Rheumatoid Arthritis
Advanced treatment for rheumatoid arthritis in Encinitas CA
Seaside Rheumatology and Wellness Center is known for providing quality care and advanced therapies in Encinitas, CA. We treat all types of rheumatological conditions, including rheumatoid arthritis (RA). Rheumatoid arthritis is an inflammatory condition affecting the synovium, which is a connective membrane in joints. It serves several functions, the most important being production of synovial fluid, which is the lubricant that keeps joints moving freely.
In people affected by rheumatoid arthritis, the synovium inflammation causes proliferation and abnormal fibrous tissue growth. Over time, the abnormal fibrous tissue can invade ligaments, cartilage, and bone tissue around joints. It causes swelling and pain, with eventual degradation and deformity of the impacted joint.
Causative factors
The exact cause of rheumatoid arthritis is still unknown, but researchers believe that some people may be genetically predisposed to rheumatoid arthritis, which is then triggered by environmental conditions. Rheumatoid arthritis is thought to activate the adaptive immune system, which actually perpetuates the condition, while the innate immune system is exerting a persistent adjuvant effect.
Rheumatoid factor (RF) and other antibodies are commonly present in blood of rheumatoid arthritis patients. They may be detected years before the development of rheumatoid arthritis.
Dr. Peter Lloyd - Treatment Options for Rheumatoid Arthritis at Seaside Rheumatology and Wellness Center
Rheumatoid arthritis is an inflammatory arthritis that can lead to significant joint deformity if left untreated. Rheumatoid arthritis can affect any age group—it can happen in young children, middle-aged individuals, or even elderly adults.
Rheumatoid arthritis is diagnosed based on clinical symptoms, labs, and various imaging modalities such as X-ray and MRI. The treatment goal for rheumatoid arthritis is to essentially reduce inflammation enough to a point that the disease is in remission.
There is no cure for rheumatoid arthritis, and therefore, patients will require maintenance therapy for many years.
There are several types of medication treatments. Treatment for rheumatoid arthritis is initially with a combination of natural supplements and medications known as disease-modifying anti-rheumatic medications. This combination provides significant benefit in most patients. However, a large group of these patients will continue to have active disease despite using these medications.
Therefore, patients with persistent disease despite the more traditional treatment methods will then require newer medications known as biologic therapies. These medications are, for the most part, injectable. Some of the newer ones on the market are actually oral medications now.
The overall goal of these medications is similar to the traditional disease-modifying anti-rheumatic medications in that they modulate or suppress the immune system in a way that reduces inflammation in this disease and prevents joint damage from happening.
Environmental factors may trigger the onset of rheumatoid arthritis or exacerbate symptoms. These factors include:
- Changes in oral, digestive, or respiratory microbiomes
- Exposure to silica
- Nicotine use
- Parvovirus B19, Epstein-Barr, and certain other viruses
Risk factors for rheumatoid arthritis
- Ethnicity – This is not a risk factor
- Gender – Women are three times more likely to get rheumatoid arthritis than men are
- Age – Symptoms can develop at any age, but most often begin between the ages of 40 and 60
Progression of symptoms
Rheumatoid arthritis can range from debilitating to mild symptoms, depending on the patient and the progression of the condition. In more than half of patients, the symptoms develop slowly and insidiously, over a period of weeks or months. In 20 percent of patients, the onset is subacute (somewhat rapid) onset, and about 10 percent have acute (very sudden) aggressive onset.
In most patients, smaller joints are affected before larger ones are. Commonly affected joints include:
- Hands and feet – Metatarsophalangeal, proximal interphalangeal, metacarpophalangeal, and wrists
- Spine – Especially C1 and C2 vertebra in the neck
- Other joints in the body
Some patients develop extra-articular (not involving joints) symptoms. This is more common in males who are HLA-DR4 positive and RF positive. Extra-articular symptoms may include:
- Rashes or nodules below the skin
- Pericarditis or myocarditis (types of heart related inflammation)
- Neuropathy (nerve dysfunction, often affecting hands or feet)
- Ocular inflammation
- Lymphoma (a cancer of the blood)
- Felty’s syndrome (a condition characterized by low white blood cell count, rheumatoid arthritis, and enlargement of the spleen)
- Interstitial lung disease (a progressive lung condition)
- Sjogren’s syndrome (affects mucous membranes)
- Amyloidosis (accumulation of harmful proteins in organs)
- Atherosclerosis (buildup of plaque in the arteries)
How rheumatoid arthritis is treated
Researchers have made significant progress identifying the genetic and immunologic factors of rheumatoid arthritis, as well as clarifying the epidemiological and clinical features of the condition. Even more important, the medical community has made great strides in developing biologic and systemic treatment options.
Traditional therapies include:
- NSAIDS – Over the counter or prescription medications such as indomethacin, diclofenac, naproxen, or ibuprofen, can provide fast and temporary pain relief and reduction of inflammation. However, they only address symptoms. They do not slow the progression of the condition.
- DMARDs – cyclosporine, minocycline, azathioprine, methotrexate, hydroxychloroquine, sulfasalazine, leflunomide, and cyclosporine can slow or halt development of the condition and help prevent joint damage. However, it can take months for these medications to fully take effect.
