5 Questions to ask your Rheumatologist about Rheumatoid Arthritis
Updated: Dec 8, 2022
1. Is my rheumatoid arthritis seropositive or seronegative?
Seropositive rheumatoid arthritis is associated with either a positive rheumatoid factor or anti-CCP antibodies, or both. Seropositive RA usually portends a more severe clinical course and possibly a worse prognosis. It is more likely to cause rheumatoid nodules to occur over the tendons or joints, as well as manifestations of the autoimmune disease outside the musculoskeletal system.
On the other hand, seronegative rheumatoid arthritis does not have typical findings in blood work. The diagnosis is based on swelling of the joints on examination, or damage detected on joint X-rays.
2. Do I have any erosions developing on my joint X-rays?
Erosions are evidence of permanent damage starting to occur in your joints, which can be spotted on imaging such as X-rays and MRIs. It usually results from severe or uncontrolled RA causing ongoing inflammation in your joints and other tissues over months or years. Erosions that have already occurred on joints cannot be reversed. This, the main goal is to prevent erosions from occurring altogether.
Usually the patients I have seen with severe erosions and chronic deformities of the fingers, wrists, and other joints are ones who were diagnosed before good treatments were available, or ones who didn’t have access to proper care. Usually we are able to prevent erosions from developing by using the variety of medications we have now.
3. Am I considered to have high, moderate, or low disease activity level?
Another goal of good rheumatologic care is to maintain low disease activity levels, which means that rheumatoid arthritis is considered in remission and doesn’t affect a person’s quality of life. Low disease activity levels usually means that RA won’t result in permanent joint erosions.
There are certain disease activity scales such as RAPID3 and CDAI which measure how many tender and swollen joints are present, and how much one is able to do tasks like get dressed or pick up a cup without pain. Certain lab markers of inflammation such as ESR and CRP may also be taken into account when determining disease activity level.
4. Are my treatments meant for symptom suppression or symptom resolution?
Ask your rheumatologist whether your treatments for rheumatoid arthritis are just covering up the symptoms or actually addressing the underlying issues of inflammation and the autoimmune process. Certain medications such as methotrexate are "disease-modifying," meaning they have long-term protective effects for the joints, whereas pain medications like Tylenol or ibuprofen are just a temporary band-aid to cover up the symptoms without any long-term benefit.
5. Are there any lifestyle changes I can make to help manage my arthritis?
Your rheumatologist may discuss lifestyle changes such as quitting smoking to reduce inflammation in the body. He or she may also discuss the anti-inflammatory diet and good nutrition for arthritis. Exercise and physical therapy for arthritis may also help you to become as active as you would like to be. Hand physical therapy can help you regain strength and dexterity of the hands while preventing stiffness and poor functioning.