Rheumatoid arthritis (RA) is not the same arthritis that may affect your grandparents. RA is different than wear-and-tear arthritis (osteoarthritis) because it is an autoimmune disease, where the body’s immune system attacks the joints, causing severe joint pain, swelling, and damage. RA often shows up in people between the ages of 30 and 50, but it can affect anyone of any age, including children. About 1.3 million Americans live with this very debilitating condition.
RA is definitely a disease of challenges. The good news is that you don’t have to do it alone. You can build yourself a great team of health professionals to help you along the way.
Here is what you need to know about your RA healthcare team, including why you need one, the key players, and your role in the process.
You Need a Team
RA is a condition where a team approach is absolutely necessary for successful treatment outcomes and maintaining your quality of life. This is because RA is a complex condition affecting many parts of your life. Your healthcare team can take a combined approach in managing symptoms and the disease’s effects on your overall physical, psychological, and social functioning. They can create a treatment plan that leads to the best control of your disease and keeps you functioning.
Your health care usually starts with a primary care doctor and a specialist—a rheumatologist—who is well aware of the treatments needed throughout the course of your disease. In addition to your primary care doctor and your rheumatologist, you will need to add additional healthcare professionals to your team as the need arises.
Many of these specialists can help you in various aspects of your health care from moving better and protecting your joints, to navigating paperwork, learning coping skills, and more.
When building your team of RA healthcare professionals, make sure you add the following key players.
Primary Care Doctor
Your primary care doctor—also known as a family doctor—treats a variety of health conditions. Your primary care doctor is likely the person who first identified your RA symptoms and referred you to a rheumatologist.
Your primary care doctor can treat conditions related to RA, such as an infection or flu complications. This person can also treat other health conditions, such as high blood pressure, and help you to take preventative measures to protect your health, which may include staying on top of vaccinations, losing weight, or quitting smoking.
Your primary care doctor can monitor you and screen for heart disease and other serious illnesses associated with RA. This person is also in the best position to help you manage risk factors, because having RA puts you at a higher risk for many serious conditions, especially heart disease. People with RA have an increased risk of cardiovascular disease, but according to a report from 2019, most are unaware of the connection between the two conditions. This meta-analysis report looked at six older studies finding that at least 73% of people with rheumatoid arthritis were unaware of their increased risk for heart disease.
A rheumatologist is an internist or pediatrician who has additional training in the diagnosis and treatment of autoimmune and musculoskeletal diseases. In addition to treating RA, these doctors also treat other arthritis conditions, such as psoriatic arthritis, gout, osteoarthritis, and more.
RA requires a comprehensive treatment plan that includes treating and managing joint health and working towards prevention of complications that affect the organs, including the heart, kidneys, and eyes. Your rheumatologist understands special aspects of RA, plus specific treatments and their side effects. This person can design a treatment plan based on your unique situation, which includes your overall health and medical history, age, occupation, lifestyle, and what your expectations and needs are.
Because your rheumatologist is the most important person in your RA treatment team, you will need to see this doctor regularly. You should share with your rheumatologist about how you are doing and include any troubles you are having or questions about your medications.
Your rheumatologist can also put you in touch with other professionals you will want to add to your team.
Your rheumatology nurse does a lot when it comes to your treatment and management of RA. In fact, this person is usually your main point of contact any time you need to reach your rheumatologist outside of regular visits, and you may see this person at every rheumatology visit before the rheumatologist steps into the exam room.
The role of the rheumatology nurse involves taking down your medical history, evaluating symptoms, administering tests, answering questions, overseeing treatment (including prescription refills), teaching you about injection and infusion therapies, educating you and loved ones about RA, and coordinating and communicating with other members of your healthcare team.
One 2017 survey asked primary care nurse practitioners about their certifications, patients, information received from rheumatologists about shared patients, RA resources, confidence and interest in managing RA patient care, and preferences for exchanging educational information with colleagues. What the researchers found was the role of the nurse practitioner could easily be optimized with some simple steps, including improved communication with treating rheumatologists, access to educational resources, and further training on management of RA.
This survey is important because the need for rheumatology healthcare professionals is increasing and the role of nurses and nurse practitioners in rheumatology can help to meet this demand and improve patient access to rheumatology services. This translates into early detection and treatment of RA—things both vital in reducing the risk for serious complications of the disease.