- Steroids – These fast-acting treatments can significantly improve swelling and pain, usually within 24 hours. However, they are not recommended for long-term use due to side effects.
- Biologics – This group of medications includes infliximab (Remicade®), certolizumab (Cimzia®), golimumab (Simponi®), adalimumab (Humira), and etanercept (Enbrel®), which are tumor necrosis factor-alpha blockers. It also includes tocilizumab (Actemra ®), rituximab (Rituxan®), anakinra (Kineret®), and abatacept (Orencia®), which are non-TNF inhibitors. These medicines are administered intravenously or via injections, and they work to slow or stop rheumatoid arthritis.
- Other – The oral medication tofacitinib (Xeljanz®), which is a JAK kinase inhibitor, may be used in some cases.
Integrative rheumatoid arthritis therapies include supplemental nutrition and dietary changes. This is often a highly successful approach, when supervised by a skilled rheumatologist such as Dr. Lloyd. This may include:
- Elimination diets
- Supplemental omega-3 polyunsaturated fatty acids
- Prebiotics and probiotics
- Sea cucumber extract
- Herbal supplements such as devil’s claw, Oregon grape, black currant seed oil, Boswellia, turmeric, and yucca schidigera
It is important to seek treatment early, in order to minimize or avoid progressive joint damage. Without treatment, it can become severely painful and lead to irreversible deformities.
Frequently Asked Questions About Rheumatoid Arthritis
What are the early signs of rheumatoid arthritis, and when should I see a rheumatologist?
Early rheumatoid arthritis symptoms may include persistent joint pain, swelling, warmth, and stiffness, particularly in the hands, wrists, feet, or knees. Morning stiffness that lasts 30 minutes or longer can also be a warning sign. Unlike occasional joint discomfort, rheumatoid arthritis symptoms may affect multiple joints and persist for weeks. Seeing a rheumatologist early is important because prompt diagnosis and treatment can help control inflammation and reduce the risk of permanent joint damage.
How is rheumatoid arthritis diagnosed when symptoms can resemble other joint conditions?
Rheumatoid arthritis diagnosis typically involves a combination of your medical history, physical examination, blood tests, and imaging. A rheumatologist may evaluate the location and pattern of joint swelling and order tests for inflammatory markers and antibodies associated with rheumatoid arthritis. X-rays, ultrasound, or other imaging may also help assess joint inflammation or damage. At Seaside Rheumatology and Wellness Center, patients receive a comprehensive evaluation designed to distinguish rheumatoid arthritis from osteoarthritis and other inflammatory conditions.
What rheumatoid arthritis treatment options can help reduce joint pain, stiffness, and inflammation?
Rheumatoid arthritis treatment focuses on controlling inflammation, relieving symptoms, preserving joint function, and slowing disease progression. Depending on your condition, treatment may include disease-modifying antirheumatic drugs, biologic medications, targeted therapies, or other medications for pain and inflammation. Exercise, physical therapy, and lifestyle modifications may also support mobility and overall wellness. Because rheumatoid arthritis affects each person differently, treatment is typically adjusted according to symptoms, disease activity, and response to medication.
Can rheumatoid arthritis cause permanent joint damage if treatment is delayed?
Yes. Persistent inflammation from uncontrolled rheumatoid arthritis can gradually damage cartilage, bone, tendons, and surrounding joint structures. Over time, this may lead to reduced mobility, joint deformity, and difficulty completing everyday activities. Early treatment of rheumatoid arthritis can significantly reduce inflammation and help protect joints before irreversible damage occurs. Regular follow-up with a rheumatologist is also important for monitoring disease activity and modifying treatment when necessary.
How does a rheumatologist determine which rheumatoid arthritis medication is right for me?
Medication selection depends on several factors, including the severity of your rheumatoid arthritis, which joints are affected, previous treatments, other health considerations, and your individual response to therapy. At Seaside Rheumatology and Wellness Center in Encinitas, California, treatment plans are personalized rather than relying on a one-size-fits-all approach. Ongoing monitoring allows the rheumatology team to evaluate how well medication is controlling inflammation and make adjustments when appropriate.
How long does rheumatoid arthritis treatment take to start improving my symptoms?
The timeline varies depending on the medication and the severity of your symptoms. Some treatments may begin reducing pain or inflammation relatively quickly, while disease-modifying medications and biologic therapies can take several weeks or longer to provide their full benefit. It is important to continue treatment as prescribed rather than stopping because improvement is not immediate. Your rheumatologist can monitor your progress and determine whether your treatment needs additional time or adjustment.
How often should I see a rheumatologist after starting treatment for rheumatoid arthritis?
Appointments may be more frequent when you are first diagnosed, beginning a new medication, or experiencing a rheumatoid arthritis flare. Once the condition is well controlled, visits may be spaced farther apart. At Seaside Rheumatology and Wellness Center, ongoing rheumatoid arthritis care includes monitoring symptoms, joint health, medication effectiveness, potential side effects, and laboratory results when needed. Consistent follow-up helps keep treatment aligned with changes in your condition and supports long-term disease management.
If you have been diagnosed with rheumatoid arthritis, or you are exhibiting any signs of the condition, please call Seaside Rheumatology and Wellness Center and schedule a consultation.
