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Frequently asked questions about RA Dr Joseph
My blood tests are normal; how can I have RA? It is very important to remember that not all people with RA have the characteristic blood results (antibodies in their blood like the ‘rheumatoid factor’). There are at least 25% of people with RA that have so called ‘seronegative’ RA meaning that the antibodies in question are negative while they actually have the condition.
I know I have RA because I have the blood test which is positive In contrast to our previous point, one should remember that the diagnosis of RA is made by the rheumatologist using the history, the clinical examination and the support of some blood tests like the markers of inflammation and the rheumatoid factor. However having positive rheumatoid factor on a blood test is something that may occur in people without RA. It is not enough to have rheumatoid factor in the blood for the diagnosis to be made. The clinical picture, history, examination, xRay findings and disease progression need to fit rather than just having a positive blood test.
I have been taking drugs for a month now but I have seen no result This is a logical and frequent point made by people with RA. Most drugs that change the disease course (the so called disease modifying antirheumatic drugs) take two or even three months to work fully. The only way for someone to respond quickly during the first days and weeks is by taking cortisone treatment either into the joint by injection or by mouth, or by intramuscular injection. Antirheumatic drugs need time to work and a significant proportion of patients will need a second and sometimes a third drug or to replace one drug with another etc. The management of RA by the rheumatologist is not simply taking a tablet to be cured, but a long undertaking and has at its centre the close cooperation of patient and rheumatologist.
It has been suggested that I take cortisone but I know that I should never take this drug This is one of the biggest myths in rheumatology as well as in other specialties of medicine. In large doses without control, cortisone is
a very dangerous drug. But given in small doses for short periods of time, or with continuous and careful monitoring by doctors, then it is not as dangerous as leaving the disease untreated. In other words, if you weigh on the one hand the damage that the disease can cause and on the other the potential side effects of low dose cortisone, surely the damage from the disease weighs more.
I am taking long term antirheumatic drugs. Surely they will do some damage to my body There are no drugs in medicine without side effects. The important point about the antirheumatic drugs is that they are watched carefully by the rheumatologist and in particular they are monitored frequently using blood tests. The blood test makes sure that in almost all cases there is no danger of severe side effects. When we have abnormal blood results then we can reduce or discontinue the treatment appropriately. The vast majority of people taking antirheumatic drugs do not have any significant side effects.
I have been well for many months now. Why should I continue taking the drugs? This emphasizes why the diagnosis of RA has to be made by specialists. Once the antirheumatic drug is started and because its role is to avoid or reduce the damage to joints, then its use is long term. The aim is for someone to live a normal life if possible without remembering that they have the disease but just because someone is well doesn’t mean they can stop their drugs. This is because in people who really have RA, stopping the drugs tends to result in a worse flare of the condition and antirheumatic drugs tend not to work as well when they are restarted.
What else should I pay attention to apart from my joints? A recent and very important observation in rheumatology is that people with RA have increased chances of cardiovascular events like heart attacks and strokes. Therefore one should be very careful with risk factors like smoking, high blood pressure, high cholesterol, diabetes and not taking adequate exercise.
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