WASHINGTON, DC—Detecting rheumatoid arthritis early is critical in order to ensure that the quality of life of a patient does not decline.

“If patients are suspected of having the early clinical phase of RA, they can be treated early. With early treatment, hopefully, they will achieve a clinical remission and down the road, have an excellent quality of life,” said Army Col Leslie Jackson, MD, the consultant to the army surgeon general on RA and chief of Rheumatology Service at Madigan Army Medical Center.

RA is a form of arthritis that causes pain, swelling, stiffness, and the loss of function in the joints. It can affect any joint, but is common in the wrist and fingers, according to the NIH. The disease often begins with morning stiffness and muscle aches. Early treatment is important to delay joint destruction, since there is no cure for the disease.

Having RA is a disqualifier for joining the Army, but it is possible for some servicemembers who are already on active duty when they develop RA to continue to serve, Jackson explained. At issue is where servicemembers who develop RA can serve because they need to be located somewhere geographically to allow for appropriate care and monitoring of their medications.

Since servicemembers on these medications do not meet retention standards, they must undergo a formal board proceeding to determine if they can still remain on active duty with this geographical limitation. “Some folks are found fit for duty and they can remain on active duty, but some folks are not because of functional disability from the disease and they can’t participate physically to the full extent that is required,” she said.

Women and RA

According to the CDC, an estimated 1.3 million adults aged 18 and older had RA in 2005, down from the previous 1990 estimate of 2.1 million. While a range of environmental and genetic variables have been evaluated as potential risk factors for RA, no definitive risk factors for RA have been identified, according to the CDC. Of the environmental factors examined, the most consistent evidence exists for an association between tobacco use and RA, the CDC stated. Research has indicated that the risk of developing RA is nearly double for current smokers compared with those who do not smoke.

Women tend to be affected by the disease more than men. The incidence of RA is typically two to three times higher in women than men, according to the CDC.

The peak age of onset of RA is the late 40s and early 50s. For many women, this is also when they are experiencing perimenopause. Jackson said that it is uncertain what role hormones play in the onset of RA. It is possible that other potential RA factors in the setting of hormonal changes may allow for the expression of RA, she said.

Women in menopause are at an increased risk for developing osteoporosis. A concern for a perimenopausal woman with RA is that they are often treated with corticosteroid medications to help control inflammation. Corticosteroids are associated with bone loss, which is particularly problematic for women who may already be at risk for osteoporosis. “That is a consideration when women are diagnosed at that time. We really are cognizant that we need to make sure they have a baseline bone marrow density test. [In addition,] that they are on calcium and vitamin D, that they are remaining as physically active as possible to help strengthen their bones, and are modifying any other risk factors such as smoking and the use of alcohol,” said Jackson.

She further added that young women are also struck by the disease. Patients who are pregnant with RAare typically followed closely by an OB/GYN and a rheumatologist. Jackson, however, pointed out that during pregnancy RA symptoms can improve. A 2008 Netherlands study from the Erasmus Medical Center, University Medical Center Rotterdam, found that disease activity decreased with statistical significance during pregnancy and increased postpartum.

Treating RA

Because RA can affect physical function, it can be very life altering. “People may have to alter their life style significantly and they may be taking medications that they are not used to,” she said. Still, Jackson also noted that many patients with RA live full lives, especially with the medications that are currently available. “We really can push people into a clinical remission or get their disease activity scores down much better than we were able to with our traditional disease modifying agents in the ’80s and early ’90s,” she said.

Educating patients on the condition is also key in helping them, she noted. “Importantly, as a rheumatologist, I think that education with our patients is critical. Not just paying attention to medications to treat the disease, but getting patients to occupational therapy and physical therapy. If they are having any issues with depression surrounding their diagnosis, getting them into behavioral health is very useful.”

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