Arizona’s Rheumatoid Arthritis Specialists
A guide to rheumatoid arthritis pain management and treatment from Arizona’s rheumatoid arthritis specialists
Topic Guide
What is Rheumatoid Arthritis?
Symptoms of Rheumatoid Arthritis
What Causes Rheumatoid Arthritis?
Rheumatoid Arthritis Diagnosis
Rheumatoid Arthritis Treatment
Rheumatoid Arthritis Treatment
What is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is the second most common form of arthritis after osteoarthritis. RA is an autoimmune disease and occurs when the body’s immune system mistakenly attacks joints, often in the hands, wrists, and knees. Because rheumatoid arthritis is triggered by the immune system, symptoms can develop at any time, and may worsen in cycles that are known as “flares”. Rheumatoid arthritis often develops quickly compared to other forms of arthritis and progresses to cause joint damage over time if left untreated.
Unlike osteoarthritis which often develops gradually in adults 45 and older, rheumatoid arthritis is frequently diagnosed in middle-aged adults. However, RA may develop in young adults and children, or even in adults in their 60’s-70’s. When rheumatoid arthritis develops in children ages 6 months to 16 years, this is known as juvenile rheumatoid arthritis and is typically treated by a pediatric rheumatologist.
Symptoms of Rheumatoid Arthritis
Rheumatoid arthritis symptoms may come and go, but most people experience some, or all of the following symptoms:
- Aching or pain in more than one joint
- Joint stiffness or swelling
- Joint redness and warmth
- Fatigue
- Difficulty grasping or holding objects
- Fever
- Weight loss
Early Signs of Rheumatoid Arthritis
Some early symptoms of rheumatoid arthritis are similar to other diseases, which can make diagnosis difficult. Most patients who are diagnosed with rheumatoid arthritis develop difficulty doing daily tasks that involve fine motor skills of the hands, dressing, and twisting tops. If you experience new or worsening fatigue in combination with new joint stiffness or tenderness on both sides of your body, numbness or tingling in your hands and feet coupled with swelling of your hands and feet, or have a recent decrease in range of motion, you should contact your doctor or a rheumatoid arthritis specialist.
What Causes Rheumatoid Arthritis?
People with autoimmune diseases have immune systems that get disrupted to target and damage healthy tissues. The resulting inflammation is an overactive immune response and leads to what are recognized as symptoms. In the case of rheumatoid arthritis, inflammation within and around the joints causes pain, swelling, and redness. If this reaction is left untreated, the immune reaction continues and can cause damage to the joints. Bone, cartilage, and tendon damage, as well as joint deformity, are all possible risks of untreated rheumatoid arthritis.
It is believed that genes play a partial role in the development of rheumatoid arthritis. If you have a family member with RA, your risk of developing the disease may increase. There are also certain environmental triggers that have been linked to rheumatoid arthritis, including smoking, high alcohol consumption, and diet. Women are also about 3 times more likely to develop RA than men. This association is likely due to the role estrogen plays in regulating the immune system.
Rheumatoid Arthritis and Arizona Climate
Climate and weather do not directly cause rheumatoid arthritis, but they can have an impact on the severity of symptoms and the onset of flares. Here in Arizona, the dry air may help improve arthritis symptoms for those who were previously living in a colder or more humid climate.
Research suggests that changes in barometric pressure associated with higher humidity can cause the tissues around the joints to expand, which may increase arthritis pain and discomfort. In Phoenix, the average humidity is around 30-35%. Patients with RA who live in Phoenix may feel better during the warmer months and may feel a change in symptoms when traveling to cooler climates. It is recommended that patients who spend part of the year in Arizona and part of the year in another state (snowbirds) have rheumatoid arthritis specialists in both locations to help manage symptoms and medications between traveling.
Rheumatoid Arthritis Diagnosis
Rheumatologists or rheumatoid arthritis specialists usually diagnose RA after ruling out other potential causes for your symptoms. If you visit your primary care physician, they may refer you to a rheumatology specialist if they suspect you may be showing signs of RA or another rheumatic disease. Certain labs and X-rays of the joints with symptoms can be helpful to expedite your diagnosis. However, you do not always need a referral to visit an Arizona rheumatologist. Check with your insurance provider to determine whether a referral is required.
Rheumatoid Arthritis Tests
There are often several required tests to confirm a rheumatoid arthritis diagnosis. Rheumatoid Factor (RF) and Anti-Citrullinated Antibody (anti-CCP) are the most common labs used to diagnose rheumatoid arthritis. This quick blood draw can detect the presence of antibodies in the blood that can indicate if your immune system may be attacking your joints. Other blood tests include an ESR (erythrocyte sedimentation rate) and CRP (C reactive protein) that measure inflammation. Occasionally, these labs may be negative or normal, and imaging becomes helpful to determine if joint pain is due to rheumatoid arthritis. The types of imaging that are most helpful are:
- X-ray: These can detect bone damage around the joints caused by RA. In those with early-phase rheumatoid arthritis, an X-ray may not be enough to diagnose.
- Ultrasounds: This test uses sound waves to detect damage to bones and cartilage.
- CT Scan: This test may be more effective at identifying early-stage bone erosion caused by rheumatoid arthritis.
