Bill Klaproth (Host): Rheumatoid arthritis is an autoimmune disorder that causes pain, swelling and loss of joint function. And here to talk with us about rheumatoid arthritis and other conditions rheumatologists treat is Dr. Kam Newman, a rheumatologist at Eisenhower Medical Center. Dr. Newman, thank you for your time. Can you explain to us what rheumatic diseases are, how they are discovered and what do you see most in your practice?
Dr. Kam Newman, MD (Guest): Sure, and thank you for your time and asking these questions. Actually, rheumatology is the disease regarding the joints, ligaments and cartilage. The rheum comes from the Greek word means river and at that time, people were thinking there is a disease in the river which damages the joints and they called it rheumatism. The most common one I see in the clinic is rheumatoid arthritis which is chronic inflammatory arthritis damaging the hands, and feet which is preventable. We have lots of treatment options and besides rheumatoid arthritis, we have some other common rheumatologic disorders such as lupus and Sjogren's and lupus is famous for the skin rash and kidney damage and Sjogren's is dry eyes, dry mouth, arthritis and easy fatigability.
Bill: So, there are many different rheumatic diseases then.
Dr. Newman: We have bunch of rheumatologic disorders which comes from fighting of your own immune system with your own body. That being said, the damage can be head to toe, from the brain to the eyes, to the mouth, to the joints, and actually rheumatology is not the science of the joint and cartilage and bone only; half of the patients come with a skin rash. So, that being said, this first tissue can be affected too.
Bill: So, many different areas of the body can be affected. And how debilitating can rheumatoid arthritis be?
Dr. Newman: Rheumatoid arthritis can damage the joints. All of us know that. However, the inflammation of the rheumatoid arthritis can go to the lung which we call it rheumatoid lung, can go to the heart and patient may come with coronary artery disease and also can affect other organs including the kidneys, but the most prominent manifestation is deforming joints, mostly in the hands and when the damage is done, unfortunately we do not have treatment for it. So, I recommend see the rheumatologist as soon as possible and seek for treatment to prevent damage to the joints and also your heart and lungs.
Bill: So, Dr. Newman, what are the early signs that may help someone recognize their need to see a specialist?
Dr. Newman: The most common sign is morning stiffness. I always ask my patients, morning stiffness, when you wake up in the morning you feel stiffness in the small joints. Mostly in the toes and fingers and it gets better during the day, at nighttime you have the stiffness again. Also, it's the pain and swelling and sometimes patients tell me they cannot use their ring because it does not fit anymore. Their finger is getting swollen and besides that, it can present just with cough, dry cough and shortness of breath or skin rash. But most commonly we see with swollen, tender joints, more than six weeks.
Bill: So, Dr. Newman, you said once the damage is done, it's done. So early intervention is important then?
Dr. Newman: It's absolutely true. We have - recently I had a presentation here at Eisenhower Medical Center as part of the CME, Continuous Medical Education and I called it Golden Age of Rheumatology. We can target the inflammation. We have new medications. We call it biologics. You hear a lot in TV advertisement these days. And we can target inflammation with less side effects with our previous medications such as prednisone without going anywhere else, we target the joints and we remove the inflammation from the joint and we prevent damage to the joint with less side effects. I recommend patients seek for treatment of RA as soon as they are diagnosed, and the American College of Rheumatology guidelines says we need to treat Rheumatoid arthritis aggressively before damage to the hands and wrists is done.
Bill: And how does rheumatoid arthritis affect women differently than men and does hereditary makeup play a part in this?
Dr. Newman: Absolutely it is true, and you asked the one-million-dollar question. We have genes for RA and RA is more common in women. Those genes we call it HLA, human leukocyte antigen. And that prones patients to have rheumatoid arthritis and it is somewhere between 20-60% of the patients with RA they are carrying that gene. HLA DR4 which is the gene also smoking that study shows that smoking both induces and promotes the RA. If you have RA, you have to stop smoking as soon as possible. Also, patients who are exposed to silica, they may develop RA more than other patients. Environment is very important.
Bill: Well, that's very interesting. So, we know that genes play a role, so then can lifestyle changes lower the risk for rheumatoid arthritis?
Dr. Newman: That's absolutely true. Lifestyle change number one is smoking and number two is lots of studies support gingivitis induces RA. The bacteria which induces gingivitis, inflammation of the gum, they are prone to have more rheumatoid arthritis. If you have rheumatoid arthritis, I always send my patients to the dentist to make sure my patient does not have gingivitis. That's very important. Also, the third thing is the bacteria. When you are prone to have more infections, you may develop rheumatoid arthritis, that's very important too.
Bill: Wow, that is really interesting. So, when it comes to treatment then, I know you said you want to hit it hard very aggressively. What is the long-term outlook for someone with rheumatoid arthritis and how do you treat it differently today, than you did 20 years ago?
Dr. Newman: Twenty years, actually rheumatology changed in the past five to six years. Our vision absolutely changed. We used to treat with either prednisone or hydroxychloroquine but now we treat aggressively with biologics to prevent damage to the joints and I want to mention most of our patients are in their productive ages, somewhere between 30-50 still they are working, they need their hands and we need to treat rheumatoid arthritis aggressively. Somewhere between 10-15% of them, they may receive treatment and we may kill the rheumatic arthritis. So, I really encourage patients to seek for treatment as soon as possible because we can prevent damage to the joints, we can give them quality of their life and we can get back to work with no pain, no stiffness, no deformity of the hands.
Bill: Such good news Dr. Newman. So, with early intervention, and aggressive treatment, and then lifestyle changes; someone can effectively manage this throughout their lifetime. Is that right?
Dr. Newman: That's absolutely true. And these days, as of today in 2018, we should not see anybody with joint damage, with hand deformity or disability. I just want to mention right now, disability in the United States the number one reason is arthritis because you are healthy, you cannot use your hands, you go for disability. I want my patients to take this message very seriously and prevent damage to the hands and deformity of the hands so that they can get back to their work and a normal life.
Bill: So, early intervention. Thank you for sharing those warning signs with us. We really appreciate it. and letting us know the importance of early intervention and how you treat it then aggressively and then lifestyle changes can manage it throughout someone's lifetime. Really good stuff Dr. Newman. Thank you so much for your time today. To learn more about Eisenhower Health's Rheumatology Specialty Clinic visit www.eisenhowerhealth.org/rheumatology that's www.eisenhowerhealth.org/rheumatology or you can call 760-837-8569. This is Living Well with Eisenhower Health. I'm Bill Klaproth. Thanks for listening.