Being Well 702:  Rheumatoid Arthritis

Being Well 702: Rheumatoid Arthritis

January 13, 2020 0 By Jose Scott

[Music Playing]>>Lori Casey:
According to the Arthritis Foundation, about 1.5 million people in the United States have
Rheumatoid Arthritis. And nearly three times as many women have the disease as men. Today,
on Being Well, Dr. Chip Rowe from Paris Community Hospital Family Medical Center, will be here
to talk about RA, its symptoms, treatment options and more. There’s a lot of helpful
information coming your way so stay right here.
[Music Playing]>>Female Speaker 1:
Production for Being Well is made possible in part by Sarah Bush Lincoln Health System,
supporting healthy lifestyles, eating a heart healthy diet, staying active, managing stress,
and regular checkups are ways of reducing your health risks. Proper health is important
to all at Sarah Bush Lincoln Health System; information available at Alpha-Care
specializing in adult care services that range form those recovering from recent hospitalizations
to someone attempting to remain independent while coping with a disability, chronic illness,
or age related infirmity. Alpha-Care, compassionate, professional, home care. Additional funding
by Jazzercise of Charleston.>>Lori Casey:
Orthopedic surgeon, Dr. Chip Rowe has brought joints for us today for our discussion about
rheumatoid arthritis. Thanks for coming over.>>Dr. Chip Rowe:
Thank you, Lori, I appreciate being here, again.
>>Lori Casey: Right, it’s been a few sessions since we’ve
had you back, but we want to talk about rheumatoid arthritis because it does affect several million
people.>>Dr. Chip Rowe:
It does.>>Lori Casey:
We hear about arthritis in general but there is a difference between RA and the more typical
osteoarthritis.>>Dr. Chip Rowe:
There is.>>Lori Casey:
Okay.>>Dr. Chip Rowe:
The arthritis, plain and simple, is just the wearing out of the joint surface. The joint
surface is covered with cartilage that has very little friction. If that cartilage starts
to break down, then you start to get friction, it doesn’t function as well, in the most common
form of arthritis, which is wear and tear or osteoarthritis, the joint just wears out
with time. Whereas, with rheumatoid arthritis, there is an actual active process that destroys
the cartilage itself.>>Lori Casey:
Okay.>>Dr. Chip Rowe:
And that’s mediated through something that we call an autoimmune process where whatever
reasons we don’t completely understand, our immune system identifies our own cartilage
or the lining of our joint; the synovial is being abnormal and actively beings to attack
it.>>Lori Casey:
Okay.>>Dr. Chip Rowe:
And the consequence, it destroys the cartilage.>>Lori Casey:
Okay, so can you grab one of your models and actually show like where– what’s happening?
>>Dr. Chip Rowe: Well, visually this happens to be a model
of the knee, this would be the right knee. If you were to look at the ends of the bones,
you were to break the joint apart; it would have a nice, white, shiny, smooth surface.
What gives it that appearance is that layer of what we call articular cartilage. With
rheumatoid arthritis, or degenerative arthritis, that cartilage undergoes change and it reaches
a point where the bone is no longer completely covered with that nice, smooth, shiny white
surface. It starts to become roughened and irregular and that is a source of pain, limitation
of motion, deterioration of function.>>Lori Casey:
Okay, so how does someone know if they have RA versus osteoarthritis?
>>Dr. Chip Rowe: Well, unfortunately, it’s not a simple yes
and no question.>>Lori Casey:
Okay.>>Dr. Chip Rowe:
Rheumatoid arthritis is what we put into the category of a syndrome, meaning that there’s
not one specific thing that enables us to say you do or you do not have rheumatoid arthritis.
