rheumatoid arthritis living with...rheumatoid arthritis (ra) treatment has come a long way. drugs...

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M Y S T O R Y :LIVING WITH RA

T O A S K Y O U R DOCTOR

QUESTIONS

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2 LIVING W I T H | RHEUMATOID ARTHRITIS

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RHEUMATOID ARTHRITISTHE LATEST ON

70%

50%

Percentage of people with RA who are middle-aged women.

Number of women who have improvements in symptoms during pregnancy. SOURCE: Clinical Reviews in Allergy and Immunology

Percentage of people with RA who also have heart disease. Talk to your doctor about your risk.

Two hours of yoga every weekday for 2 months, in addition to prescribed medications, relieved arthritis symptoms more than medication alone in 72 people with RA. After the 2-month trial, people in the yoga group also saw reductions in inflammation and in the rate at which their cells age – a process that is usually accelerated in people with RA. The yogis had improvements in depression symptoms, disability, and overall disease activity, too.SOURCE: IOS Press

Are you taking the best medication to control your RA symptoms? New research shows that certain biologic medications – but not all of them – might not be as effective for people who are obese. If you are overweight or obese and feel your biologic medication is not working as well as it should, ask your doctor if a different one might bring you more relief. SOURCE: Joint Bone Spine

For some people living with RA, standard medications simply don’t help. But a new experimental treatment might bring relief. Doctors implanted a tiny nerve stimulator in the neck right under the surface of the skin of people who had already tried two arthritis medications without benefit. They divided the people into three groups. For one group, doctors never turned the stimulator on. For another, they activated it for 1 minute, four times a day, for 12 weeks. The others got 1 minute a day. After 12 weeks, the 1-minute-per-day group reported a significant improvement in their symptoms. SOURCE: European League Against Rheumatism

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SOURCE: Journal of Rheumatology

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SOURCE: Clinical Reviews in Allergy and Immunology

LEARN MORE ABOUT...Rheumatoid Arthritis

• Managing Symptoms

• Staying Active

• Best Foods

• Treatments

For more information and

exclusive videos, visit

WebMD.com/betterlivingra

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THIS CONTENT IS CREATED AND CONTROLLED BY WEBMD’S EDITORIAL STAFF

3THIS CONTENT IS CREATED AND CONTROLLED BY WEBMD’S EDITORIAL STAFF

JUNE 2 0 2 0 | WEBMD.COM

How will I know if my treatment is working?+ When your disease is well-controlled, you

won’t have tender or swollen joints. Blood tests your doctor gives you shouldn’t find elevated markers of inflammation.

Do I need to change medicine?+ The first drug you try may control your disease.

But if your joints have become inflamed enough to interfere with your daily life, it’s time to consider switching medicines or adding a new treatment.

Can physical therapy help?+ Physical therapy improves your flexibility and

helps to strengthen the muscles that support your joints. The therapist will also teach you how to perform your daily activities in a more streamlined and less painful way.

A S K Y O U R D O C T O R

D I S C U S S I O N G U I D E

HERE’S THE TALK YOU NEED TO HAVE WITH YOUR RHEUMATOLOGIST By Stephanie Watson Reviewed by Brunilda Nazario, MD, WebMD Senior Medical Editor

QUESTIONS FOR YOUR DOCTOR

Rheumatoid arthritis (RA) treatment has come a long way. Drugs can slow the disease enough to prevent joint damage and put RA into remission.

If your symptoms aren’t well-controlled, don’t settle for a life filled with pain and stiffness. Plodding through your symp-toms could put you on a course for future disability. “If you’re having persistent inflammatory symptoms, that often is a sign that you’re at risk for progressive joint damage,” says Beth Jonas, MD, chief in the Division of Rheumatology, Allergy and Immunology at the UNC Thurston Arthritis Research Center in Chapel Hill, North Carolina. “That’s why it’s important for patients to speak up.”

Tell your doctor which symptoms you’re experiencing (pain, swelling, stiffness, fatigue), and explain how those symptoms affect your day-to-day life. Did you have to stop writing or

knitting? Is it too painful to type on your computer keyboard?

It’s also helpful for your doctor to know whether your symptoms are caused by inflammation or exist-ing joint damage. This is where blood tests, X-rays, and ultrasound imaging can provide a window inside your joints. If your symptoms are due to inflammation, it may be time to switch to a biologic or other new drug. If joint damage is behind your pain, “Switching medicine isn’t really going to help,” Jonas says. In that case, you’ll need treatments that directly target your pain.

