That doesn’t mean that you have to be sidelined from staying active—far from it. For many RA warriors diagnosed today, when the disease is caught in early stages, exercise is an essential ingredient in your care plan to keep symptoms from progressing.

Elizabeth Schulman, M.D, rheumatologist at HSS and Zachary Rogers, PT, DPT, OCS, CSCS, physical therapist at HSS, share strategies to addresses RA joint issues in an interview with Health Central.

Read the full article at healthcentral.com. 

Throbbing from Axial spondyloarthritis tends to center on your lower back, and it might be worse during the night or when you first wake up because you’ve been lying still in bed for so long, said Dr. Schulman. Important to note: Some primary care docs can mistakenly believe people with nonradiographic axSpA have mechanical back pain. That’s because there’s often no visible damage to your spine with the condition when viewed on an X-ray, Dr. Schulman says, and you have to spot it through an MRI. A lot of the time it takes a rheumatologist trained in treating axSpA to recognize (and accurately test for) it, Dr. Schulman explained.

If you have psoriasis, there’s a roughly 30% chance you’ll also develop psoriatic arthritis (PsA)—and then have a 20% chance of having spinal issues that stem from it, Dr. Schulman said. Because PsA is an inflammatory condition, your immune system kicks into high gear, and your body might mistakenly attack healthy cells and tissues all over your body—and that includes your back. 

Read the full article at self.com. 

Psoriatic arthritis, (PsA) can affect your digits, causing joint aches, swelling, and permanent damage. It often affects distal interphalangeal joints (otherwise known as your toes) and can be really uncomfortable, making walking and mobility in general a challenge.

“Working with your provider to get your disease under control is the first step in managing PsA toe involvement,” explained Dr. Schulman. If you are waiting for a new treatment to work, non-steroidal anti-inflammatory drugs (NSAIDs) may help to reduce symptoms, she added.

“Switching to supportive footwear can help with the mechanical stress on the feet,” said Dr. Schulman. Give your toes a little extra breathing room by wearing, at least temporarily, a shoe with a wider toe box (possibly a man’s sneaker sized for a woman, for example). This may reduce further aggravation to the toes, which can compound their already inflamed state.

Read the full article at healthcentral.com. 

Dr. Schulman explained that its best to inform a physician of worsening symptoms so they can determine if it is related to PsA. “We would rather know now than have you wait,” she noted.

She continued, “We really care about patients’ activity of daily living and their participation in their work, personal life, and the things they like to do.”

Fatigue is a common and challenging part of living with PsA. According to Dr. Schulman, “When your body is inflamed, it’s chronically fighting itself. The cytokines [immune system proteins] that are stimulated [during chronic inflammation] can cause a patient to feel malaise and fatigue.”

If pain and stiffness is interfering with sleep, or causing early morning wakening, that can also contribute to fatigue, she added.

Dr. Schulman said PsA is different for everyone, but an uptick in the frequency or severity of flares could indicate that a medication isn’t working well anymore. “There are no consistent guidelines to how many flares are acceptable — some would say that no flares are acceptable,” she noted.

More skin flares might be an indication for a change in therapy. “Some medications work better for the skin and don’t work as well for the joints, so it must be a collaborative effort with the dermatologist, rheumatologist, and patient,” said Dr. Schulman.

Dr. Schulman also explained other symptoms that might be signs of disease progression, including back pain, inflammation where a tendon or ligament attaches to bone, swollen and puffy fingers, changes in nails or eye inflammation.

Read the full article at Creakyjoints.org.

Firstly, it’s important to take the medication as directed. “That means taking it on time, taking the right dose, and using the right route of administration,” explained Dr. Schulman.

To help overcome a fear of injections, Dr. Schulman advised, “Fear of injections is not something to minimize. I explain to my patients the benefit is that they are really easy to use, and oftentimes patients don’t even need to see the needle.”

She added, “For the vast majority of patients, once they get over the initial fear, the benefit is so great that they may prefer injectables compared to taking pills.”

Stay on top of a treatment regimen by working closely with a provider to fully understand how to administer the injectable. “The first time, if not the first couple of times, I have them come into the office or set up a nurse visit to really go through, step by step, how to use the medication—both for safety and for comfort,” noted Dr. Schulman.

Education is also key to understanding the medication, such as when a medication is expected to start working. “I make sure to also provide online or home resources for patient education,” said Dr. Schulman.

Read the full article at Psoriasis.kopa.com.

Dr. Schulman said, “When you’re prescribed a medication, it’s in your best interest to take it exactly as it’s been prescribed. That’s the best way for us to gauge how well the medication is working.”

Unclear directions and forgetfulness can make it difficult to stick with an oral treatment plan. Dr. Schulman explained it can be hard to keep instructions straight, especially when taking multiple medications that may be separated by time or taken on am empty stomach or with food.

“People’s lives are busy—they may not remember to take medications. Especially if you have an afternoon or evening dose—those are often more easily missed,” she added.

Schulman recommended being forthright with a healthcare provider to address any concerns and clear up confusion. “Medications can be complicated, and oftentimes there’s not much time during your visit. So, ask any questions or clarifications, and make sure you’re on the same page with your doctor,” she noted.

Schulman also suggested using a pill box organizer or setting up phone reminders. “Patients who are tech savvy—especially busy parents or people who are working and have many things going on in their lives—have found success using alerts on their phone or different apps with medication reminders,” she added.

“The most important thing is making sure the medication fits into your lifestyle, and it’s not an extra burden. The more accessible it is, the more adherent you’ll be,” said Schulman.

Read the full article at Psoriasis.kopa.com.

