-essential-everyday-exercises-for-RA-pain for a great overview.

Surprise! You have RA!

This post is especially for people who’ve just been diagnosed with RA:

You’ve just discovered you have rheumatoid arthritis. Your doctor talked to you about it, but now you’re at home, and you can’t really remember much of what a_daa-small-Surprised-Catshe said. You were so shocked! “Arthritis!” you mutter to yourself, staring at the sore, swollen knuckles that prompted your initial visit to the doctor in the first place. Now, the results of the blood test in hand along with your list of symptoms, she’s given you the news and referred you to a rheumatologist.

Naturally, you’re feeling a bit bewildered. Angry, too, now that the shock is wearing off. “That can’t be right. I’m too young! And I’m healthy! I go to the gym almost every day!”

Don’t feel alone. The fact is, most people who’re given a diagnosis of rheumatoid arthritis are baffled—at least initially. There’s a good reason: We tend to think of arthritis as a disease that older people get—maybe even very old people. But anyone of any age can get RA, from infants to octegenarians, though three times more women than men get it. The “arthritis” we hear the most about is actually osteoarthritis, the common “wear andu tear” arthritis that sometimes strikes middle-to-older-aged people.

But you’re only 26! The doctor has to be wrong!

She’s not. Rheumatoid arthritis is an autoimmune disease. With RA, your own immune system—your body’s natural defense against foreign invaders like bacteria and viruses—attacks it’s own tissues by mistake. RA generally goes after the lining and fluid between the joints. It causes inflammation, which in turn causes heat, swelling and pain. That sore shoulder you had last week? The one that made washing your hair, blowing it dry and getting dressed before work in the morning a study in courage and determination?

Yep. Rheumatoid arthritis.

RA also attacks the soft tissues of the body. It can go after the heart, the lungs, the eyes, even the veins. It affect joints on both sides of the body in a symmetrical manner. And leaving it untreated just invites it to do its worst: cause awful joint deformity and permanent disability—not to mention pain.

As things stand today, rheumatoid arthritis is still incurable. That doesn’t mean it’s untreatable, because you can treat this disease. The medications available today can greatly decrease the pain and disability of the disease while slowing it’s progress down to a snail’s pace. They can even—and sometimes do—put the disease into remission.

So, newbie: Here’s your assignment. Learn as much as you can about rheumatoid arthritis. The more you know, the better off you’ll be. Click to watch this short, thorough video about what rheumatoid arthritis is, how it affects those who are diagnosed with it and how it’s treated: www.healthline.com/health/rheumatoid-arthritis .


Autumn equinox

From the Japanese maple just outside my kitchen window at home in the mountains...

From the Japanese maple just outside my kitchen window at home in the mountains…

I can hardly express how pleased I am that, as of today, fall has officially begun in the Western Hemisphere. With a couple of exceptions (several days here and there of over 100 degrees Fahrenheit, and in July a full week of them) it’s been a rather mild summer for northern California, so I can’t really complain. Still, well, fall.

And it’s off to a lovely start. Yesterday dawned with gray skies and a soaking overnight rain; by mid-day, that gentle rain had whipped up into an actual storm,

Sweet-gum leaves in early fall, just after a storm.

Sweet-gum leaves in early fall, just after a storm.

complete with lightning and explosions of thunder. It blew in and blew out just as quickly, and this morning greeted us with sunshine. A month ago it would have been hot sunshine, but now, with autumn underway, the sunlight is coming from a different angle, a cooler one that casts more shadows. The temperature barely topped 80 today, and the forecast for the coming week will stay about the same. I’m delighted.

Autumn has been my favorite season since I was a small child. I’ve always loved

Fall and winter blend by late November in the Sierras...

Fall and winter blend by late November in the Sierras…

that crisp, cool feel to the mornings and the brisk breeze that livens up the afternoons in the fall. And that first frost! Mmmm. I love pumpkins and Halloween–that my birthday is in the middle of the season hasn’t hurt a bit–and taking a long walk, scuffling through the crunchy fallen leaves after Thanksgiving dinner is almost better than the dinner itself.

Here in California, the trees haven’t started putting on their fall colors, yet. That won’t happen until late October and November. By then it will be even cooler outdoors–maybe as low as the 60s during the day. I know that doesn’t sound like much to those of you who live in colder climes, but for me it will be nice to finally put away the summer clothes and bring out long pants, socks and maybe even sweaters!

Happy Autumn, everyone!

One of the dragon-slayers

There are some weapons in the battle against RA that I consider “dragon-

Illustration by Howard David Johnson

Illustration by Howard David Johnson

slayers.” Unfortunately, I was unable to tolerate the one I’ll be telling you about, but from everything I’ve learned over the years, it’s one of the best.