When considering your options, have a frank discus-sion with your doctor about your treatment goals. For example, what kinds of drug side effects are you willing to accept in order to control your disease? Once your doctor knows your goals, he

or she can help you decide on the best drug to manage your RA, Jonas says.

Medicine is one com-ponent of RA treatment, but lifestyle interventions are important, too. Jonas stresses the need to take time for yourself, especially if you work or you’re the primary caregiver for other family members. “Set aside time to rest. Set aside time to exer-cise. Make sure you’re eating a good diet,” she says. “Don’t smoke. Maintain a healthy body weight. Try to avoid really sugary foods, which I believe drive inflammation.”

Hold the last five to 10 minutes of your visit to dis-cuss these lifestyle changes with your doctor and then ask about exercise. Find out which types of exercises are safest for you, how to get started in a new program, and whether your doctor recommends that you visit a physical therapist.GE

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IMAG

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PROVEN TO HELP REDUCE PAIN, SWELLING, & STIFFNESS

HELPS STOP FURTHERJOINT DAMAGE

SIGNIFICANTLY REDUCES FATIGUE FOR SOME

RINVOQ IS A ONCE-DAILY PILL THAT CAN DRAMATICALLY IMPROVE RA SYMPTOMS. TALK TO YOUR RHEUMATOLOGIST ABOUT

RINVOQOR LEARN MORE AT RINVOQ.COM

TALK TO YOUR RHEUMATOLOGIST ABOUT


YOUR MISSION: YOUR MISSION:

- Swelling- Pain or tenderness in the leg- Sudden unexplained chest pain- Shortness of breath

• Have a fever or stomach-area pain that does not go away, and a change in your bowel habits.

WHAT ARE THE COMMON SIDE EFFECTS OF RINVOQ?

These include: upper respiratory tract infections (common cold, sinus infections), nausea, cough, and fever. These are not all the possible side eff ects of RINVOQ.

RINVOQ is taken once a day with or without food. Do not split, break, crush, or chew the tablet. Take RINVOQ exactly as your HCP tells you to use it.

This is the most important information to know about RINVOQ. For more information, talk to your HCP.

You are encouraged to report negative side e ects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

If you are having di� iculty paying for your medicine, AbbVie may be able to help. Visit AbbVie.com/myAbbVieAssist to learn more.

Please see following pages for a brief summary of the full Prescribing Information.

Reference: 1. RINVOQ [package insert]. North Chicago, IL: AbbVie Inc.

©2020 AbbVie Inc. North Chicago, IL 60064US-RNQR-200083 February 2020

WHAT IS RINVOQ?1

RINVOQ is a prescription medicine used to treat adults with moderate to severe rheumatoid arthritis in whom methotrexate did not work well or could not be tolerated. It is not known if RINVOQ is safe and eff ective in children under 18 years of age.

WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD KNOW ABOUT RINVOQ?

RINVOQ is a medicine that can lower the ability of your immune system to fight infections. You should not start taking RINVOQ if you have any kind of infection unless your healthcare provider (HCP) tells you it is okay.

• Serious infections have happened in some people taking RINVOQ, including tuberculosis (TB) and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections. Your HCP should test you for TB before starting RINVOQ and check you closely for signs and symptoms of TB during treatment with RINVOQ. You may be at higher risk of developing shingles (herpes zoster).

• Lymphoma and other cancers, including skin cancers, can happen in people taking RINVOQ.

• Blood clots in the veins of the legs or lungs and arteries are possible in some people taking RINVOQ. This may be life-threatening and cause death.

• Tears in the stomach or intestines and changes in certain laboratory tests can happen. Your HCP should do blood tests before you start taking RINVOQ and while you take it. Your HCP may stop your RINVOQ treatment for a period of time if needed because of changes in these blood test results.

WHAT SHOULD I TELL MY HCP BEFORE STARTING RINVOQ?Tell your HCP if you:• Are being treated for an infection, have an infection that

won’t go away or keeps coming back, or have symptoms of an infection such as:

- Fever, sweating, or chills- Shortness of breath- Warm, red, or painful skin or sores on your body- Muscle aches- Feeling tired- Blood in phlegm

- Diarrhea or stomach pain- Cough- Weight loss- Burning when urinating or urinating more often than normal

• Have TB or have been in close contact with someone with TB.

