Unfortunately, many individuals with rheumatoid arthritis (RA) postpone seeking medical care...and once they do, doctors may not accurately diagnose the disease or may fail to refer patients to rheumatologists, the specialists best equipped to treat RA. In a recent study in Arthritis & Rheumatism, 69% of RA patients did not see a rheumatologist within the crucial first 12 weeks when the disease's progression can be limited-and the delay contributed to a 30% faster rate of joint destruction and an 87% lower likelihood of remission, compared with patients who saw a specialist promptly.

"Permanent joint damage can occur at a very early stage of the disease. Medication can slow and sometimes prevent joint destruction—but once damage is done, we can't reverse it," said Beth L. Jonas, MD, director of the Rheumatology Fellowship Program at the University of North Carolina Thurston Arthritis Research Center.

New concern: Some research links the high levels of inflammation associated with RA to cardiovascular disease, Dr. Jonas said.

What about people who have already missed that window of opportunity for early treatment? Avoiding further delay is vital because the new medications still can help somewhat...whereas RA sufferers left untreated face a significantly increased risk of becoming disabled.

Spotting The Signs

With RA, the immune system attacks the synovial membranes that line the joints. This lining becomes inflamed and thickened...fluid builds up.. ligaments and tendons weaken and stretch out...cartilage is destroyed.. and bone is damaged. Over time, patients develop crippling chronic pain and joint deformity.

Women are two to three times more likely than men to get RA. The disease can arise at any time but usually appears in midlife. While genetics may play some role, most RA patients have no close relatives with the disease-so we all should be on the lookout for RA. See your doctor without delay if you experience any of the following…

  • Pain, tenderness and/or stiffness in any of the small joints—fingers, wrists, toes, ankles-usually occurring symmetrically on both sides of the body. (As RA progresses, the neck, shoulders, elbows, hips and/or knees also may be affected).
  • Morning stiffness that lasts for more than 30 minutes.
  • Redness, swelling and/or sensations of heat at the joints.
  • Numbness, tingling or burning sensations in the hands or feet.

Confirming an RA diagnosis can be tricky because the symptoms mimic those of lupus, Lyme disease and other forms of arthritis. Diag. nosis is based on a physical exam...blood tests for antibodies (including rheumatoid factor and anti-cyclic citrullinated peptide) plus various markers of inflammation...and imaging tests (ultrasound, MRI, X-ray).

So if your doctor suspects RA, ask to be referred to a rheumatologist or get a referral through the American College of Rheumatology (visit www.rheumatology.org and click on "Find a member").

Better Posture Eases Pain

People feel more powerful, in control and able to tolerate pain when they stand tall. Better posture may increase levels of testosterone, which improves pain tolerance and decreases stress hormones.

Three Most Overused Back Pain Tests

The American College of Physicians' new guidelines state that X-rays, CT scans and MRI scans ordered for back pain are frequently not needed and that routine imaging does not improve outcomes...is costly...needlessly exposes patients to radiation (except with MRD... and often uncovers abnormalities that may be treated unnecessarily. Back pain often vanishes after a month-with exercise and staying active.

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