Approximately 15 million people in the United States live with autoimmune diseases, and women account for at least two-thirds of those cases. Rheumatoid arthritis represents a significant share of that group, taking a considerable toll on patients.
Still, an expanding array of treatments is offering many people with rheumatoid arthritis the chance to reclaim a satisfying quality of life.
“I had perfect health in my life,” notes Kate Zulak of Ambler, Pennsylvania.
Zulak enjoyed good health well into her seventies before anything changed.
“All of a sudden, my left arm wasn’t working,” she recalls. “From there, it really went to my feet. I would wake up in the morning, and I could not walk to the bathroom.”
Initially, her physicians suspected a muscle problem or a spinal disk issue.
When six weeks of physical therapy brought no improvement, blood work revealed rheumatoid arthritis, commonly known as RA.
“It is a condition where the immune system is attacking the joints,” says Dr. Enid Sun, a rheumatologist with Temple Health.
According to Dr. Sun, inflammation defines RA.
“That would include swelling in the joints, redness, warmth,” she says.
The condition differs from osteoarthritis, which involves joint deterioration caused by cartilage loss. RA also does not typically target the spine or hips the way osteoarthritis does.
Instead, as Zulak experienced, RA frequently strikes the small joints of the hands and feet first.
“I can’t make a fist anymore. I mean, the hands will close, but there’s no pressure,” she says.
The trouble with her hands led to some unexpected challenges.
“I remember I could not put my trousers on. So I had to then purchase elastic trousers and things, because my hands could not do the button or the zipper,” she says. “Dry eyes, dry mouth, It affects your whole body.”
The disease also generates antibodies in the bloodstream that serve as markers for the condition.
Dr. Sun notes that patients now have many choices for bringing down RA inflammation.
“All the medications work by suppressing or altering the immune system in some way,” she explains.
Zulak tried multiple therapies before landing on one that worked.
The first, a chemotherapy medication, relieved her hand symptoms right away and kept working for six months. However, blood tests eventually flagged concerns.
“I wasn’t tolerating it, and there were liver issues,” Zulak says. “Put on another drug, which didn’t work, and then another drug. And then a year ago, decided to try the biologics and that has worked in conjunction with a daily pill that I take.”
Dr. Sun believes that developing a screening test for inflammatory markers could help reduce that process of trial and error.
“Maybe we can, kind of, more precisely pick a medicine that’s going to work better for them,” she says.
Zulak credits staying active , walking two or three miles each day and a half-century of daily yoga , with supporting her mobility and function. Managing stress and pacing herself also help.
“Patience is very important because it will be with you the rest of your life,” Zulak says.
Although the precise cause of RA remains unknown, Dr. Sun says the initial onset and flare-ups likely stem from a combination of genetic factors and environmental triggers such as smoking and infections.