• Have had any type of cancer, hepatitis B or C, shingles (herpes zoster), or blood clots in the veins of your legs or lungs, diverticulitis (inflammation in parts of the large intestine), or ulcers in your stomach or intestines.

• Have other medical conditions including liver problems, low blood cell counts, diabetes, chronic lung disease, HIV, or a weak immune system.

• Live, have lived, or have traveled to parts of the country that increase your risk of getting certain kinds of fungal infections, such as the Ohio and Mississippi River valleys and the Southwest. If you are unsure if you’ve been to these areas, ask your HCP.

• Have recently received or are scheduled to receive a vaccine. People who take RINVOQ should not receive live vaccines.

• Are pregnant or plan to become pregnant. Based on animal studies, RINVOQ may harm your unborn baby. Your HCP will check whether or not you are pregnant before you start RINVOQ. You should use eff ective birth control (contraception) to avoid becoming pregnant while taking RINVOQ and for at least 4 weeks after your last dose.

• Are breastfeeding or plan to breastfeed. RINVOQ may pass into your breast milk. You should not breastfeed while taking RINVOQ and for at least 6 days after your last dose.

Tell your HCP about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. RINVOQ and other medicines may aff ect each other, causing side eff ects.

Especially tell your HCP if you take:

• Medicines for fungal or bacterial infections

• Rifampicin or phenytoin

• Medicines that aff ect your immune system

Ask your HCP or pharmacist if you are not sure if you are taking any of these medicines.

WHAT SHOULD I TELL MY HCP AFTER STARTING RINVOQ?

Tell your HCP right away if you:

• Have any symptoms of an infection. RINVOQ can make you more likely to get infections or make any infections you have worse.

• Have any signs or symptoms of blood clots during treatment with RINVOQ, including:

USE AND IMPORTANT SAFETY INFORMATION

FOR ADULTS WITH MODERATE TO SEVERE RHEUMATOID ARTHRITIS (RA)FOR WHOM METHOTREXATE DID NOT WORK WELL

1/2”Total15-7308 US RNQR 200083 AD.indd 1 3/10/20 9:11 AM

GUIDES-StandardFullPage.indd 2 3/19/20 8:56 AM

PROVEN TO HELP REDUCE PAIN, SWELLING, & STIFFNESS

HELPS STOP FURTHERJOINT DAMAGE

SIGNIFICANTLY REDUCES FATIGUE FOR SOME

RINVOQ IS A ONCE-DAILY PILL THAT CAN DRAMATICALLY IMPROVE RA SYMPTOMS. TALK TO YOUR RHEUMATOLOGIST ABOUT


TALK TO YOUR RHEUMATOLOGIST ABOUT


YOUR MISSION: YOUR MISSION:

- Swelling- Pain or tenderness in the leg- Sudden unexplained chest pain- Shortness of breath

• Have a fever or stomach-area pain that does not go away, and a change in your bowel habits.

WHAT ARE THE COMMON SIDE EFFECTS OF RINVOQ?

These include: upper respiratory tract infections (common cold, sinus infections), nausea, cough, and fever. These are not all the possible side eff ects of RINVOQ.

RINVOQ is taken once a day with or without food. Do not split, break, crush, or chew the tablet. Take RINVOQ exactly as your HCP tells you to use it.

This is the most important information to know about RINVOQ. For more information, talk to your HCP.

You are encouraged to report negative side e ects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

If you are having di� iculty paying for your medicine, AbbVie may be able to help. Visit AbbVie.com/myAbbVieAssist to learn more.

Please see following pages for a brief summary of the full Prescribing Information.

Reference: 1. RINVOQ [package insert]. North Chicago, IL: AbbVie Inc.

©2020 AbbVie Inc. North Chicago, IL 60064US-RNQR-200083 February 2020

WHAT IS RINVOQ?1

RINVOQ is a prescription medicine used to treat adults with moderate to severe rheumatoid arthritis in whom methotrexate did not work well or could not be tolerated. It is not known if RINVOQ is safe and eff ective in children under 18 years of age.

WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD KNOW ABOUT RINVOQ?

RINVOQ is a medicine that can lower the ability of your immune system to fight infections. You should not start taking RINVOQ if you have any kind of infection unless your healthcare provider (HCP) tells you it is okay.

• Serious infections have happened in some people taking RINVOQ, including tuberculosis (TB) and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections. Your HCP should test you for TB before starting RINVOQ and check you closely for signs and symptoms of TB during treatment with RINVOQ. You may be at higher risk of developing shingles (herpes zoster).

