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- The immune system as many people are aware of is
like a good police force that is out there
to keep your body and your community safe.
So it's always watching out for and taking care
of bad actors, and by that I mean infections.
And even cancer, so if you have viruses that are affecting
your body, bacteria, that are affecting your body
it's your immune system that fights off these bad actors
and then makes your body healthy again.
That's what a healthy immune system does.
But sometimes the immune system turns against it's own
self instead of just watching out
and taking out the bad actors it's actually coming out
and damaging or destroying it's own self.
So that is the meaning of the term Autoimmunity.
So when I think abut Rheumatoid Arthritis, I think about
a chronic, which means lifelong arthritis
which means involving the joints.
And Autoimmune Arthritis which means it's the immune system
which is causing damage and destruction to the joints
however Rheumatoid Arthritis is much more than the joints
only because it can involve other parts of your body
as well such as skin, lungs, eyes, et cetera.
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So when a patient has Rheumatoid Arthritis particularly
if it's untreated, they have ongoing inflammation
in the body when you think about
chronic ongoing inflammation I almost think about
chronic smoldering fire, you have to put it out.
Because if you don't it's gonna cause damage
and destruction, so what the patient experiences
is not only pain, stiffness, and swelling that is directed
in their joints these symptoms include fatigue.
Fatigue is a very common presentation of patients
with Autoimmune diseases, so they may feel unusually tired
not able to do things that they would want to do
on a typical day, as I have just mentioned
it can involve their eyes.
Patients can have dryness of their eyes and their mouth.
Patients can experience symptoms in their lungs,
they can have a chronic cough, they can have shortness
of breath because the inflammation
can affect their lungs as well.
Some patients can present with a condition known as
Raynaud's Phenomenon, Raynaud's Phenomenon is when your
fingers and even toes can turn white or they're very
effected by the cold weather, and then they can have
involvement of their skin as well.
So sometimes patients can develop ulcers that are also
related to Rheumatoid Arthritis.
They can also have involvement of their nerves so a patient
may come to my clinic and say doctor Haque,
I'm experiencing numbness and tingling in my feet
I wonder why and that itself can be also related to damage
to the nerves in the hands and feet again,
because of Rheumatoid Arthritis.
So as a Rheumatologist, when I'm seeing a patient with
Rheumatoid Arthritis I'm of course focusing on their joints
but then I'm focusing on other organs and I'm making sure
that I pay attention to what else Rheumatoid Arthritis is
effecting in that particular patient.
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Many people think that in Rheumatology we take care of
old age diseases, that's actually not the case,
many patients with Autoimmune diseases are effected
in their 20s and their 30s, but if you look at the peak
age when Rheumatoid Arthritis is diagnosed it's typically
in a patient whose in their 40s or their 50s.
That does not mean that patients in their 70s
and 80s cannot be diagnosed with Rheumatoid Arthritis so we
can diagnose this disease any time of a patient's life.
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Two decades ago when a patient was diagnosed with
Rheumatoid Arthritis I think the biggest concern that the
patient and the treating Rheumatologist had was how do I
control this disease so that the patient can avoid
being in a wheelchair in the next decade or two?
Well the wonderful news about medical advancement in
treatment of Rheumatoid Arthritis, is that we have such
effective therapies for Rheumatoid Arthritis that we have
been able to have a big impact on chronic disability.
And that patient you know in terms of their risk of
ending up in a wheel chair it's, really at this point
we have minimized it to the point that it is rather
not existent, however for that of course the key is
effective treatment and good followup
with your Rheumatologist.
While we have made a big impact on treatment
and avoiding disability in our patients, there's still
something that we as Rheumatologists want to keep a very
close eye on and monitor in our patients
with Rheumatoid Arthritis and I think the key for me
is their risk of heart disease and strokes.
We know that patients with Rheumatoid Arthritis
are at twice the risk of having a heart attack
or a stroke compared to a patient who does not have
Rheumatoid Arthritis, so I'm always thinking about
in this 40 year old patient with Rheumatoid Arthritis.
How do I minimize that risk and that basically means
we want to make sure their blood pressure's well controlled
their diabetes is well controlled,
cholesterol is well managed, the patients are exercising,
they're eating a good diet and keeping an ideal weight.
The other concern that I always have for my patients
with Rheumatoid Arthritis were on these very powerful
medications for Rheumatoid Arthritis.
Is that I want to make sure that I am closely monitoring
them for any medication toxicity and side effects.
As I said, while we have miraculous medications,
they need to be taken under supervision
of a Rheumatologist, of a physician
who has expertise in managing patients on these medications
so I think that's the other thing,
we want to make sure that over the lifespan of our patients.
That we manage them and monitor them very closely
for any side effects of these medications.
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