Healthy Focus

Riding the ups and downs of rheumatoid arthritis

You may think of arthritis as a disease for people in their golden years, but that’s not always the case. Rheumatoid arthritis (RA) can strike at any age, and symptoms commonly start between the ages of 30 and 60 for women.

Women are also at much higher risk for this chronic autoimmune disease that has no cure, but researchers have been making steady progress in refining treatments and keeping symptoms under better control. Here’s a look at the latest advancements in treating RA.

RA from A to Z

Dr. Mark Cutright, Orthopedic Surgeon with Innovative Orthopedics and Sports Medicine

In people with RA, the body’s immune system attacks its own tissues, including the synovium, or the lining of the joints. Once the synovium is inflamed, the joints can become swollen and painful.

“The disease can involve multiple organs, but it is predominantly a disease of the joints,” says Dr. Mark Cutright, Orthopedic Surgeon with Innovative Orthopedics and Sports Medicine. “The most common complaints are pain, stiffness and swelling of the joints, especially involving the hands and feet, and fatigue can also be a significant complaint.”

RA can be difficult to diagnose, however, because the symptoms tend to vary and can be more or less severe at any given time. It can also cause other conditions like carpal tunnel syndrome and plantar fasciitis that may not appear to be RA symptoms.

Risk factors

While doctors do not yet know the cause of rheumatoid arthritis, several studies suggest that genetic factors play a role in the disease. Certain genes associated with the immune system may increase the chances for developing RA, according to researchers. And studies point to certain bacteria and viruses, combined with other factors like female hormones, that may contribute to developing RA.

Smoking may increase your chances for developing the disease. In fact, people with certain genes who also smoke may experience more prevalent RA symptoms and find that treatments aren’t as effective.

Making a diagnosis

Your physician may be able to make a preliminary diagnosis of RA by checking for joint swelling, excessive warmth of the joints, muscle strength and reflexes. Another telltale sign of RA is the presence of tissue lumps, or nodules, which occur in approximately one quarter of people with the disease.

Blood tests can also help properly diagnose RA. People with the disease often have rheumatoid factor and/or anti-cyclic citrullinated peptide–or anti-CCP–antibodies, as well as elevated erythrocyte sedimentation rate, or ESR. If RA is suspected, your physician may also order X-rays to determine how far the disease has progressed.

Treatment tactics

While RA cannot be cured, several treatment options can help ease symptoms. Non-steroidal inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, for example, can reduce pain and swelling, and analgesics such as acetaminophen can also be helpful.

Among prescription-strength medications, steroids such as prednisone can alleviate some of the RA symptoms. In some cases a physician may recommend corticosteroids, but these are typically not given more than two to four times a year.

Disease-modifying anti-rheumatic drugs, or DMARDs, can also help by slowing the progression of RA. Popular DMARDs like hydroxychloroquine and minocycline can reduce the severity of disease symptoms but also can have serious side effects. Other DMARDs include methotrexate and the newer biologic drugs such as tofacitinib.

Therapy is another treatment option, such as physical therapy that includes exercises aimed at easing pain by keeping joints flexible.

“We begin to lose mobility when not moving our joints because of the pain we’re experiencing,” says Dr. Cutright. “Occupational therapy, when done in conjunction with drug therapies, can help increase ease of function for everyday tasks, such as brushing teeth or chopping vegetables.”

Studies have also shown that some alternative therapies can help, such as yoga, tai chi, acupuncture and meditation.

“There are many new treatments in development as well,” adds Dr. Cutright. “The real key is early diagnosis and prompt initiation of appropriate therapy.”

6 common rheumatoid arthritis symptoms

  1. Regular joint stiffness in the morning
  2. Persistent joint pain that doesn’t improve or gets worse
  3. Swollen, red, hot or tender to the touch joints
  4. Joint pain with fever
  5. Several joints affected by symptoms
  6. Joint problems that interfere with your ability to move or function

Source: Arthritis Foundation

Robotic surgery: Where the art of medicine meets the power of technology

If the idea of robotic surgery conjures up images of the quirky “Star Wars” character R2-D2 attired in scrubs, think again.

Flesh-and-blood surgeons are increasingly gravitating toward robotic systems to help them provide better outcomes for their patients and reduce recovery times substantially. Using a surgical robot gives the surgeon added advantages by providing a three-dimensional view of the surgical site within the body, and a heightened ability to maneuver in tight places.

John Beddies, MD
Urologist at Kentucky Lake Urologic Associates

“Essentially, robotic surgery is a variation on laparoscopic [minimally invasive] surgery,” says Dr. John Beddies, a urologist with Kentucky Lake Urologic Associates. “We’re operating through small incisions in the abdomen, where we insert narrow tubes, through which we can pass long, thin instruments. Robotic instruments can flex like a wrist, so . . . it gives you the ability to reach around a corner with the robotic instrument,” he adds.

How it works

To perform robotic surgery, the surgeon has to prep the patient, make the incisions, and insert and position the robotic instruments. But while the surgery itself is in progress, the surgeon sits at a console in the surgical theater, away from the operating table.

“Think of it as computer-assisted surgery,” says Dr. Beddies. “And because the doctor isn’t standing for long periods, there is less of a fatigue factor, which is important in procedures that last for hours.”

Before you undergo a robotic surgery procedure, your doctor will provide material to familiarize you with how the surgery is performed and what you can expect afterward.

Healing advantages

After a robotic surgery procedure, you’re likely to heal faster because the length and difficulty of post-surgical recovery often has less to do with the organ or tissue that was operated on, and more to do with the incision site.

The future

As robotic equipment and techniques continue to evolve, this type of surgery will become an increasingly utilized alternative to traditional surgical methods, say experts.

“I’d say we could have the technology to do 80 to 90 percent of surgeries with minimally invasive procedures,” says Dr. Beddies.

With new technology comes a learning curve, and Dr. Beddies encourages patients to ask many questions when considering a robotically assisted procedure.

“Here at HCMC, we have performed many minimally invasive surgeries, including robotic assisted,” he adds.

Surgeries that can be performed using minimally invasive robotic systems:

  • Cardiac
  • Colorectal
  • Gynecologic
  • Thoracic
  • Urologic
  • Obesity
  • Gallbladder

Toasted Cinnamon Walnuts

This delicious snack provides the double health benefits of cinnamon and walnuts, which may reduce your risk of heart disease if you also eat fewer foods high in saturated fat and cholesterol. Let the fat-free egg white absorb the cinnamon before you proceed with the recipe.

1 tablespoon water
2 teaspoons ground cinnamon
1 egg white
1/4 cup granulated sugar
5 tablespoons light brown sugar
1/4 teaspoon salt
1/2 teaspoon vanilla extract
1 pound raw walnut halves (about 4 cups)

Stir water and cinnamon together in a large bowl. Set aside for 5 minutes. Add egg white and beat with wire whisk until frothy. Whisk in granulated sugar, brown sugar and salt. Whisk in vanilla. Stir in walnuts with large spoon, lightly coating nuts with cinnamon mixture.

Line a baking sheet with heavy-duty aluminum foil. Spray with nonstick cooking spray. Spread walnuts over foil. Bake walnuts in preheated 275-degree oven for 45 minutes or until crisp and lightly browned, stirring every 10 to 15 minutes. Remove from oven. Let cool on foil. Break up walnut clusters into bite-size or individual pieces.

Makes 16 (1/4-cup) servings.

Per serving: 215 calories / 18.5 grams total fat / 6.5 grams protein / 11.5 grams carbohydrates / 42 milligrams sodium / 2 grams dietary fiber