• Lymphoma and other cancers, including skin cancers, can happen in people taking RINVOQ.

• Blood clots in the veins of the legs or lungs and arteries are possible in some people taking RINVOQ. This may be life-threatening and cause death.

• Tears in the stomach or intestines and changes in certain laboratory tests can happen. Your HCP should do blood tests before you start taking RINVOQ and while you take it. Your HCP may stop your RINVOQ treatment for a period of time if needed because of changes in these blood test results.

WHAT SHOULD I TELL MY HCP BEFORE STARTING RINVOQ?Tell your HCP if you:• Are being treated for an infection, have an infection that

won’t go away or keeps coming back, or have symptoms of an infection such as:

- Fever, sweating, or chills- Shortness of breath- Warm, red, or painful skin or sores on your body- Muscle aches- Feeling tired- Blood in phlegm

- Diarrhea or stomach pain- Cough- Weight loss- Burning when urinating or urinating more often than normal

• Have TB or have been in close contact with someone with TB.

• Have had any type of cancer, hepatitis B or C, shingles (herpes zoster), or blood clots in the veins of your legs or lungs, diverticulitis (inflammation in parts of the large intestine), or ulcers in your stomach or intestines.

• Have other medical conditions including liver problems, low blood cell counts, diabetes, chronic lung disease, HIV, or a weak immune system.

• Live, have lived, or have traveled to parts of the country that increase your risk of getting certain kinds of fungal infections, such as the Ohio and Mississippi River valleys and the Southwest. If you are unsure if you’ve been to these areas, ask your HCP.

• Have recently received or are scheduled to receive a vaccine. People who take RINVOQ should not receive live vaccines.

• Are pregnant or plan to become pregnant. Based on animal studies, RINVOQ may harm your unborn baby. Your HCP will check whether or not you are pregnant before you start RINVOQ. You should use eff ective birth control (contraception) to avoid becoming pregnant while taking RINVOQ and for at least 4 weeks after your last dose.

• Are breastfeeding or plan to breastfeed. RINVOQ may pass into your breast milk. You should not breastfeed while taking RINVOQ and for at least 6 days after your last dose.

Tell your HCP about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. RINVOQ and other medicines may aff ect each other, causing side eff ects.

Especially tell your HCP if you take:

• Medicines for fungal or bacterial infections

• Rifampicin or phenytoin

• Medicines that aff ect your immune system

Ask your HCP or pharmacist if you are not sure if you are taking any of these medicines.

WHAT SHOULD I TELL MY HCP AFTER STARTING RINVOQ?

Tell your HCP right away if you:

• Have any symptoms of an infection. RINVOQ can make you more likely to get infections or make any infections you have worse.

• Have any signs or symptoms of blood clots during treatment with RINVOQ, including:

USE AND IMPORTANT SAFETY INFORMATION

FOR ADULTS WITH MODERATE TO SEVERE RHEUMATOID ARTHRITIS (RA)FOR WHOM METHOTREXATE DID NOT WORK WELL

1/2”Total15-7308 US RNQR 200083 AD.indd 1 3/10/20 9:11 AM


• Swallow RINVOQ whole with water at about the same time each day. Do not split or break, crush, or chew the tablets.

What are the possible side effects of RINVOQ?

RINVOQ can cause serious side effects including:See “What is the most important information I should know about RINVOQ?”Common side effects of RINVOQ include: upper respiratory tract infections (common cold, sinus infections), nausea, cough, and fever. These are not all the possible side effects of RINVOQ. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

How should I store RINVOQ?

• Store RINVOQ in original container at 36°F to 77°F (2°C to 25°C) to protect it from moisture.

• Keep RINVOQ and all medicines out of the reach of children.

General information about the safe and effective use of RINVOQ.

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use RINVOQ for a condition for which it was not prescribed. Do not give RINVOQ to other people, even if they have the same symptoms that you have. It may harm them. You can ask your healthcare provider or pharmacist for information about RINVOQ that is written for health professionals.

Manufactured by: AbbVie Ireland NL B.V., Sligo, Ireland Marketed by: AbbVie Inc., North Chicago, IL 60064 RINVOQ is a trademark of AbbVie Biotechnology Ltd. ©2019 AbbVie Inc.

For more information, call 1-800-2-RINVOQ (1-800-274-6867) or go to www.RINVOQ.com.

Ref: 03-B725 Revised: August, 2019

LAB-2725 MASTER

US-RNQR-200083


What is the most important information I should know about RINVOQ?