There are a constellation of about 10 factors that we look at; morning stiffness, swelling
of the joint, limited range in motion. But then we couple with laboratory studies. The
common ones are something called a test for a rheumatoid factor, which is positive in
about 70-80% of people with rheumatoid arthritis. But there’s 30% of people or so where the
rheumatoid factor is negative. More recently, they’ve come up with a test called ACPA, which
is looking for a different type of antibody and that actually is a little bit more specific
for rheumatoid arthritis. But we also look at signs of inflammation, such as a sedimentation
rate and C-reactive protein. And again, in everybody who has rheumatoid arthritis, all
of those factors are not positive. So, we take those constellation of things and if
six or more of them are positive, then you’re presumed to have rheumatoid arthritis. If
three of them are positive and the rest of them are negative, we kind of scratch our
head and we look for other potential things like Lupus, Lyme disease, or there’s various
other types of syndromes that can overlap with rheumatoid arthritis.
>>Lori Casey: It sounds like it?s a little bit of a mysterious
kind of disease in some ways.>>Dr. Chip Rowe:
It is because we like to think that things are simple but with rheumatoid arthritis there’s
not 100% genetic relationship so just because you have it doesn’t necessarily mean that
a child has it.>>Lori Casey:
Okay.>>Dr. Chip Rowe:
They say that hereditary is a 50% factor in terms of whether you’re going to develop rheumatoid
arthritis. But, I mean, the statistics, they show that men particularly who are heavy smokers
have a three times increased likelihood of developing Rheumatoid Arthritis than a man
who does not smoke.>>Lori Casey:
Okay.>>Dr. Chip Rowe:
So, there are also environmental factors and there’s always been the debate whether there
is some infectious cause such as a virus that triggers it because we know that people who
have Epstein-Barr virus, there’s relationship with rheumatoid arthritis. So, you’re right,
it is mysterious in that we can’t pigeonhole and say that if you’re this age and have a
parent that has that and if you smoke and you get this infection. So it’s a little bit
of a random type thing but once it does affect you, it usually stays with you for the rest
of your life.>>Lori Casey:
Okay. It affects the joints; does it affect certain ones more than others?
>>Dr. Chip Rowe: Most commonly, it affects the small joints
of the hands and the feet. Also can affect the cervical spine. But it can affect any
joint. It can affect the knee joints and the should joints and even the hip joints.
>>Lori Casey: Okay. You had mentioned a few risk factors.
Are there other things that increase some risk for developing RA?
>>Dr. Chip Rowe: Smoking seems to be the biggest one. And we’ve
mentioned hereditary, if you have a family member who has had it, that increases your
likelihood. The other things in terms of exercise, lack of exercise, obesity, there really does
not seem to be a correlation.>>Lori Casey:
Okay. So if someone thinks, well I might have this, what course of action should they take
because you’re, you know, — there’s, you know, you’re a surgeon, there’s rheumatologists.
Do people typically start with their family practice physician and go from there?
>>Dr. Chip Rowe: Most often I’d say they do see their primary
care physician. And I end up seeing some of them because they get referred to me for pain
in their hands or swelling in their hands or arthritis because I probably am more accessible
than rheumatologists are today. And I will take a history and I will examine them and
I will often initiate the initial laboratory testing. And if that’s confirmatory or I’m
uncertain, then I will usually refer them to a rheumatologist for further evaluation
and work up.>>Lori Casey:
So is a rheumatologist– that is all they study and deal with is RA?
>>Dr. Chip Rowe: No, they deal with all forms of arthritis
but more often they’re involved with the inflammatory arthritis. But they do also overlap with orthopedic
surgeons and care for patients who have osteoarthritis.>>Lori Casey:
Okay. What is– what are the long-term effects if people don’t seek any treatment for it?
