What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation in the joints and surrounding tissue. It occurs when the body’s immune system mistakenly attacks healthy cells and tissues, leading to swelling, pain, and damage in the affected joints. RA can affect any joint in the body, but it most commonly affects the small joints in the hands and feet. The symptoms of RA can vary in severity and can include:

• Pain and stiffness in the joints, especially in the morning or after a period of inactivity
• Swelling and tenderness in the joints
• Loss of range of motion in the affected joints
• Fatigue
• Fever
• Weight loss

RA is a progressive disease, meaning it tends to get worse over time. It can also cause complications in other parts of the body, such as the lungs, heart, and blood vessels. There is no cure for RA, but it can be managed with medication, physical therapy, and lifestyle changes.

What are the common drug types used to treat RA?

There are several types of drugs that can be used to treat rheumatoid arthritis (RA), and the most appropriate treatment plan will depend on the severity of the disease, the individual’s symptoms, and other factors. Commonly used medications for RA include:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications can help reduce pain and swelling in the joints. Examples include ibuprofen and naproxen.
2. Disease-modifying antirheumatic drugs (DMARDs): These medications can slow the progression of RA and prevent joint damage. Examples include methotrexate, hydroxychloroquine, and sulfasalazine.
3. Biologics: These are newer medications that are designed to target specific immune system proteins that contribute to inflammation. Examples include tumor necrosis factor (TNF) inhibitors such as adalimumab, etanercept, and infliximab, and interleukin-6 (IL-6) inhibitors such as tocilizumab.
4. Corticosteroids: These medications can be taken orally or injected into the joints to reduce inflammation and pain. Examples include prednisone and methylprednisolone.
5. Analgesics: These medications can help relieve pain. Examples include acetaminophen and opioid pain medications such as codeine or morphine.

It is important to note that these types medications may have side effects and may not be suitable for everyone. It is important to discuss the benefits and risks of each medication with a healthcare provider before starting treatment.

What is a Rheumatoid Arthritis flare up?

A flare-up, like it sounds, or flare, is a period of increased symptoms and worsening of disease activity in rheumatoid arthritis (RA). During a flare-up, a person with RA may experience more pain, swelling, and stiffness in their joints, as well as increased fatigue and possibly a fever. Flare-ups can be unpredictable and may last for a few days or several weeks. They can be triggered by various factors, such as stress, illness, injury, or changes in the weather.

It is important for people with RA to have a plan in place for managing flare-ups, which may include taking medications as prescribed, getting enough rest, and using heat or cold therapy to help reduce pain and swelling. It is also important to stay in close communication with a healthcare provider during a flare-up and to seek medical attention if the symptoms are severe or do not improve.

So, I have had both knees replaced. The first knee went well, I was moving around a little ahead of schedule. I did everything I could to get the knee back into shape. You really have to work when it comes to knees.

The second knee, my left had actually been my strong knee. It carried me as the right knee was in worse shape, more painful and so was the first to be replaced. Now everything has flip flopped. I lost most use of the left knee around October 2020, I had a replacement scheduled for February, first available, I really wanted this done.

Well early 2020 Covid hit, craziness at all hospitals and my surgery was postponed until the end of May. When I went in to get it replaced it started out bad. I was given an epidural which didn’t work or whatever. Within 24 hours I was screaming in pain and had a whole nightmare begin.

The situation with opioids has created a climate where hospitals are now reluctant to give pain relief beyond Tylenol. As it turned out, I had blood clots in my legs and one in my lung. I am lucky to be alive. I was in the hospital for about a month. I went home in very bad shape and the wound would not close, I was losing blood daily and wound up back in for a new surgery to *button things up*.

The buttoning didn’t go well, and I wound up in wound treatment getting hyperbaric oxygen treatments, which worked, after a few months. It is a pretty big commitment, 2 hours a day, 5 days a week for a couple months. It worked though, and that is what counts. Also, the treatment is painless and easy, just a lot of time.

After that, I had swelling which I still have. My left leg is now very weak and very swollen, 40% bigger than the other knee. I was told a few weeks ago, I need a new right shoulder and I don’t know what to do. I never want to do surgery again frankly…nobody discusses the chance that there is a problem, a bad outcome. I can’t imagine having a serious issue with my dominant arm…what’s a boy to do?

The net net is, pay attention to the details. Ask what can go wrong and you need to mentally prepare for that. Your doctors won’t focus on this and very well may just not address it. It only happens to a small number of cases. BUT, once it is YOUR case, it changes big time. AND if you have Rheumatoid Arthritis, you are at greater risk. I am not saying avoid surgery, I am saying, people have bad outcomes.

Interestingly, the same doctors that don’t talk about bad outcomes will have a lot of stories about their cases once you have had a bad outcome…and you will be surprised at the AMMOUNT of these stories your doctor will have for you. Bad outcomes with Rheumatoid Arthritis happen more often than you would think, and you need to be ready for it. I wasn’t, and it has taken a lot to get my head around it.

So, make sure you are ready for surgery, when it starts getting discussed. Go get a second opinion, I did, that didn’t matter, but you should get one anyway. This is really serious stuff, you are dealing with your life and mobility.

Regardless of what you heard, rheumatoid arthritis is an Insidious awful disease. it affects one and a hundred people and by a margin of 3 to 1 it affects women more than men. When caught early a lot of irreparable damage can be avoided and it is critical that you get this checked quickly by competent medical professionals. it is Progressive and chronic, stays with you forever and gets worse. 

