Rheumatoid Arthritis


Feet

 Rheumatoid Arthritis

A look at symptoms

RA or Rheumatoid Arthritis is a poly-inflammatory arthritis meaning it causes swelling and pain in more than one joint.

It’s not your granny’s arthritis. While Osteoarthritis can develop in patients with Rheumatoid Arthritis, they are two distinct processes.

Rheumatoid Arthritis is an autoimmune disease. This means the patient’s immune system is malfunctioning and attacking the patient’s joints.  Since RA is a systemic disease, it can affect the heart, lungs, eyes, blood vessels, neurological system,  and even the blood components.

Symptoms of RA are usually insidious. At first the patient will have fatigue, loss of appetite, weakness, low-grade fever, and vague musculoskeletal symptoms.

As the disease progresses, the patient develops pain and swelling in multiple joints.  This usually happens in a symmetrical pattern–both hands, both feet, both knees. All joints may be affected by the disease.

The joints become painful, tender, and stiff. Morning stiffness lasts more than an hour and can last several hours. The stiffness of Rheumatoid Arthritis is nothing like muscle stiffness or joint stiffness from over-use. It’s much worse and can affect the person’s gait due to stiffness in the joints of the feet.

Possible symptoms of RA include:

  • Fatigue – The fatigue associated with RA is not relieved by rest. In fact, many times the patient wakes more fatigued than when he went to sleep the night before.
  • Joint inflammation – it may start in the joints nearest the hand – the wrists and fingers, but it may involve all of the joints. This inflammation can lead to joint erosion causing increased pain and deformity
  • Fever – Usually a low-grade temperature
  • RA Nodules – Not everyone develops these small bumps of tissue that form under the skin, but those who do, develop them on pressure areas. Nodules vary in size and aren’t usually painful.
  • Tendon inflammation and possible rupture
  • Anemia
  • Ischemic heart disease
  • Pericarditis – inflammation of the sac surrounding the heart
  • Pericardial effusion – fluid in the pericardial sac (sac around the heart).
  • Cardiac Tamponade – compression of the heart muscle caused by fluid in the pericardial sac – can be very serious.
  • Pleural Effusion – fluid accumulation in the sac lining the lungs
  • Pulmonary nodules – nodules forming in the lungs
  • Dry eye syndrome
  • Scleritis – inflammation of the sclera(whites) of the eye.
  • Keratitis – inflammation of the cornea
  • Scleromalacia – Thinning of the sclera of the eye
  • Nodules near nerve roots causing neurological symptoms
  • Cervical spine subluxation – dislocation of the first vertebra of the neck.
  • Hoarseness – caused by Rheumatoid changes in the cricoarytenoid joints (joints of the voice box)
  • Systemic vasculitis – inflammation of the blood vessels
  • Felty’s Syndrome – A syndrome that affects the blood countsBook Ad
  • Increased susceptibility to infection
  • Depression
  • Anxiety

Rheumatoid Arthritis is so much more than “just arthritis”.  This debilitating disease impacts the patient’s life significantly. On average, within ten years from diagnosis, the patient is no longer able to continue working, relationships are impacted because the patient is no longer able to participate in the activities he use to love.

As a systemic disease, RA decreases the life span an average of ten years. In patients with severe disease, untreated disease, or disease affecting the heart, lungs or blood vessels may have a severely decreased life span.

Sources:

WebMD
Family Practice Notebook
Arthritis.com
Healthline
Harrison’s Rheumatology Second Edition; Editor Anthony S. Fauci

Disabilities in Disney World

Disney World

There has been much discussion on the DisDining Blog on her Top 10 Bad Behaviors on a Disney World Vacation. Her number 6 urges park goers to watch out for strollers, wheelchairs, and scooters and not cut them off because none of these can stop quickly.

Many of the people have made some remarks about those who use scooter and/or wheelchairs. These comments show a lack of understanding about invisible diseases like Lupus, Rheumatoid Arthritis, Psoriatic Arthritis, Multiple Sclerosis, Heart Disease, severe Peripheral Neuropathy, and many, many more.

The comments ranged from frustrated to cruel. Here are a few examples:

there are privileges for people in wheel chairs at Disney also. One year we had to use it for our daughter when she had rods put in her back. BUT the number of rude people in wheel chairs and parents pushing strollers is huge. I could bet that 80% of the people who use them don’t really need them at all. Most are overweight and that is their excuse for using one.

One pet peeve of mine is scooters going to the front of the line. I am fine with it obviously if you are handicapped and you truly cant stand in line but a person who has a scooter because they are overweight or have a sore ankle and brings 5 or 6 people with them to the front of the line and then get off the scooter and walk onto the ride. Its fine to have a scooter to get around the park to cut down on the amount of time you are on your feet but if you can walk on your own then wait in line like everybody else.

#6 – this is a two way street! I won’t cut them off, but most of these people upset me every day on my trip because they are using wheelchairs when they don’t need to or they are constantly cutting me off!

The fat ppl who rent the motor scooters ans practically hit and run ur children. Also obesity is not a handicap and an excuse to cut the line. A bunch of excited four year olds should get first crack at pirates or the mansion over someone who ate too many fries to walk

I have to agree with most, however im not a 100% in agreement with #6 as I read on a lot of people also feel the same way. If I see a family walking with a stroller I will stop and stop my children so the rest of the family with the stroller can stay together that’s not a problem for me. My problem is the scooters and the wheel chairs . If some one is in a wheelchair or scooter for a medical reason fine its the over weight people and the lazy people that don’t feel like walking all day that drive me crazy . So stay back at the pool. I don’t mean to sound mean but some people use the wheelchairs and scooters to hold bags and to cart young tired children around or they are too heavy to walk . Now, aunt gertie lets little Bobby drive the scooter in circles while waiting for his family to come off space mountain and running everyone in sight over. And instead of saying oh im sorry they think its cute lil Bobby is driving a scooter. like I said before stay back at the hotel lil Bobby im sure will tell you all about his trip to magic kingdom in the morning.