RINVOQ may cause serious side effects, including:1. Serious Infections.RINVOQ is a medicine that affects your immune system. RINVOQ can lower the ability of your immune system to fight infections. Some people have had serious infections while taking RINVOQ, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections. • Your healthcare provider should test you for TB

before starting treatment with RINVOQ.• Your healthcare provider should watch you

closely for signs and symptoms of TB during treatment with RINVOQ.

• You should not start taking RINVOQ if you have any kind of infection unless your healthcare provider tells you it is okay. You may be at a higher risk of developing shingles (herpes zoster).

• Before starting RINVOQ, tell your healthcare provider if you:• are being treated for an infection.• have had an infection that does not go away or

that keeps coming back.• have diabetes, chronic lung disease, HIV, or a

weak immune system.• have TB or have been in close contact with

someone with TB.• have had shingles (herpes zoster).• have had hepatitis B or C.• live or have lived, or have traveled to certain

parts of the country (such as the Ohio and Mississippi River valleys and the Southwest) where there is an increased chance for getting certain kinds of fungal infections. These infections may happen or become more severe if you use RINVOQ. Ask your healthcare provider if you do not know if you have lived in an area where these infections are common.

• think you have an infection or have symptoms of an infection such as:

• fever, sweating, or chills

• shortness of breath

• warm, red, or painful skin or sores on your body

• muscle aches

• feeling tired• blood in your

phlegm• diarrhea or

stomach pain

• cough• weight loss• burning

when you urinate or urinating more often than usual

After starting RINVOQ, call your healthcare provider right away if you have any symptoms of an infection. RINVOQ can make you more likely to get infections or make worse any infections that you have. 2. Cancer.RINVOQ may increase your risk of certain cancers by changing the way your immune system works.

RINVOQTM (rin-ˈvōk) (upadacitinib) extended-release tablets, for oral use

CONSUMER BRIEF SUMMARYCONSULT PACKAGE INSERT FOR FULL PRESCRIBING INFORMATION

Patient InformationRead the Medication Guide that comes with RINVOQ before you start taking it and each time you get a refill. There may be new information. This brief summary does not take the place of talking with your doctor about your medical condition or treatment.

Lymphoma and other cancers, including skin cancers can happen in people taking RINVOQ. Tell your healthcare provider if you have ever had any type of cancer. 3. Blood Clots (thrombosis).Blood clots in the veins of your legs (deep vein thrombosis, DVT) or lungs (pulmonary embolism, PE) and arteries (arterial thrombosis) can happen in some people taking RINVOQ. This may be life-threatening and cause death. • Tell your healthcare provider if you have had

blood clots in the veins of your legs or lungs in the past.

• Tell your healthcare provider right away if you have any signs and symptoms of blood clots during treatment with RINVOQ, including:

• swelling• pain or tenderness

in the leg

• sudden unexplained chest pain

• shortness of breath4. Tears (perforation) in the stomach or intestines.• Tell your healthcare provider if you have had

diverticulitis (inflammation in parts of the large intestine) or ulcers in your stomach or intestines. Some people taking RINVOQ can get tears in their stomach or intestines. This happens most often in people who take nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or methotrexate.

• Tell your healthcare provider right away if you have fever and stomach-area pain that does not go away, and a change in your bowel habits.

5. Changes in certain laboratory test results.Your healthcare provider should do blood tests before you start taking RINVOQ and while you take RINVOQ to check for the following:

• low neutrophil and lymphocyte counts. Neutrophils and lymphocytes are types of white blood cells that help the body fight off infections.

• low red blood cell counts. Red blood cells carry oxygen. Low red blood cells means you may have anemia, which may make you feel weak and tired.

• increased cholesterol levels. Your healthcare provider should do blood tests to check your cholesterol levels approximately 12 weeks after you start taking RINVOQ, and as needed.

• elevated liver enzymes. Liver enzymes help to tell if your liver is functioning normally. Elevated liver enzymes may indicate that your healthcare provider needs to do additional tests on your liver.

You should not take RINVOQ if your neutrophil count, lymphocyte count, or red blood cell count is too low or your liver tests are too high. Your healthcare provider may stop your RINVOQ treatment for a period of time if needed because of changes in these blood test results. See “What are the possible side effects of RINVOQ?” for more information about side effects.

What is RINVOQ?

