Ask the Expert: Dr. Susan Goodman, Rheumatologist, Answers Your Questions on Rheumatoid Arthritis
Q1: My mother developed RA in her mid fifties and many female relatives on her side of the family also had it. As her daughter, are the odds against me that I will develop it as well?
Although RA has a strong genetic component, it is a complex disease so multiple other factors additionally play a role. Studies in identical twins, a genetically homogenous group, reveal that only about half of identical twins develop the disease. This indicates that genetic factors are not the exclusive cause of RA. Moreover, twins who smoke are much more likely to develop RA than non-smoking twins, demonstrating the importance of environmental factors as well as genetic factors. Diet and exercise may also play a role. Although you are at higher risk of developing RA, the odds in your favor are good, in particular if you avoid factors such as smoking, which are known to increase your risk.
Q2: Are there certain lifestyle habits that can cause or bring on RA? I thought I read someplace that smoking could be a contributing factor and while I am not a smoker, wondering what else should be avoided or what can be done to prevent it.
Smoking is the habit most clearly related to the development of RA, and can also decrease the response to therapy and increase the severity of the illness. Although the Mediterranean diet, rich in fish and olive oil, or fish oil supplements, may improve pain and function in RA patients, this hasn’t been shown to decrease joint damage or delay or prevent the onset of RA. Hormone therapy and alcohol may improve the course of RA, but there are multiple other health considerations that may take precedence, so I don’t recommend them, but I do advise everyone to quit smoking and watch your diet.
Rheumatoid arthritis is a systemic disease characterized by inflammation of the joints, which can result in pain and damage as a result of the inflammation. Osteoarthritis may be caused by injury or overuse, and there is typically much less inflammation. Medications can treat RA systemically, and change the outcome. The course of OA cannot be altered by medication, but limiting trauma, losing weight, and strengthening the supporting muscles can slow joint damage.
Q4: If I have rheumatoid arthritis in one area of my body does that mean I will get it in another?
Although RA may affect a single joint, that is unusual. One joint may be disproportionately affected, however. There are other forms of arthritis, such as Lyme disease, that commonly affect a single joint, and should be looked for
Q5: Have alternative therapies such as acupuncture been proven to work?
The answer really depends on what you mean by work. Acupuncture can relieve pain, as can fish oil, but does not slow or stop joint damage. Alternative therapies can add a lot in terms of symptom control, but should not replace medications, which are quite effective in diminishing or preventing joint damage.
Dr. Susan Goodman is a rheumatologist and internist at Hospital for Special Surgery. She specializes in the treatment of rheumatic disease such as inflammatory arthritis. Dr. Goodman’s research interests have focused on the perioperative outcomes of rheumatic disease patients undergoing arthroplasty.