The over-reaching think I see, is many of these people believe those who rent scooters and don’t look ill, are just fat and lazy.

I do realize some of the people making these comments do not want to understand chronic, invisible illness and nothing anyone says will make a difference, but there are some people who honestly don’t understand invisible illnesses and think if someone looks healthy, they are. After all, most of us with chronic illnesses strive to look our best when we go out in public. We actually put on make-up, dress decent, and try to appear normal.

In this post, I’m going to focus on autoimmune diseases in general. Future posts I will delve into the individual diseases and the symptoms caused be each one. Hopefully some of my friends who suffer from various diseases will allow me to share their photos.

Below, I’ve shared some of my photos. This is something I rarely do, but I thought it was important. I don’t look ill, in spite of having more than one autoimmune disease.

The first photo is before I developed the autoimmune diseases. Second is several years after a very bad flare necessitating prednisone for many years. The third photo is more current. I’ve been off prednisone except in short bursts for several years.

In the middle photo, it’s obvious that I’m quite heavy, and in the last photo, I’m still heavy. It’s something I’m working on, but it’s difficult when mobility is limited. The point of the photos is, while I look obese in the last ones, I don’t look ill.

Most people with autoimmune diseases look just fine. We don’t have missing limbs, limbs in casts (unless we’ve had recent surgery or a flare causing problems in a specific joint). In fact, to look us most people would never know we had a chronic illness.

I’ve shared these photos to show how chronic illness has changed me. Before I developed RA, I was very active: went to the gym three days a week, took Tae Kwon Do three nights a week, and played football, volleyball, went bowling, dancing, etc on the weekends – in addition to practicing Tae Kwon Do. I was young, energetic, and healthy.

Fast forward a few years. The middle picture shows what immobility and prednisone can do to the body. This photo was taken after I’d been on prednisone for many years. I didn’t like the changes in my body, but there was little I could do. 

Finally, my physician found the right combination of medications and I’m no longer on prednisone except in short bursts. I am still overweight. It’s a long road to return to a healthy weight.

My diseases have progressed to the point that I now must use a scooter to go any distance. I haven’t been able to go to Disney World or Disneyland for several years without the use of a scooter. If I’m going to a large store, I have to use one also.

People look at me like I’m “fat and lazy” and use the scooter because I don’t want to walk. This couldn’t be any farther from the truth. I would love to be that energetic girl who went non-stop once again, but unfortunately I cannot. For many years when we went to theme parks, I pushed myself and refused to use a wheelchair or scooter, but these diseases don’t stand still – even with medications the disease progresses. Not like it would without the medications, however. 

Most autoimmune diseases cause the following symptoms:

Fatigue – unlike normal fatigue, the deep, bone-aching, intense fatigue isn’t relieved by rest. Many times those with autoimmune diseases wake up feeling even more tired than when they went to bed. Many times we cannot do the things we really want to do. It’s frustrating for us, then when others get angry or upset with us over it, it multiplies the symptoms.

Muscle and Joint Pain – This can range from burning and aching to feeling like someone has a jackhammer destroying the joints – which in the case of Rheumatoid Arthritis and Psoriatic Arthritis – is kind of true since the body’s immune system is destroying the joint. The pain may also move. One day it may be the feet, the next the hand. It can also move hour to hour. Many times it’s a generalized achiness. 

Fever – at times people with autoimmune disorders will have an elevated temperature. With some AIs (autoimmune) it can be a low-grade, but in others, the fever may go quite high.

Hair loss – The hair loss can be caused by the disease or by the medications to treat the illness.

Flu-like symptoms – All AIs cause generalized malaise, or ill-feeling. Think about how you felt the last time you had the flu. People with an autoimmune disease feel like this most of the time. 

Brain-fog – This symptoms comes and goes, but it causes the person with the autoimmune to feel a little disoriented. It can be caused by the disease or the medications.

Depression – Finding out you have a debilitating, chronic illness that you will deal with for the rest of your life is depressing. Then you add medications that can cause depression to the mix and most with autoimmune diseases suffer some degree of depression. 

Isolation – while this is not a direct symptom of the disease or medications, it is a result of not being able to fully participate in life. We do go on vacations, to family get-togethers, etc as much as possible, but for the most part, we spend a great deal of time alone.

The next time you see someone using a wheelchair or scooter, even if they can “obviously” walk, keep in mind, while they may walk a little ways, walking the entire park, store, mall, etc may be overwhelming due to the fatigue and pain.

Try to imagine living your life with a bad case of the flu. Every. Single. Day. You ache all over, feel exhausted, and have fever, dizziness, and nausea at times.

Most people who get the flu go to bed, take medication, and put life on hold until they recover. Those with chronic illnesses don’t get that luxury. We must push on for our families, and because we want to be a part of life. Being absent from life adds to the feelings of depression and isolation.

Before you make the harsh comments, stop a minute and think about those who have invisible diseases. The comments about us just being “fat and lazy” do hurt. We would trade places and walk the parks, stores, etc at any time. However, we would never wish this illness on you or anyone else.