What can happen over the course of time?>>Dr. Chip Rowe:
Rheumatoid arthritis follows a variable course. Some people, it can be episodic where they’ll
have a flare-up and then things will quiet down. It may or may not flare up again. That
would probably be, less-likely be rheumatoid arthritis. But left untreated, the disease
typically marches on with progressive destruction of the joints, subsequent loss of function,
certainly deformity. People think of people with rheumatoid arthritis as–
>>Lori Casey: As having real big knuckles or kind of deformed
hands.>>Dr. Chip Rowe:
Absolutely, the big knuckles and the fingers kind of drifting off to the sides is kind
of everybody’s picture of rheumatoid arthritis. And so, there can be progressive loss of function
associated with deformity.>>Lori Casey:
Okay. You talked about flare-ups and I think anybody that deals with rheumatoid arthritis
or arthritis just talks about flare-ups. What– are there things that might bring those flare-ups
on that your patients told you about?>>Dr. Chip Rowe:
Again, it tends to be more patient-dependent but I actually have a daughter who, in her
late twenties, who does have rheumatoid arthritis and I know while she was in school, during
the time of finals and that sort of thing, it always use to flare up on her. So, there’s
always been a feeling that stress, fatigue, probably, as they say, cigarette smoking could
do it. So, they’re poorly understood factors but they are appreciated as things that if
you can moderate, you’ll probably experience less sever and less frequent flare-ups.
>>Lori Casey: Okay. So for people who have RA, they know
what their flare-ups are like, but maybe for some like me that isn’t around that or maybe
someone who has a loved one. Explain to us what a flare-up is like; the level of pain
and discomfort that a patient is going through.>>Dr. Chip Rowe:
It can be quite severe. I mean, where we can avoid narcotic medication, sometimes it does
require narcotic medication. There typically is kind of an overwhelming sense of fatigue.
Significant morning stiffness that may take an hour or more to resolve; just being able
to, you know, making a fist with your hand or to even be able to walk comfortably on
your feet. The joints will typically, those that are involved will typically become more
swollen, which can be, you know, quite visible. And they’ll often become warm and red.
>>Lori Casey: So, are there some at-home treatments that
people can try first before maybe needing more advanced, you know, narcotics that you
said?>>Dr. Chip Rowe:
Well, probably the thing most people reach for is one of the anti-inflammatory medications.
So, Aleve or Advil or if it’s been prescribed, celebrex and those types of medications. Aspirin
was, is still frequently used to treat children with rheumatoid arthritis, was really one
of the original medications used to treat rheumatoid arthritis. Tylenol can help and
can be taken in conjunction with one of the anti-inflammatory medications. But if it’s
persistent and/or seems to be getting worse than that would prompt me to recommend that
people see their primary doctor or, you know, ask to make an appointment with an orthopedic
surgeon or a rheumatologist. But usually a rheumatologist is not necessarily going to
see them about a referral.>>Lori Casey:
Okay. So, will someone, after they’ve had the disease for many years, will they get
more flare-ups as time goes on or no?>>Dr. Chip Rowe:
Not necessarily and with the newer medications today, flare-ups have actually become less
severe and less frequent. And we’re seeing much less severe destruction or damage to
the joint surface. That’s our goal, is to prevent the functional limitations and the
deformities.>>Lori Casey:
So when people– if people have persistent flare-ups, it’s the flare-up that eventually
is causing the degeneration after awhile?>>Dr. Chip Rowe:
There is a correlation with the frequency and the severity of flare-ups with damage
to the joint surface.>>Lori Casey:
Okay. I had a question here and I should’ve asked it. I was doing my research and I understand
that there’s two different types of RA?>>Dr. Chip Rowe:
Well, there’s probably many more than two types of RA, but just because of laboratory
tests and kind of traditionally, and it does help us kind of determine prognostic factors,
is one of the earliest tests for rheumatoid arthritis is something called the rheumatoid
fact and still today if you see me or see a rheumatologist or even your primary care
doctor and they’re concerned about it, that’s probably one of the first tests that they’re
going to run is a rheumatoid factor. And we alluded to that before that the about 70%
of people with rheumatoid arthritis do have a positive rheumatoid factor. There are those
that do not have a positive rheumatoid factor; we call those people seronegative. Now, we
know that the people who have a positive rheumatoid factor, particularly at higher levels, that
there is a correlation there with the severity of the disease. And also with the newer tests,
the antibodies, there is a correlation with that and the amount of that so that– and
just because you may start of as seronegative, a year or so after the diagnosis it then may
convert to positive. So it’s kind of an arbitrary designation but it does help us kind of provide
people with expectations in terms of their prognosis.
