Rheumatoid arthritis is an aggressive and destructive condition. Joints, tendons, and ligaments can be destroyed that result in pain and functional limitation. The treatments introduced the last 15 years have dramatically altered the outlook for this condition. The newer treatments certainly need to be monitored closely, but they prevent progression of the disease unlike any other treatments available. For someone who starts treatment prior to developing any damage, it is reasonable to predict that with treatment their condition should not progress throughout their lifetime. This does not mean the condition has been cured. Rather with treatment it is under control and put into a remission state.

So what happens if someone with RA is still symptomatic? Using a combination of musculoskeletal ultrasound combined with a focused exam and basic lab tests can help determine whether an actively inflamed process from RA is at fault. If so, then adjusting RA meds may be necessary. There are so many outstanding biologic treatments available for RA, if one isn’t working, changing to another medication can make a big difference.

Alternatively, if it’s determined that there is no active inflammation, then evaluating for a degenerative process affecting joints or tendons is necessary. RA patients are more likely to suffer from degenerative musculoskeletal problems as well; partially due to chronic damage from previously injured joints. Degenerative conditions even in RA patients can be treated with some of the newer regenerative medicine techniques. These other non-inflammatory conditions are frequently dismissed as just “old age arthritis”. But they are painful, functionally limiting, and can severely affect quality of life. These shouldn’t be ignored. Using newer cell based biologic treatments that are specific for osteoarthritis and tendinitis these frequently dismissed problems can be treated as well. In addition, thyroid deficiency is more common in individuals with RA, and nutritional deficiencies such as vitamin D and B12 are common and can cause pain and fatigue as well. In other words, avoiding tunnel vision and addressing the other concerns in RA patients can further improve their quality of life.

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