• RINVOQ is a prescription medicine that is a Janus kinase (JAK) inhibitor. RINVOQ is used to treat adults with moderate to severe rheumatoid arthritis in whom methotrexate did not work well or could not be tolerated.

It is not known if RINVOQ is safe and effective in children under 18 years of age. Before taking RINVOQ, tell your healthcare provider about all of your medical conditions, including if you:• See “What is the most important information I

should know about RINVOQ?”• have an infection.• have liver problems.• have low red or white blood cell counts.• have recently received or are scheduled to

receive an immunization (vaccine). People who take RINVOQ should not receive live vaccines.

• are pregnant or plan to become pregnant. Based on animal studies, RINVOQ may harm your unborn baby. Your healthcare provider will check whether or not you are pregnant before you start RINVOQ. You should use effective birth control (contraception) to avoid becoming pregnant while taking RINVOQ, and for at least 4 weeks after your last dose of RINVOQ.

• are breastfeeding or plan to breastfeed. RINVOQ may pass into your breast milk. You and your healthcare provider should decide if you will take RINVOQ or breastfeed. You should not do both. You should not breastfeed until 6 days after your last dose of RINVOQ.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. RINVOQ and other medicines may affect each other causing side effects. Especially tell your healthcare provider if you take:• medicines for fungal infections (such as

ketoconazole, itraconazole, posaconazole or voriconazole) or clarithromycin (for bacterial infections) as these medicines may increase the amount of RINVOQ in your blood.

• rifampicin (for bacterial infections) or phenytoin (for neurological disorders) as these medicines may decrease the effect of RINVOQ.

• medicines that affect your immune system (such as azathioprine and cyclosporine) as these medicines may increase your risk of infection.

Ask your healthcare provider or pharmacist, if you are not sure if you are taking any of these medicines. Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.

How should I take RINVOQ?

• Take RINVOQ exactly as your healthcare provider tells you to use it.

• Take RINVOQ 1 time a day with or without food.



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A COUNSELOR USES HER PERSONAL EXPERIENCE WITH RA TO HELP OTHERS WITH PAINFUL CHRONIC ILLNESSESBy Amanda DuttonReviewed by Brunilda Nazario, MD, WebMD Senior Medical Editor

In 2014, I was searching for a solution to what was going on with my body. Not only did I have joint pain, but I also had issues with my lungs, heart, thyroid, and eyes. I was only 35 years old, and my symptoms just didn’t make sense for my age. When I looked at my medical records, I had 17 different diagnoses. I had so many individual problems that I thought there had to be some medical condition underly-ing all of them.

When I finally saw a rheumatologist and had lab work done, the tests came back positive for rheumatoid arthritis. Getting an answer to my symptoms was a double-edged sword. On the one hand, I was relieved to finally have a diagnosis, but I also felt terror and grief at learning that I had such a scary disease. I felt like part of my life was ending. I had a little pity party until my husband reminded me that I was a therapist and I knew

better. He told me I needed to get my foot out of the grave and keep going.

I pretty quickly started on my first medication, a disease-modifying drug. I didn’t notice any improvement, so after about 4 months I switched to another medication. Over the last 5 years I’ve been on five different

drugs. I’m about to start my sixth, a biologic that also treats Crohn’s disease, which I was diagnosed with 2 months ago.

In addition to managing my symptoms with medica-tion, I take antioxidants and other supplements to bring down inflammation. I use a food journal to keep track of which foods trigger my symptoms. I’ve discovered

that I’m sensitive to certain types of cooking oil and I have to avoid fried foods. I also stay away from soda because I get dehydrated very easily.

I exercise regularly—most-ly stretching. I practice some variations of light yoga moves. Movement is essential. I never sit for more than one counseling session without giving myself a 15-minute break to get up, walk around, and stretch. If I sit still for too long, I’m in pain.

I’m managing my condi-tion a lot better today, and I attribute that to reeling myself in on how much I can realistically do. I’ve really pulled back and learned to say “no” to a lot of things, and I practice a lot more self-care. I’ve moved my counseling business to my home. Now I only see clients online, so I don’t have to go into an office on days when I’m not feeling up to it.

Disclosing my condition has helped me relate better to my clients and where they’re coming from with their own illnesses. I can physically see shoulders drop down, hear a sigh of relief, and watch a change come over them when they see that somebody hears them, sometimes for the first time. With these invisible illnesses, having somebody validate what you’re going through is so rare that when you do hear it, it breaks down a wall you may not have even realized was there.

