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Rheumatoid Arthritis – Disease Overview | Johns Hopkins

(calming music) – The immune system as many people are aware of is like a good police force that is out there to keep your body and your community safe. So it’s always watching out for and taking care of bad actors, and by that I mean infections. And even cancer, so if you have viruses that are affecting your body, bacteria, that are affecting your body it’s your immune system that fights off these bad actors and then makes your body healthy again.

That’s what a healthy immune system does. But sometimes the immune system turns against it’s own self instead of just watching out and taking out the bad actors it’s actually coming out and damaging or destroying it’s own self. So that is the meaning of the term Autoimmunity. So when I think abut Rheumatoid Arthritis, I think about a chronic, which means lifelong arthritis which means involving the joints. And Autoimmune Arthritis which means it’s the immune system which is causing damage and destruction to the joints however Rheumatoid Arthritis is much more than the joints only because it can involve other parts of your body as well such as skin, lungs, eyes, et cetera.

(calm music) So when a patient has Rheumatoid Arthritis particularly if it’s untreated, they have ongoing inflammation in the body when you think about chronic ongoing inflammation I almost think about chronic smoldering fire, you have to put it out. Because if you don’t it’s gonna cause damage and destruction, so what the patient experiences is not only pain, stiffness, and swelling that is directed in their joints these symptoms include fatigue. Fatigue is a very common presentation of patients with Autoimmune diseases, so they may feel unusually tired not able to do things that they would want to do on a typical day, as I have just mentioned it can involve their eyes. Patients can have dryness of their eyes and their mouth. Patients can experience symptoms in their lungs, they can have a chronic cough, they can have shortness of breath because the inflammation can affect their lungs as well.

Some patients can present with a condition known as Raynaud’s Phenomenon, Raynaud’s Phenomenon is when your fingers and even toes can turn white or they’re very effected by the cold weather, and then they can have involvement of their skin as well. So sometimes patients can develop ulcers that are also related to Rheumatoid Arthritis. They can also have involvement of their nerves so a patient may come to my clinic and say doctor Haque, I’m experiencing numbness and tingling in my feet I wonder why and that itself can be also related to damage to the nerves in the hands and feet again, because of Rheumatoid Arthritis.

So as a Rheumatologist, when I’m seeing a patient with Rheumatoid Arthritis I’m of course focusing on their joints but then I’m focusing on other organs and I’m making sure that I pay attention to what else Rheumatoid Arthritis is effecting in that particular patient. (calm music) Many people think that in Rheumatology we take care of old age diseases, that’s actually not the case, many patients with Autoimmune diseases are effected in their 20s and their 30s, but if you look at the peak age when Rheumatoid Arthritis is diagnosed it’s typically in a patient whose in their 40s or their 50s. That does not mean that patients in their 70s and 80s cannot be diagnosed with Rheumatoid Arthritis so we can diagnose this disease any time of a patient’s life. (calm music) Two decades ago when a patient was diagnosed with Rheumatoid Arthritis I think the biggest concern that the patient and the treating Rheumatologist had was how do I control this disease so that the patient can avoid being in a wheelchair in the next decade or two? Well the wonderful news about medical advancement in treatment of Rheumatoid Arthritis, is that we have such effective therapies for Rheumatoid Arthritis that we have been able to have a big impact on chronic disability.

And that patient you know in terms of their risk of ending up in a wheel chair it’s, really at this point we have minimized it to the point that it is rather not existent, however for that of course the key is effective treatment and good followup with your Rheumatologist. While we have made a big impact on treatment and avoiding disability in our patients, there’s still something that we as Rheumatologists want to keep a very close eye on and monitor in our patients with Rheumatoid Arthritis and I think the key for me is their risk of heart disease and strokes.

We know that patients with Rheumatoid Arthritis are at twice the risk of having a heart attack or a stroke compared to a patient who does not have Rheumatoid Arthritis, so I’m always thinking about in this 40 year old patient with Rheumatoid Arthritis. How do I minimize that risk and that basically means we want to make sure their blood pressure’s well controlled their diabetes is well controlled, cholesterol is well managed, the patients are exercising, they’re eating a good diet and keeping an ideal weight. The other concern that I always have for my patients with Rheumatoid Arthritis were on these very powerful medications for Rheumatoid Arthritis. Is that I want to make sure that I am closely monitoring them for any medication toxicity and side effects. As I said, while we have miraculous medications, they need to be taken under supervision of a Rheumatologist, of a physician who has expertise in managing patients on these medications so I think that’s the other thing, we want to make sure that over the lifespan of our patients.

That we manage them and monitor them very closely for any side effects of these medications. (calm music).

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