>>Lori Casey: Okay. So, when you’re doing all these diagnostic
tests, do you use X-rays, MRIs, CT scans to look at the joint? What’s the most common
practice?>>Dr. Chip Rowe:
All of them have their place but for rheumatoid arthritis, I would say the most common are
plain X-rays. There are characteristic changes, loss of bone density around the bones next
to the joints you can see actually the soft tissue swelling. In more advanced rheumatoid
arthritis you will actually see loss of the space between the two ends of the bone and
there often will be irregularities. And one of the things that helps distinguish osteoarthritis
from rheumatoid arthritis is, at least by X-ray, is with osteoarthritis, you typically
see the development of what we call, spurs or osteo-fights, which they appear on X-rays
as boney prominences. They tend to be conspicuously absent on the X-rays of patients with rheumatoid
arthritis. You’ll see loss of the space without a lot of the boney response to the arthritis
like we see with osteoarthritis.>>Lori Casey:
Okay, now I want to ask about exercise and movement, things like that. If you have RA,
you probably, you may not want to go out. You kind of want to go for a walk or jog or
ride a bike but can exercise be good and sometimes bad for RA patients?
>>Dr. Chip Rowe: It definitely is beneficial.
>>Lori Casey: Okay.
>>Dr. Chip Rowe: Because it keeps the muscle strong with provides
the support for the joint. It also serves to keep the surfaces kind of polished and
smooth. It also stimulates the body to secrete increased lubricating fluids. It can be beneficial.
I’m not aware of studies that show that it’s associated with flare-ups but we do recommend
in rheumatoid arthritis they can do lower impact activities such as swimming or riding
a bike. That’s preferential to something like running or jumping or weight-bearing activities.
>>Lori Casey: So, what about, you know, weight-bearing activities
in terms of like lifting weights and things like that. Is that good or bad?
>>Dr. Chip Rowe: I would say its good, but again light weights,
repetition, again, to try and preserve function and the range in motion and just that sense
of well-being.>>Lori Casey:
Okay, so keep up the exercise.>>Dr. Chip Rowe:
Absolutely.>>Lori Casey:
But talk to your doctor first about what might be best.
>>Dr. Chip Rowe: Well, and keep your weight down. The means
to do that is consistent exercise.>>Lori Casey:
Well, that’s true. Are there any kinds of dietary things or food things that are good
for RA patients or nutritional supplements, vitamins that sort of stuff?
>>Dr. Chip Rowe: There are a whole host of things that are
promoted out there but none of them that have been truly proven to have a significant impact.
>>Lori Casey: Okay. But for general health, eating a good
healthy diet is always a good idea.>>Dr. Chip Rowe:
Yes, absolutely.>>Lori Casey:
So, I know, I mean we saw on TV, there’s ads all the time for new medications, are the
medications for RA getting better and better at helping people?
>>Dr. Chip Rowe: Oh, there’s been huge changes within the last
probably 8-10 years that have significantly improved the quality of life for people with
rheumatoid arthritis.>>Lori Casey:
Is it typically an injection sort of medication? I have a friend that has– that’s what she
takes.>>Dr. Chip Rowe:
Yes, there are a couple of medications, Enbrel is one of them, which are used for other autoimmune
diseases as well; psoriatic arthritis crosses over with rheumatoid arthritis a little bit.