I think health-wise I’m as good as I can be at this point. I manage from day-to-day pretty well. Pain and other issues are just going to be there, but I’ve gotten to a place of acceptance. I feel like I’m at the end stage of the grieving process. This is my new normal, so I have to learn to be OK with that.

M Y S T O R Y

FINDING ACCEPTANCE

Search for the articleStay Active With RA atWebMD.com/betterlivingra.


9JUNE 2 0 2 0 | WEBMD.COM


Your immune system should provide protection against threats to your health, like bacteria and viruses. But things can go wrong. The result: Inflammatory diseases like rheumatoid arthritis that attack healthy parts of your own body. RA primarily focuses its assaults on the lining of your joints, called the synovium. Your hands, wrists, shoulders, and knees are among its major targets, and it causes pain, tenderness, swelling, and stiffness.

“People have a lot of stiffness and a great deal of difficulty moving in the morning,” says rheumatologist Andrew Gross, MD, chief of the UCSF Rheumatology Clinic in San Francisco.

Its symptoms fall on a spectrum from very mild to

very severe, and the level of your symptoms will help determine the likelihood of damage to your joints.

“With severe disease, you’re more likely to go on to have more damage,” Gross says.

Much of that damage, he says, occurs in the early stages of RA.

“Often the phase when the disease is most active is during the first one to two years,” he says.

That makes early interven-tion critical, in order to get the disease under control and to prevent or limit the damage that it can do to your joints. Your main line of defense will be medication.

“Medication has been shown over and over to be the most important thing in preventing joint damage,” Gross says.

Rheumatoid arthritis is a chronic, progressive disease that damages your joints and can cause disability. Fortunately, plenty of options exist to limit its impact.By Matt McMillenReviewed by Brunilda Nazario, MD, WebMD Senior Medical Editor

PROTECT YOUR JOINTS

S T A Y O N T R A C K

But treatment involves more than medications. To keep your disease in check, you may have to make significant lifestyle changes. Foremost among them: physical activity.

“Physical activity is important for joint health and for feeling better,” Gross says. “Any kind can be good, from aerobics to weight lifting to high intensity interval training to simply going for a walk.”

Start your exercise routine slowly, in consultation with your doctor. You don’t have to push yourself too hard. Your breathing should be a bit heavier than normal, but not so heavily that you can’t carry on a conversation.

“As you feel better, ramp it up,” Gross says.

Another focus: weight loss. The heavier you are, the more you strain your joints. And, he says, research suggests that excessive body fat may reduce the effectiveness of your medications and lead to more inflammation. That further risks your joint health. Exercise along with a healthy diet can help you achieve a more joint-friendly weight.

Above all, stick with the medications you’ve been prescribed as long as they continue to help, and talk to your doctor right away if you feel your drugs have become less effective. There

are options.“One of the miracles of the

last 20 years is the develop-ment of over 20 medicines that have transformed the experience of having rheuma-toid arthritis,” Gross says.

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What can I do throughout the day to feel better? Sit less. Make a point to stand up twice an hour. Walk or stretch for about 2 minutes every 30 minutes.

What can help me stick with my exercise routine? Set achievable goals and use a pedometer or smartphone to track your progress. Having a partner to walk or work out with also helps.

Do you recommend any special exercise equipment? Arthritis can affect your feet, so you should have shoes with plenty of support. Consider arch supports. A podiatrist or specialty shoe store can help you select the right pair.

Does RA increase my risk of depression? It may. If you are concerned about depression, talk to your primary care doctor. Treatments like cognitive behavioral therapy can help you with the negative thoughts and feelings of hopelessness you may have, particularly when first diagnosed.

Q U E S T I O N S F O R Y O U R D O C T O R

Search for the articleStay Active With RA atWebMD.com/betterlivingra.


MEDICATION AND LIFESTYLE CHANGES CAN EASE RHEUMATOID ARTHRITIS SYMPTOMSBy Matt McMillen

Reviewed by Brunilda Nazario, MD, WebMD Senior Medical Editor

ARTHRITIS ASSIST

Howard Smith, MDrheumatologist, director, The Lupus Clinic, Department of Rheumatic and Immunologic Diseases at Cleveland Clinic“Talk with your physician. Be involved in your treatment plan. Discuss shortand long-term goals and expectations, concerns and fears, probable outcomes, and medications. Include anything else you want to ask.”