A physical therapist can provide instructions for performing safe exercises that help you to move better, manage your range of motion, and reduce pain and stiffness in your joints. In addition to exercise, this person can offer ideas and other techniques for managing pain and stiffness, such as water and laser therapies and relaxation techniques. Your physical therapist can also teach you easier ways to perform everyday activities without putting unnecessary stress on joints.
Over time, rheumatoid arthritis starts to make everyday activities more challenging. This includes the things you regularly do, such as going to work or to the grocery store, attending social events, preparing meals, and doing simple chores.
An occupational therapist (OT) can work with you to figure out what things have become harder to do and come up with a plan to address these. This can include modifications to your home and workspace, learning new skills, and using medical assistive devices, such as a cane or a splint, to help get around. This occupational therapist’s main goal is to keep you doing activities important to you in the safest ways possible.
Mental Health Professional
Rheumatoid arthritis can be physically and emotionally draining. After all, it often causes pain and disability and requires you to make drastic lifestyle changes. Numerous studies have shown people with RA are twice as likely to experience depression than others in the general population, and chronic pain—one of the most common symptoms of RA—makes it more likely to develop an anxiety disorder.
If you find you are struggling to cope with the unpredictable and changing nature of RA, a mental health professional can help. This person can perform testing to determine how you are adjusting, whether you are following your treatment plan, your coping style, your support system, and whether you are suffering from anxiety, depression, or other mood disorder. A mental professional can offer counseling, talk therapy, cognitive behavior therapy, and more to help ease depression, anxiety, and to help you better learn to the cope with the daily effects of RA.
Social workers in health care are experts on the effect an illness has on a person and their family. Their skills include assessing how well you and support persons are coping, solving problems related to your health care, and finding resources to help you maintain your functioning.
RA takes enough of a toll on your physical and mental health and having a person to help you to navigate the healthcare system, locate support for services, and even offer guidance on managing the financial aspects of your health care can make the journey a little less stressful.
A registered dietitian or nutritionist can teach you how to make changes to your diet, figure out which foods improve RA symptoms and which ones make it worse, and ensure you are getting all the nutrients you need to stay healthy. If you are overweight, this person can help you find ways to lose extra weight that may be putting extra pressure on joints. This person can also give you advice on whether vitamins and supplements are helpful or harmful, and even formulate an exercise plan tailored to your unique situation.
Orthopedic surgeons are specially trained in the diagnosis and treatment of bone and joint disorders, especially those affecting movement. Some surgeons specialize further in diseases of the spine, hips, and knees, while others treat disease in several areas of the body.
If your RA is well-controlled, you may not need surgery. Surgery is usually a last resort option for people with severe and destructive forms of the disease. The goal of orthopedic surgery is to relieve pain and to improve or maintain function.
There are several types of procedures reserved for people with arthritic conditions, including joint replacement. The method used to address a joint problem will depend on the severity of the problem and the disease, as well as a person’s age and overall health.
Pain Management Specialist
Even if you are consistently taking your RA medications and following all the lifestyle recommendations, there may come a time where your RA pain persists. The worse RA pain is, the more it interferes with your quality of life and ability to participate in daily activities of life. If your rheumatologist can’t help you in getting sufficient pain relief, you may want to consult with a pain management specialist.
A pain management specialist is a doctor who has training in the diagnosis and treatment of different types of pain. This specialist can offer additional pain relief options for managing RA pain. This may include stronger pain medications, pain-relieving procedures—such as corticosteroid injections, radiofrequency ablation to decrease pain signals from a particular nerve, complementary therapies, such as acupuncture and relaxation breathing, and body-mind therapies, such as mindful meditation.
Ask your rheumatologist or primary care doctor about a referral to a reputable pain management specialist.
It is possible you may not encounter every healthcare professional involved in RA health care. It is more likely you will add people as needed to your team. The priorities of your team are determined by you—the patient—resulting in a treatment plan that leads to the best control of your disease and improves your overall function and quality of life.
You are the key player in your rheumatoid arthritis healthcare team and all this starts with you—you are in the driver’s seat. You decide who you work with, that you are heard, and how everyone plays their important roles. You can help the process by communicating with each team member about important changes, such as those pertaining to surgeries, hospitalizations, and medications. Make sure you keep all your appointments and ask questions about anything that may be on your mind or concerning you.
Having rheumatoid arthritis isn’t easy, but you can learn as much you can about it and actively work with your RA treatment team. These are the two most effective ways to regain control of your life. You are not alone, and your healthcare team can give you the help, advice, expertise, and experience to make things a lot easier for you as you navigate life with and despite RA.