Humira is another one. Those are both, at this point in time, by injection. I am not
aware of any medications that are in that class that can be taken by mouth at this point
in time.>>Lori Casey:
Okay. In this last minute or so, just give us a little bit of advice for someone out
there who’s living with RA maybe having a hard time with it. You’ve probably had patients
that are doing well. What advice would you give to someone?
>>Dr. Chip Rowe: Two things that the patient can actively moderate
is one, their smoking and unfortunately that includes marijuana, and two, is their weight.
And, you know, seek out a professional that you can establish a good working relationship
with because unfortunately, unlike a broken leg, you’re going to be entering into a long-term
relationship with the physician who’s going to be treating you for rheumatoid arthritis.
And again, the nature of the problem is one that it can flare up without, you know, predictable
problems arising. And so, you want somebody who will be attentive to you, that you can
get in touch with relatively easily and is going to be there to optimize your care. And,
you know, that, those– taking responsibility for yourself, exercising, not smoking, keeping
your weight down, and then, you know, developing good report and a long-term relationship with
the physician who you trust are going to be the biggest factors with long-term care of
rheumatoid arthritis.>>Lori Casey:
All right, well Dr. Rowe, our time went so fast. Thank you so much for shedding some
light on RA and hopefully it can help people out there.
>>Dr. Chip Rowe: It does; I hope it does.
>>Lori Casey: Thank you.
>>Dr. Chip Rowe: Thanks, Lori.
m [Music Playing] mm>>Lori Casey:
When it comes to prescriptions, following your doctor’s orders is critical. Despite
that, some patients are not adhering to those instructions, and that can make feeling better
much harder. Susan Hendricks explains.>>Susan Hendricks:
Whether you use over-the-counter or prescription medicine, it most likely means you’re looking
for something to make you feel better. Following instructions for your medication is a big
deal.>>Rich Tomelevage:
If you veer from the plan that you and your physician have come upon and agreed upon,
then you’re not going to get the result that should have been.
>>Susan Hendricks: Pharmacist Rich Tomelevage says that applies
to most medications.>>Rich Tomelevage:
Antibiotic therapy, the infection may never go away. Anti depressant therapy, you truly
may never get to what’s called a steady state and it may never be truly be effective. Blood
pressure medication may truly never work. So with all of those examples of if you don’t
take it on a consist basis your results are going to vary dramatically.
>>Susan Hendricks: Research shows that 50% of Americans don’t
take their medicine as prescribed and the ramifications can be significant. Non-adherence
to the medication guidelines causes 30-50% of treatments to fail and 125,000 deaths annually.
>>Rich Tomelevage: It’s important for anything to truly work
the way you want it to. you have to give it a true shot, you have to give it a chance.
And once you’re there, if you continue on it, that’s the only way to keep that consistency.
>>Susan Hendricks: Tomelevage says if you miss a dose, ask for
help to get back on track.>>Rich Tomelevage:
That’s what a pharmacist is for. A pharmacist is there to answer your questions specifically
because there are so many medications.>>Susan Hendricks:
For today’s Health Minute, I’m Susan Hendricks.>>Lori Casey:
That’s all the time we have for this edition of Being Well. Check us out right here on
WEIU TV Tuesday evenings at 7 and Wednesday afternoons at 12:30. Or anytime on YouTube.
You’ll find new programs there as well as extra program content from some of our guests.
Until next week, I’m Lori Casey for Being Well.
>>Female Speaker 1: Production for Being Well is made possible
in part by Sarah Bush Lincoln Health System, supporting healthy lifestyles, eating a heart
healthy diet, staying active, managing stress, and regular checkups are ways of reducing
your health risks. Proper health is important to all at Sarah Bush Lincoln Health System;
information available at Alpha-Care specializing in adult care services that range
form those recovering from recent hospitalizations to someone attempting to remain independent
while coping with a disability, chronic illness, or age related infirmity. Alpha-Care, compassionate,
professional, home care. Additional funding by Jazzercise of Charleston.
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