Waseem Mir, MDrheumatologist, Lenox Hill Hospital, New York City“Overall, my rheumatoid arthritis patients who exercise feel better. Cardio is especially important because heart disease is very prevalent in RA patients. Exercise also eases stress, which increases disease activity, and produces chemical changes in the body that help with inflammation.”

Diane Horowitz, MDrheumatologist, director, The Arthritis Center, Division of Rheumatology, Northwell Health, Manhasset, New York “Join a support group for people with rheumatoid arthritis, especially if you’re feeling depressed or your RA is challenging your sense of self-worth. Your group will help keep you grounded, you’ll learn some good tips on living with RA, and you’ll make new friends.”

E X P E R T T I P S

1 DON’T WAIT Get treatment for RA right away to help prevent joint damage.

2 STAY HEART-HEALTHY RA boosts heart disease risk, so eat well and exercise to counter it.

3 RELAX YOUR GRIP Grasp tools and other objects as lightly as you can.

4 LOSE WEIGHT Shed excess pounds to ease the stress on your joints.

5 DRESS FOR SUCCESS Wear easy-to-don clothes like sports bras and laceless shoes.

6 EXPLORE ALTERNATIVES Better medications may be available for you, so ask your doctor about options.

7 LIFT YOURSELF UP To reduce overnight joint pain, elevate your arms or legs in bed.

8 TAKE A CLASS Seek out exercise programs designed for people with RA.

9 BE A QUITTER If you smoke, stop. It can worsen your RA symptoms.

9 EXERCISE CAUTION Stay active but don’t push yourself if you feel pain or other symptoms.

H E A L T H H I G H L I G H T S

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11JUNE 2 0 2 0 | WEBMD.COM


B Y T H E N U M B E R S

By Matt McMillen

Reviewed by Brunilda Nazario, MD, WebMD Senior Medical Editor

STATS & FACTS

Amount spent on RA research from 2013 to 2017.

Number of U.S. adults estimated to have RA.

Percentage of rheumatoid arthritis patients who are women.

Risk of depression when you have RA.

Odds of bone breaks for people with RA.

Risk of having a heart attack if you have RA.

$2.2 BILLION

75%

Percentage increased risk of RA if you are obese.

33%2x

2 X3XNumber of people with RA

who fall at least once a year.

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1.5

1 3IN

MILLION

SOURCES: Arthritis Foundation, American College of Rheumatology, Arthritis Care & Research, Medicine, BMC Musculoskeletal Disorders, Mayo Clinic Proceedings, Rheumatology Research Foundation, Arthritis Research & Therapy


Rheumatoid arthritis causes your immune system to attackhealthy parts of your body, particularly your joints. It hasno known cause or cure, and it affects more than onemillion American adults. How much do you know about it?

1. As long as my joint pain is well-controlled, I’m doing fine.

True False

2. Rheumatoid arthritis has no cure.

True False

3. If my medications stop working, I’m out of options.

True False

4. My RA is in remission. I can stop my medications.

True False

5. I should exercise and be physically active despite my RA.

True False

6. Eating right may help improve my RA symptoms.

True False

HOW MUCH DO YOU KNOW ABOUT RA?TAKE THIS QUIZ TO FIND OUT.By Matt McMillenReviewed by Brunilda Nazario, MD, WebMD Senior Medical Editor

RHEUMATOIDARTHRITIS

ANSWERS: 1. False. Rheumatoid arthritis affects more than your joints. RA increases your risk of heart and lung problems. It may weaken your bones, cause uncomfortable rashes and nodules on your skin, and harm your kidneys. See your rheumatolo-gist regularly for checkups.

2. True. RA is a chronic, lifelong disease. However, many drugs exist to relieve your symptoms and reduce the risk of complications. These include over-the-counter painkillers as well as prescription drugs, like biologics, that your doctor may prescribe.

3. False. RA—and how your body responds to it—changes over time. Such changes may require a new treatment. Talk to your doctor about switching to different medications.

4. False. Some people with RA can take a drug “holiday” during remission, but you should continue your treatment unless your doctor tells you to stop or cut back on what you take.

5. True. Aerobic workouts, like walking and biking, and weightlifting can help you maintain joint health and protect you from heart disease. Talk to your doctor or a physical therapist about the right exercise routine for you.

6. True. A nutritious diet can help reduce inflammation andhigh cholesterol. And, if you lose weight, you’ll put less stresson your joints. You will likely gain more energy and improveyour mood as well.

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rheumatoid arthritis living with...rheumatoid arthritis (ra) treatment has come a long way. drugs...

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