Rheumatoid Arthritis Treatment
Your rheumatoid arthritis specialists at Summit Rheumatology will work with you to create a treatment plan that reduces pain, increases physical function, and best fits your lifestyle. Rheumatoid arthritis treatment usually includes a combination of medications, physical therapy, and lifestyle adjustments.
Rheumatoid Arthritis Medications
Your RA treatment plan will likely include a combination of medications to best manage pain and prevent flares. Common rheumatoid arthritis medications include:
- Disease-modifying antirheumatic drugs (DMARDs): DMARDs are synthetic medications that slow disease progression. Methotrexate is the most common DMARD, but others include hydroxychloroquine, sulfasalazine, and leflunomide.
- Biologics: These are engineered medications that include live proteins that target the immune system to reduce inflammation. Biologics for RA are given via injection or infusion. Common biologic medications used to treat RA include Humira, Enbrel, Simponi Aria, Remicade, Cimzia, and Orencia. Biologics work differently depending on the individual and the type of medication. If a biologic doesn’t work for you, or stops working, your provider may prescribe a different medication.
- Non-biologic DMARDS: These medications are commonly referred to as JAK inhibitors and are oral medications that are typically used if someone has not responded to methotrexate or leflunomide. You can combine these medications with methotrexate also. The JAK inhibitors are Xeljanz, Rinvoq, and Olumiant.
- Corticosteroids: Prednisone and methylprednisolone (Medrol) are commonly prescribed steroids for RA. Steroids help decrease inflammation and pain quickly but are better used as treatments for flares rather than a long-term solution.
- NSAIDs: Nonsteroidal anti-inflammatory drugs can help reduce pain. These include ibuprofen, naproxen, celecoxib, or diclofenac.
Physical Therapy for Rheumatoid Arthritis
Physical therapy or occupational therapy can be very valuable in the treatment plan for rheumatoid arthritis. Therapy can reduce the risk of muscle atrophy, improve joint flexibility and range of motion, and help improve strength. RA physical therapy often includes a combination of stretching exercises, strengthening, and aerobic activity. Occupational therapy can help you learn how to modify your body movements so you are able to perform activities with less pain.
Your physical therapist or occupational therapist will help identify appropriate exercises for your condition. Your rheumatoid arthritis specialist will send a referral if physical or occupational therapy is right for your RA treatment plan.
Lifestyle Changes and Rheumatoid Arthritis
A combination of stress reduction habits, diet changes, and sleep hygiene can help reduce chronic inflammation in the body. Lifestyle adjustments and modifying daily habits may help improve symptoms of rheumatoid arthritis.
For instance, mindfulness meditation has been shown to reduce levels of inflammation in the body. A study on mindfulness meditation and its effects on the immune system by David S Black and George M Slavich, showed that 1600 participants practicing mindfulness meditation had a reduction in inflammation levels.
Diet may also have a large impact on the role of inflammation in the body. Certain foods, including gluten, casein found in dairy products, alcohol, sugar and refined carbohydrates, saturated and trans fats, and MSG have all been linked to chronic inflammation. Elimination of inflammation-inducing foods has been shown to improve the quality of gut bacteria in the digestive tract, which in turn decreases inflammation levels in the body. Improving the quality of foods to include more whole-food sources of nutrition, such as fruits, vegetables, whole grains, legumes, and plant-based products helps to naturally decrease inflammation.
Top anti-inflammatory foods include:
- Fruits, including blueberries, cherries, oranges
- Green vegetables (broccoli, kale, spinach)
- Fatty fish like salmon
- Olive oil or coconut oil
- Nuts and seeds
If you suspect that you might have rheumatoid arthritis, or are looking for a rheumatologist in Pheonix, Summit Rheumatology is accepting new patients. Call (480) 494-2770 or send us a message to schedule an appointment with one of our rheumatoid arthritis specialists who are ready to help you reclaim your health!
Meet Our Arthritis Specialists
Dr. Brittany Panico, DO
Chief of Rheumatology
“[Dr. Panico’s] guidance in my healthcare journey gives me great independence in my treatment...I look forward to the insight each appointment brings and am so grateful to be under her care.”
“...Dr. Panico takes the time to educate you...I know more about my condition in the 6 months I’ve been with [Dr. Panico] than I’ve understood in the 10 years with my previous practice...She is a breath of fresh air!”
W Richard Horn, NP
Rheumatology Specialist, Lupus and Fibromyalgia Specialist
“Richard Horn has been my rheumatologist since day one of being diagnosed with Lupus...He listens and [ensures] you get the answers to all of your questions... He is wonderful.”
“I’ve been seeing Richard Horn for over 10 years...He’s helped me through flares and medication changes...I highly recommend him.”
Peter Hennis, NP
Rheumatology Specialist
Peter Hennis, NP is an accredited nurse practitioner through the American College of Rheumatology. He received his degree from Case Western Reserve University and has clinical experience in the Medical and Neurological Intensive Care Units. He has a specific interest in gout, connective tissue diseases, osteoporosis, and other rheumatic conditions.
Peter has a holistic approach to treatment and values respect and dignity in his patient relationships. His ultimate goal is to help patients regain their functionality and foster education so patients can manage their autoimmune diseases with lifestyle changes.