Signs of Rheumatoid Arthritis Can Show Up Long Before Diagnosis

BY ROBERT PREIDT, HealthDay Reporter

(HEALTHDAY)

FRIDAY, May 10, 2019 (HealthDay News) -- Difficulties with daily activities such as dressing, walking and eating can be seen in rheumatoid arthritis patients a year or two before they're diagnosed, a new study shows.

"This is a new finding, and a finding that is quite intriguing," said lead author Dr. Elena Myasoedova, a rheumatologist at the Mayo Clinic in Rochester, Minn. "It may reflect an accumulation of symptoms between the time of first onset and the time required for providers to actually diagnose patients," she said in a Mayo news release.

The study also found that chronic increased levels of difficulty with daily activities (functional disability) continued even after patients were diagnosed with rheumatoid arthritis and began treatment.

That may be due to a number of factors, including increasing physical and mental pain, use of treatments such as glucocorticoids and antidepressants, and anticipation of relief from symptoms, she added.

For the study, the researchers looked at 586 rheumatoid arthritis patients and 531 people without the disease in the Rochester Epidemiology Project database of medical records.

The rate of functional disability was more than two times higher among rheumatoid arthritis patients than in those without rheumatoid arthritis. In most age groups, rheumatoid arthritis patients had a 15% or higher rate of functional disability than those without the disease.

The findings show the importance of early treatment for rheumatoid arthritis patients, according to Myasoedova.

"Alerting your health care provider to difficulties in daily living can assure that patients receive the help they need," she said.

About 1.5 million Americans have been diagnosed with rheumatoid arthritis, an autoimmune disease that most often affects the joints but can also impact other parts of the body. Rheumatoid arthritis is one of the most common chronic conditions associated with functional disability in the United States, and has a significant impact on well-being and quality of life.

Symptoms can include joint pain or swelling, but 40% of patients have symptoms that don't involve the joints, such as fatigue, fever and loss of appetite.

The study will be published in June in the journal Mayo Clinic Proceedings.


Mediterranean Diet Reduces Risk of Rheumatoid Arthritis

High adherence to a Mediterranean diet appears to be associated with a lower risk of rheumatoid arthritis (RA), especially in men and those who are seropositive, according to a study published in Arthritis Research & Therapy.

Researchers from the Karolinska Institutet performed a matched, case-controlled study that analyzed the diet of 1,721 patients with incident RA and 3,667 controls. A Mediterranean diet score (0-9) was based on a 124-item food frequency questionnaire.

Overall they found that 24% of RA patients and 28% of controls had high adherence to the Mediterranean diet (score between 6 and 9).

High adherence to a Mediterranean diet reduced the odds of developing RA by 21% (OR 0.79; 95% CI 0.65–0.96) compared to low adherence (score of 0-2).

The RA risk reduction with a Mediterranean diet only applied to men (OR 0.49; 0.33–0.73), and those who were seropositive for rheumatoid factor (RF) (OR 0.69; 95% CI 0.54–0.88) or those with antibodies to citrullinated peptides (ACPA), but not in ACPA-negative RA.  Interestingly, high adherence to a Mediterranean diet did not benefit women (OR 0.94; 95% CI 0.74–1.18), and ACPA or RF-negative RA (OR 0.96; 95% CI 0.68–1.34).

These findings indicate that the Mediterranean diet score was inversely associated with risk of RA, but only in men and those who have seropositive RA. These findings may have implications in those at risk or those deemed to have "pre-clinical RA".

In other studies the Mediterranean diet has been linked with lower risk of mortality, cardiovascular diseases and cancer.  

Recommendations for Immunomodulatory Medications with Joint Replacement Surgery

A joint committee of Rheumatologists and Orthopedic Surgeons has issued the following recommendations for medication management around hip and knee replacement:

  • Synthetic disease modifying antirheumatic drugs (DMARDs) such as methotrexate, leflunomide, hydroxychloroquine can be taken up to and through the post operative period. There is no need to hold these medications before surgery.

  • Biologic agents such as Remicade, Orencia, Humira, Enbrel, Actemra should be held 1 cycle before surgery. For example, hold Enbrel the week before, or have the surgery done just before the next IV dose of Remicade, Actemra, Orencia.

  • These agents can be restarted when the wound is clean and there is no drainage, approximately 14 days.

  • Xeljanz should be held 7 days before surgery.

  • Patients with severe lupus should continue medication up to and after surgery.

  • Patients with mild lupus should hold medication 1 week before surgery.

  • There is no reason to increase steroid dose with surgery, just continue usual dose.