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Studies show that poorly controlled rheumatoid arthritis may shorten one’s life span by about 10 years, with cardiovascular disease risk being one of the biggest risks.  Poorly controlled RA can affect many other organs outside of the joints, as it truly is a systemic disease.  Our current treatment options are generally very good at treating rheumatoid arthritis, limiting the risk of organ involvement and we believe improving life span.  Unfortunately, no medication is without its risks and treatment options for rheumatoid arthritis are no different.  For most people, the benefit of taking the medication outweighs the risks.  Every person with rheumatoid arthritis deserves to have a conversation with their rheumatologist outlining all the risks of a given medication AND their benefit, as well the benefits and risks of not taking medication, so a decision can be made based on all the information available and that is right for you.

While there are studies looking at the potential benefits of yoga for individuals with inflammatory arthritis, they are limited.  That said, the results that have been published appear encouraging, with improvement in pain and quality of life.  The risks of yoga, as would be the case for most forms of exercise, are small.  It is generally considered quite safe.  Just like someone who does not have arthritis, if something hurts, you listen to your body and stop.  However, yoga should not make the arthritis itself worse and has many potential benefits to those who participate.

Both osteoarthritis and rheumatoid arthritis can happen in the same person.  Unfortunately, if you have one, it still is possible to have the other as well.  It is important for you and your physician to be able to differentiate which joints are affected by which condition.  The best way to do this is to describe to your physician which joints are involved and how they feel, while your physician will complete an appropriate physical exam.  Further investigations such as blood tests or imaging can be helpful, they are often far from definitive in making a diagnosis on their own.

Making the right diagnosis ensures the right management choices are being made, as treatment for OA and RA are different.  To learn more about OA and RA and treatment options, please click on the highlighted links above.

There is no “hotline” available, but certainly there are resources.  This website, under the Medications tab, does list immunization/vaccination information for our patients.  Your rheumatologist also is available to take phone calls from you.  For general education needs, in Edmonton, we offer a 3 day Rheumatoid Arthritis Education program.  Speak to your rheumatologist if you are interested and they can enroll you in this excellent program.

There are no specific programs that are associated with rheumatology.  However, it is very common for spouses to attend support groups with their partner and connect with others on the effect rheumatoid arthritis has had on the patient and their family.  Speak to your rheumatologist about a referral to the Rheumatoid Arthritis Education Program, an excellent course which covers all aspects of RA, including how to provide support.

Raynaud’s is a condition where upon exposure to cold, the peripheral parts of the body – fingers and toes, but sometimes nose or ears – can become painful and change colours from white to blue to red.  It is certainly a condition that rheumatologists may see. Raynaud’s can occur in individuals “just because”, often starting as a young adult.  It can also happen in association with other rheumatic diseases, including rheumatoid arthritis, lupus, and scleroderma.  A rheumatologist can assess a person for Raynaud’s, make suggestions to help, and also ensure the person does not have any underlying rheumatic disease too.

The goal in the treatment of rheumatoid arthritis is to eliminate joint pain, stiffness and swelling while improving function and preventing joint damage.  DMARDs, including methotrexate and hydroxychloroquine, are the class of medications which are used to achieve this goal.  However, they do not always work as well as we want.  It is important to work with your rheumatologist to find the right combination of DMARDs that work for you.  Fortunately, there are many options available, and many patients are able to find success with the right combination.  Until that combination is found, treatment also needs to focus on ensuring best control of your symptoms.  That may include pain relievers, anti-inflammatories, or glucocorticoids such as Prednisone.

The process to find the right treatment combination can be slow in some patients.  That can be frustrating as it sometimes can feel like your health care team will never find the right treatments.  A positive attitude, education around your disease, and working with your rheumatologist and health care team members will help you achieve your goals.

Prednisone is a steroid, while leflunomide (Arava) is a disease modifying anti-rheumatic drug (DMARD) used to treat rheumatoid arthritis.  Another term for DMARDs is a steroid sparing agent, meaning they aim to achieve the same goals as steroids, but ideally with less side effects.   Prednisone works much faster than leflunomide, days versus weeks.  Because of that, it is not unusual for a patient to be started on both: Prednisone to help control symptoms short term and then stopped once leflunomide has begun to take effect.  This same idea would apply for most DMARDs.

When it comes to quitting most medications for arthritis, it is considered safe to just stop them.  You do not need to do it slowly over time.  This would apply to gold, which was the literal “gold standard” for treating RA years ago, but also to options like methotrexate, hydroxychloroquine, leflunomide, and the biologics.  The only one to be very cautious with is prednisone, which in most cases should NOT be stopped suddenly without input from your physician.

All that said, it is usually best to discuss with your rheumatologist prior to making this decision.  While safe, stopping medication does not mean there will not be consequences.  In particular, your rheumatologist can discuss with you the risk of your RA becoming active again when you stop your medication, and perhaps can provide strategies to help reduce those risks.

Whether or not medications can be taken at the same time, close in time, or need a brief break in time, depends on the medications being considered.  For leflunomide, it is common to use it at the same time as many biologics.  If it is being stopped, there is typically no reason to wait to start the biologic.  They should not interfere with each other.  For rheumatoid arthritis, it is, in fact, very common to use a number of the disease modifying medications (DMARDs) together, and often in combination with a biologic.  For instance, to be on methotrexate, hydroxychloroquine, and sulfasalazine at the same time is a common regimen known as triple therapy.  It is also common to be on a regular DMARD while on a biologic.  It is not considered safe to be on two biologics at the same time.