Wow, when I think back, I was sure I had a minor knee injury from a fall on ice  a  week or two before my first appointment at an orthopedic clinic. I then had  X-Rays done at the knee and the knee looked fine and I kept complaining so they did an MRI oh, and then the MRI looks fine. but the strangest thing happened a few weeks later, the other knee started hurting.  So I went back to the orthopedic doctor and Clinic and they did another X-ray and that came up negative and then they did another MRI and that came up negative.  I had a follow-up appointment after the second MRI and that was when I was introduced to a different doctor in the orthopedic clinic. and the first thing he did was look at my hands. He talked to me for a few minutes and  he said he would like to do some blood tests.  I would later find out that it was dr. Calvin Brown the head of rheumatology  at Rush Presbyterian in Chicago.So that’s how I found out.

 Rheumatoid arthritis is a very sneaky disease. It is commonly misdiagnosed and if you don’t catch it early the damage That is done cannot be repaired. Beyond that, this is a progressive disease that is chronic and stays with you for the rest of your life. You have to keep it in check ! it is very serious, Everyday you lose by not taking care of it becomes more serious as the disease progresses. The good news for you is that there are a lot of other diseases that have similar symptoms that are not chronic. The Fact or here means you need to get checked, you need to get tested and you need to get it sorted out.

Primary care physicians I’m not always on the lookout for rheumatoid arthritis. What you’ll see  below  is the difference between the criteria used in 1987 as opposed to the criteria that was approved in 2010.  I was in the right place at the right time and was diagnosed early on. But many people are not Diagnosed early. I have found there are plenty of videos for doctors, from doctors, about rheumatoid arthritis that state rheumatoid arthritis is misdiagnosed quite a bit. More importantly people don’t even think about rheumatoid arthritis when they start seeing symptoms. 

1987 criteria

1. Morning Stiffness lasting at least one hour.  Incidentally, many Rheumatoid arthritis patients experience morning stiffness 4 several hours. I know for me it’s 2 to 3 hours when the disease is active
2. Soft tissue swelling or fluid in at least three joint areas simultaneously. it’s interesting, when I was diagnosed I had no swelling except in the knees that I was aware of, furthermore, it would only affect one knee at a time and only for a little while Less than a week
3. At least one area is swollen at the inner wrist mCP or pip joint , Which is all in the hand. Once again I was very lucky to be diagnosed so early on in the late 90s 
4. Symmetric arthritis, meaning the same thing on both sides. Again focusing on the hands
5. Rheumatoid nodules,  I still don’t have these
6. Abnormal amount of serum rheumatoid Factor. This is discovered with a particular blood test but if you don’t get the blood test well … 
7. erosion sarbani decalcification on X-rays of the hand and wrist. Again really focused on the hand and wrist. add a recent doctor visit with an  internist who assumed that I had very mild r a because I didn’t have the proverbial jacked-up wrists. 

Anyway, you need four out of seven of these to  be diagnosed with rheumatoid arthritis back in the day. I didn’t have morning stiffness. I had soft tissue swelling in one joint but then it would move to another joint and then back to the other joint and it would do so over the course of weeks. I had no swelling in my wrists or pain anywhere and I didn’t have symmetric arthritis. I had one knee bothering me at a time. rheumatoid nodules I didn’t have but RA factor I did have.  And again I did not have anything going on in my hands so it would be unlikely that they would have done an x-ray of the hands and seen  erosions. For what it’s worth I’ve had rheumatoid arthritis for over 20 years and I still don’t have noticeable erosions in my hands and I just had it checked a few months ago.  Some important points here,  x-rays only catch these are oceans after 40% of the damage is already done.  I’ve been dealing with pain in my hands since my flare up over the past 3 years. The joint space is still intact for now but I have visible swelling in my hands and it’s very painful at times. Other times it’s not as painful and I’m convinced that my hands were saved because of the treatments I had early on.

 It is very important 2 call out here that Rheumatoid nodules don’t show up until the disease has progressed quite a bit and an x-ray cant catch the intrusion caused by rheumatoid arthritis until 40% of the damage is already done. There’s nothing you can do at this point to fix it. You can only slow it down and you really want to make sure you’re doing everything you can to slow it down and address Rheumatoid arthritis early on.

So again this is 1987 criteria but widely taught and updated in 2010 but according to this I didn’t have our a at the time. Fortunately I had Dr. Calvin Brown Involved in my case early on. My RA was caught very early and I’m sure that I enjoyed my 30s and 40s a lot more than if my disease had not been caught so early.

2010 Criteria 

The new criteria For diagnosing rheumatoid arthritis is  now done on a point system. 6 points means you have Rheumatoid arthritis.  Below is a slide from A presentation I found published by the Icahn School of Medicine. The net net here is they look at blood and joints And the duration of symptoms 

So Using the new system I had two large joints which gave me one point, serology I had hi CCP three points and duration of synovitis was longer than six weeks so I got a point there and I had abnormal CRP making 6 points which unfortunately for me was a winner.   So I really wish I didn’t have rheumatoid arthritis but I am now very grateful that doctor Brown figured it out so quickly.

But, I already know I have  rheumatoid arthritis oh, the question is do you? 

Well after a month of futzing with Openshot video editor I have a few videos up on the Youtube channel. This is an intro video I did to give you an idea of what my vision for the channel is. I started with sleep/meditation videos and I have one silent meditation up. Today I made a video with classical music and images of hummingbirds. Ahh, it is starting to come together.

It’s easy to think about this stuff, and a little harder to dabble, but when you get to publishing videos and a supporting website, the work adds up quickly. The journey of a thousand miles starts with a single step. Well here is the step 🙂