Taking the fight to arthritis

Five years ago I was diagnosed with rheumatoid arthritis (RA). The jury is still out as to whether I really have it since after various tests, here and abroad, I have never tested positive. I was diagnosed based on symptoms. Although I like to tell myself that I do not have RA (optimistic bias on my part), I have taken some steps to treat it - lifestyle strategies and prescription medication.

Rheumatoid arthritis is different from the most common form of arthritis, osteoarthritis, the wear-and-tear arthritis which usually troubles older people in their hips, knees and ankles. Rheumatoid arthritis is an auto-immune disease. Simply put, 'auto-immune' implies that our immune system, designed to protect us against germs, cannot tell the difference between these foreign invaders and our own body cells.

System attacks itself

Our system goes haywire and attacks our own cells; the body turns against itself. In the case of RA, the joints are attacked. This 'mistaken identity' can cause severe damage. Untreated, the joint deteriorates, becoming weak, crooked and out of line. The damage is not always confined to joints - RA may wreak havoc on the eyes, heart and lungs.

One in every 100 persons has RA. It affects more women than men and symptoms normally appear between age 20 and 50, although children can have it. The specific cause remains unknown but it can run in families.

Signs of war

RA makes its presence known in different ways:

Dull ache, soreness or stiffness in two matching joints (both sides of the body) especially upon awaking or after a period of inactivity; pain lasting more than an hour.

Fatigue, fever, general malaise and anaemia.

Joint damage seen on X-ray

Blood testing positive for rheumatoid factor, a protein substance.

An RA specialist (rheumatologist) is the best person to make the diagnosis, since there are other disease conditions with symptoms that resemble RA.

Fighting all the way

Although there is no cure for RA, treating it helps us to lead an active and productive life without disability.

Lifestyle strategies - resting the body and joints is just as important as exercising and getting physical therapy. A diet low in animal fats (meat and dairy products) and rich in omega-3 fish oil (fish such as tuna, mackerel and salmon) and linseed (flaxseed), green soya beans, plant foods such as vegetables and fruits, wholegrain bread and nuts works against inflammation. Nutritional backup includes fish oil capsules, selenium (200 micro-grams daily), vitamins C (600mg daily) and E (400 IU daily).

Medications are the first line of defence against RA but they all carry potential side effects such as stomach upset, reduced resistance to infection and blood-cell disorders. Medications include anti-inflammatory painkillers (such as aspirin, piroxicam and ibuprofen); steroids such as prednisone have been shown to reduce bone damage in early RA and disease-modifying anti-rheumatic drugs like gold, methotrexate, hydroxy-chloroquine and leflunomide influence the immune system to reduce inflammation and joint damage. Biologic response modifiers are the new kids on the block; they include adalimumab, etanercept and infliximab.

Many of these are grossly expensive, but help is here - the National Health Fund subsidises the cost of RA treatment.

Dahlia McDaniel is a pharmacist and final-year doctoral candidate in public health at the University of London; email: yourhealth@gleanerjm.com.

Taking the fight to arthritis