Dr. Schulman explained that a cold or sore throat could cause a disease flare. “Infections, including both viruses and bacteria, can trigger activation of your immune system.” In addition to prompt treatment, any symptoms from the infection should be shared with a doctor to determine if medications need to be adjusted.

Having an additional chronic condition can also be a trigger for RA. Dr. Schulman noted some chronic conditions have symptoms that can overlap symptoms of RA. “For instance, osteoarthritis and fibromyalgia are two different illnesses that can cause pain, and it’s important for your rheumatologist to help tease out those differences.” 

If symptoms continue or get worse, Dr. Schulman advised, “Rheumatologists rely on your symptoms to help guide treatment decisions and determine if your medications are working for you.”

Read the full article at CreakyJoints.org.

“Fortunately, we have many treatment options for rheumatoid arthritis,” said Dr. Schulman. “Unfortunately, we do not know which patient will respond to which medication, so it is often a thoughtful but ‘trial-and-error’ approach. Choosing the right medication needs to account for a patient’s symptoms, underlying health, comorbid conditions, and possible side effects. “Patients can have RA throughout their lifetime, so over a 50-year span of illness, there can be many therapy changes,” added Dr. Goodman.

If patients have a flare-up of RA that was previously controlled, it’s important to promptly seek the advice of your rheumatologist to decide which treatment plan is right for you, advised Dr. Schulman. “When a patient has had sustained disease activity over weeks or more, that indicates that the current regimen is failing and a different medication should be considered,” noted Dr. Goodman.” The medication your doctor recommends — whether it’s a new therapy or a higher dose or in addition to something you’re already taking — is very individualized. “Every single patient is different,” said Dr. Schulman. The treatment options to consider will depend on the progression of the disease, severity of flare, comorbidities, and a patient’s personal preferences. However, there is one common factor: “Treatment choices are always a balance between risks and benefits,” noted Dr. Goodman.

If you’re anxious about trying a new medication or are afraid you can’t afford it, don’t hesitate to let your rheumatologist know. “We want to understand all of your concerns surrounding your medication so we can help guide you and make recommendations,” said Dr. Schulman. “The goal is to get patients back to doing what they love to do and to restore their quality of life and function.”

Read the full article at CreakyJoints.org.

“Inflammation is the root cause of RA pain,” said Dr. Schulman. “The joint lining can get inflamed, thickened, and irritated, which causes pain, swelling, and stiffness in the joints.” If RA patients have low levels of inflammation and few swollen joints but are still experiencing pain, this could indicate the presence of co-occurring conditions that can be common among RA patients, such as fibromyalgia or osteoarthritis. Mental health conditions like depression and anxiety may also play a role, she added. 

Dr. Schulman explained RA pain is a symptom of an RA flare. “RA pain would be part of the evaluation that a rheumatologist would do to determine if a patient is having a flare.” It’s not uncommon for an RA patient who is on medication and in low disease activity or remission to have one or two RA flares per year. However, if you find yourself getting flares that don’t resolve or come back often, this may mean that your medications are no longer working as well as they should, noted Dr. Schulman. This may mean it is time to discuss a medication change with your doctor.

A goal of RA treatment is for you to achieve a state of complete remission from RA, which means no stiffness, swelling, or systemic inflammation — and little to no pain, said Dr. Schulman. “Yet even if remission isn’t possible for you, you can still work with your doctor to achieve low disease activity and fewer bouts of pain.”

Read the full article at Creakyjoints.org.

Treatment side effects vary depending on the type of medication being taken, and Dr. Schulman explained if you’ve experienced infections in the past, this will be a consideration when determining which treatment is best for you. “Overall, the medications that treat rheumatoid arthritis are aimed to bring down the inflammation that's overactive in the body,” she said. “So with that comes, oftentimes, an increased risk for infections.”

Following an RA diagnosis patients can anticipate their physician will want to see them every few months for blood work and to talk about their symptoms. The frequent check-ins allow physicians to reevaluate their patient’s condition (e.g., making sure medication is working and that side effects are manageable), as well as for patients to be included in their treatment decisions. “An overarching principle in the treatment of rheumatoid arthritis is that this is really a shared decision making between the patient and the physician,” cited Dr. Schulman. It’s important to make sure that the treatment feels comfortable to you and that you understand the physician is going to do their best to minimize all possible side effects, she added.

In addition to starting medication, a number of lifestyle modifications are important in managing RA (e.g., stress management, prioritizing mental health, getting enough sleep at night, etc.). Newly diagnosed RA patients are often unsure if they should be partaking in exercise, however Dr. Schulman advised to consider it. Depending on how advanced your disease is, you may need to work with a physical therapist or trainer to find a program that works for you, “but we highly recommend a routine exercise program, both for cardiovascular health and joint health, and for mental health,” she noted.

Read the full article at Self.com.

For patients who have been in remission for a while, but are experiencing joint pain, swelling, and stiffness that is impacting their quality of life, there is a good chance they are experiencing a relapse. “Usually that prompts a visit to the rheumatologist to try to figure out whether or not this is just a flare of your disease or whether it's actually a relapse,” explained Dr. Schulman. “You should also be on the lookout for more subtle signs of a relapse, like fatigue and malaise. These are both signs of inflammation that don’t present right in the joints,” she added.

Dr. Schulman noted most RA patients will relapse if they are off all medications. “We still don't know who is going to be able to be in a drug-free remission and who won't get a relapse,” she said. Additionally, sometimes a medication may stop being effective and lead patients to relapse. “So the medications that have been working and controlling your disease for months, or even years, can start to be less effective because your body has almost built up a resistance to it,” cited Dr. Schulman.

Read the full article at Self.com.