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Rajni’s Story
Rajni* is a 55-year-old first-generation American Indian citizen of the United States who lives in Seattle. She recently started having pain, swelling, and stiffness in both her wrists, which has been worse in the mornings and after periods of rest. She has also been feeling tired and has lost her appetite. When she consulted her primary care provider and they conducted a few tests, she was told that she was suffering from rheumatoid arthritis. She has not heard of this disease and anxiously contacted us with a need for guidance on dealing with it.
*Name changed upon request
Q: What is rheumatoid arthritis?
Dr. Sharma: Rajni, rheumatoid arthritis is a long-lasting autoimmune disease, meaning that one’s own immune cells start attacking the joints. There are four stages to this disease:
- In the first stage, there is pain, swelling, and stiffness in the lining of the joints, and this is what you are experiencing now.
- In the second stage, the cartilage, which is the firm, whitish, flexible connective tissue around the joints, is damaged.
- In the third stage, the bones around the joints are damaged, and
- In the fourth stage, while the inflammation stops, there is a problem in moving the joints, and they get deformed. It affects 0.5-1% of the adult population and is more common in women. There are several types of arthritis, and rheumatoid arthritis is different from osteoarthritis, which is more common and occurs due to overuse.
The diagnosis of rheumatoid arthritis is made by checking for rheumatoid antibody, which is present in many patients, and checking for anti-cyclic citrullinated peptide antibody, which may also be present in many patients. Commonly, erythrocyte sedimentation rate and C-reactive protein levels in the blood are elevated. In later stages, imaging studies can reveal the extent of joint damage.
Q: What causes rheumatoid arthritis? Can it be prevented?
Dr. Sharma: The exact cause of rheumatoid arthritis – why immune cells start attacking joints – is not known. However, some risk factors are family history, smoking, obesity, stress, poor oral hygiene (periodontitis), and exposure to irritants and pollutants. So, while rheumatoid arthritis cannot be completely prevented, there are certain lifestyles that can be adopted. These include not smoking, regular exercise, maintaining a healthy weight, maintaining good oral hygiene, and taking a diet that does not induce inflammation, such as one rich in fruits, vegetables, nuts, and limiting ultra-processed foods, sugary foods, and saturated fats. Reducing exposure to environmental pollutants and preventing infections is also helpful.
Q: What are the treatment options for combating rheumatoid arthritis?
Dr. Sharma: Treatment of rheumatoid arthritis has improved over the years. So, that is good news, Rajni. First-line drugs for reducing inflammation, non-steroidal anti-inflammatory drugs (NSAIDs), and corticosteroids may be prescribed. Second-line treatment may consist of disease-modifying anti-rheumatic drugs (DMARDs). Newer drugs such as Janus kinase (JAK) inhibitors and biologics are rapidly changing the treatment regimes. Your healthcare provider would be the right person to discuss all potential choices with you. Physical therapy and occupational therapy are also integral parts of treatment. In late stages, surgery may be considered.
Q: What are the complications of rheumatoid arthritis?
Dr. Sharma: Due to painful joints, it is difficult to exercise, thereby causing weight gain. It also makes people vulnerable to elevated cholesterol levels, high blood pressure, diabetes, and heart disease. Rheumatoid arthritis can affect different parts of the body. These include the eyes, where rheumatoid arthritis can cause dryness, pain, sensitivity to light, and trouble seeing properly. It can cause dryness of the mouth. It can also affect the lungs and damage blood vessels.
Q: What can I do besides getting medical treatment for rheumatoid arthritis?
Dr. Sharma: Rajni, a balance between rest and exercise is very important. Low-impact physical exercises, such as water-based exercises or yoga, are very helpful. One should take care of the affected joints. Sometimes, under the supervision of an occupational therapist, a splint, mostly on hands and wrists, as in your case, may be worn to reduce pain and swelling. Other assistive devices, such as an adaptive toothbrush or devices to get up from the toilet seat, etc., can also reduce the burden on joints.
You should continue to monitor your symptoms and keep a log to update your healthcare provider. Managing stress is essential in this condition. There are numerous stress management techniques* to relax, reduce anxiety, manage anger, set goals, and others.
Q: Can you share some additional resources?
Dr. Sharma: Here are some additional resources for more information:
- Arthritis Foundation’s website on rheumatoid arthritis
- Cleveland Clinic’s website on rheumatoid arthritis, including information on management and treatment
- Mayo Clinic’s website on rheumatoid arthritis
- Practical Stress Management – A comprehensive book with individual chapters on various aspects of managing stress that help someone to cope with rheumatoid arthritis
- Yoga for arthritis video series from Johns Hopkins Arthritis Center
*(Romas, J. A., & Sharma, M. (2025). Practical stress management. A comprehensive workbook. (9th ed.). Cambridge, MA: Academic Press (Elsevier).
If you have questions, reach out to Dr. Manoj Sharma at editor@indiacurrents.com
