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  • To Prevent Pain and Damage from Rheumatoid Arthritis, Take Your Meds!

    January 20, 2015

    Powerful advances in the treatment of rheumatoid arthritis (RA) have changed the outlook for this chronic, debilitating illness. While no cure exists, a new class of medications, known as biologics, can do a lot to slow the progress of this disease.

    BiologicsAccording to Dr. Linda Shookster, a specialist in rheumatology, biologics are more effective for treating pain and swelling and preventing the deformed joints that can occur with RA.

    Biologics are made from biological or genetic materials.  Simply put, they work by blocking the substances that destroy cartilage, which is the flexible connective tissue between the joints. Cartilage destruction can eventually disfigure the joints.

    "It can take as little as six to twelve months for bone to start to be eaten away," Dr. Shookster said. This time is critical. If a specialist is not seen early, destruction of bone and cartilage can occur. Once that happens, the damage is permanent. "Hence, it is important to see a Rheumatologist early on," she stressed.

    For biologics to work, a patient must faithfully take the medication as prescribed. Not doing so defeats the goal of reducing pain and preventing deformities.

    Still, some patients are stubborn and the reasons for not taking their medicine are long:

    • a friend may have told them that he or she is doing fine without medication
    • denial and disbelief about having lifelong illness
    • a general dislike for all medication
    • the feeling that taking a pill shows weakness
    • the bottle is not kept in a handy place
    • forgetfulness

    Dr. Shookster mentioned many of these excuses and gave one more: some patients refuse medication after reading the pharmacy printout. "They have read possible side effects on it that are so rare, you couldn't possibly think of them happening," Dr. Shookster said. But reading all the possible outcomes "scares some people off," she added.

    Also, some patients try to treat themselves with over-the-counter pills such as Glucosamine. "They just don't work," said Dr. Shookster.  The doctor explained that drug store and health food pills don't stand up to this problem. "They are just not strong enough," she said.

    The best way to fight this chronic inflammatory disease is to start taking the medicine and keep on taking it. Also, consult your doctor if the side effects are too difficult to handle.

    At least 1.3 million adults in the United States have this progressively chronic disease, according the American College of Rheumatology. Of those with this form of arthritis, 75 percent are women. People usually develop RA between their late thirties and sixties. However, RA can present itself at any age, even in infants.Dancers

    RA's cause is unknown. Evidence suggests that inheritance plays a part. What doctors do know is that it is an autoimmune disease, which means that certain cells of the immune system work improperly and attack healthy tissues. The target of this attack is the synovium, the tissue that lines the joint. Molecules within the system break down the joints' protective lining, causing the joints to become inflamed. From there the disease progresses and attacks the cartilage. It can cause permanent bone loss, which is the cause of deformities and loss of function.

    Diagnosing RA can be difficult, especially during the first six months, because no definitive test exists. At the beginning, the time when catching the disease is critical, the symptoms may be subtle and hard to detect. Sore achy joints and stiffness in the morning are among the first signs. A mild fever, making it seem more the flu, may also occur. Only a series of laboratory tests, X-rays, and a thorough history and physical examination can make a diagnosis of RA. Once the diagnosis is confirmed, seeing a rheumatologist is critical.

    A percentage of RA patients experience a lessening of the swelling and pain over time. Biologics can certainly reduce symptoms in at least half of RA patients. "They have changed the course of this disease," said Dr. Shookster. She also said that the effect of lowering the dosage of the medication during remissions is being studied by researchers.

    Other factors that play a part in managing the disease are keeping your weight down and staying active. "Being overweight puts a strain on the joints and bones," the doctor said. That is why weight loss is essential. In addition to burning calories, "exercise and physical therapy help to build strength," she said. But she cautions, "it shouldn't be done when the inflammation is active."

    RA is a tough disease, and Dr. Shookster admits "it's really hard to exercise when you're in pain." Here, again, it's taking the medicine that counts. With biologics the pain can be eased, making exercise easier.

    For more information on Rheumatoid Arthritis visit or

    Dr. Linda Shookster is a rheumatologist and has been treating patients with rheumatic conditions for about 25 years. A graduate of Columbia University College of Physicians and Surgeons, she works for Medalliance Medical Health Services in the Bronx and is on staff at Montefiore Medical Center in New Rochelle, NY.

    Comments (2)

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