It’s a Disease Modifying Anti-Rheumatic Drug (DMARD) that’s considered the “gold standard” in rheumatoid arthritis treatment. At some point, most rheumatologists prescribe it to their patients who have moderate to severe RA. In many of them, this drug causes their disease symptoms to greatly improve—or even disappear entirely. RA is incurable, but this rheuma-dragon slayer can send it yelping off with its tail between its legs.

What is this miracle drug?

It’s methotrexate—MTX for short—a powerful chemotherapy drug developed in 1950 to treat a variety of different cancers, including acute lymphoblastic leukemia in children. It works by keeping the body’s cells from metabolizing folic acid, a substance that is integral to cell growth and reproduction. Without adequate folic acid, cells die—in particular, fast-multiplying cancer cells. With methotrexate, many people who suffer from cancer may have a much better chance of surviving.

Methotrexate was quickly discovered to have a beneficial effect against several autoimmune diseases, including psoriasis, psoriatic arthritis, lupus, Crohn’s disease and many form of vasculitis. It was first used to treat rheumatoid arthritis in 1951. Generally safe, well-tolerated and effective in lower doses, methotrexate was approved by the FDA for use in treating RA in 1988.

As it does in treating cancers, MTX inhibits cells from metabolizing some of the folic acid found in the foods we eat, so most rheumatologists have their RA patients take a folic acid supplement along with their methotrexate. Doing so helps to relieve some of this powerful drug’s more common side effects (which occur in a small percentage of patients) such as nausea, headaches, fatigue and hair loss.

While it doesn’t work for everyone, methotrexate has been effective enough that it’s become the first line of treatment for rheumatoid arthritis. When it does work, it reduces the number of swollen, painful and tender joints patients report and, often, slows or even stops the progress of the disease altogether.

Methotrexate can be hard on the liver, so patients taking it must undergo frequent blood tests, monitored by their rheumatologists. In addition, because of the potential danger of liver damage, those who take it are asked to avoid alcoholic beverages. Women who wish to have a baby must stop taking the drug before becoming pregnant; men who are taking the drug should continue using birth control for three months after they stop taking MTX. Otherwise, the drug may cause harm or death to the fetus.

Sometimes, methotrexate alone isn’t enough to affect RA, so it’s given along with one or two other DMARDs. Usually, it’s taken in tablet form: several tablets just once a week. For those who cannot tolerate the oral form because of nausea, methotrexate can also be given by self-injection.

For more information about this “dragon slaying” drug, visit www.healthline.com/health-slideshow/rheumatoid-arthritis-methotrexate .


Describing RA pain


RA bloggers often describe their joint pain as “burning,” as if the affected joint is on fire.

I’ve had RA for a little over half my lifetime, but my joint pain has never felt that way. Aching, throbbing, and/or stabbing, yes. Burning, no. It has been hard for me to imagine. Just like my pain is hard for someone—a friend, a family member, a concerned stranger—to imagine. She’s sympathetic, but has never felt it herself.

As I write this, however, my left palm, knuckles and fingers feel as if a fire ishand-joint-pain smoldering inside them. While this pain, on the ubiquitous zero-to-10 pain scale, is just a “five” and only halfway to “the worst pain I can imagine,” it’s very unpleasant. I have no experience of this sort of pain beyond times when I’ve actually burnt myself on a hot iron or while cooking.

My personal “worst,” my “10” on the scale, is the pain in my left hip that hospitalized me for three days way back in 1989, just two years after I was diagnosed. This pain came on suddenly, like most of my flares. Within an hour I could barely walk. I couldn’t sit or lie down, and even standing was indescribably painful. Narcotic painkiller tablets were, for the first time ever, ineffective. I waited 24 hours for the flare to go away. When it didn’t, I crashed my doctor’s office without an appointment and begged the nurse to ask him to see me. I promised I wouldn’t take up much of his time.

Kind and concerned, he saw me a half-hour later. It turned out that he couldn’t prescribe me any stronger painkillers that I could safely take at home. So, alarmed at the intensity of the pain I was in, he admitted me to hospital and ordered intravenous morphine.

I remember very little about those three days other than several separate, floating moments of agony that dissolved into a pleasant mist as a nurse emptied a syringe into my IV tubing. I slept almost continuously. I must have eaten meals and used the bathroom and had visitors, but I don’t remember any of that. Finally, in the early evening of the third day the pain disappeared. Poof, it was gone. I went home the following morning with nothing but the sharp memory of an extended nightmare to show for my three lost days.

Today, I can fully empathize with my fellow RA bloggers who describe their joint pain as “burning.”  And I hope that the sensation doesn’t—now or ever—approach my personal “10.”

NOTE: For an excellent explanatory, animated slideshow on what rheumatoid arthritis is and how it affects the joints, click here.