I have been working on this rheumatoid arthritis guide for months! And it’s finally here! I’ve tried to accumulate as many explanations for rheumatoid arthritis patients as possible – which is why I’ve had to split it up. In this post, we’re starting off with talking about autoimmune diseases, biosimilars, CRP, flare-ups, inflammation, and so much more.
In addition to definitions and studies, I’ve tried to include anecdotal experience, but please keep in mind that no two patients are the exact same. This series is not the end-all-be-all of rheumatoid arthritis terms and information; I’ve just tried to include the best arthritis information I can.
As mentioned, this is a 3-part series. Check out Part 2 and Part 3. Get all 3 parts in an ad-free version in my Ko-Fi store.
I am not a medical professional of any kind. This post contains affiliate links; thank you for supporting Kate the (Almost) Great®!
I would be remiss to not mention the inspiration for these posts: Sheryl’s post Antiphospholipid Syndrome Diagnosis: The A to Z Guide as a Patient on her blog A Chronic Voice. I know that she’s not the first person to share something like that for their illness, but it’s what prompted this post. Be sure to check out her blog for more chronic illness resources!
As a heads up, these posts are organized alphabetically. This means that there will be some terms and concepts introduced out of logical order – for example, the ANA blood test explanation comes before the autoimmune disease definition.
Rheumatoid Arthritis Guide A-I
A
ANA
When it comes to diagnosing autoimmune and/or inflammatory arthritis, doctors run a few blood tests. These are to check inflammation levels in the body and also some immune system components.
One such test is the ANA, or Antinuclear Antibody Test. As you know if you’ve been paying attention to COVID vaccines in the last few years, “Antibodies are proteins that your immune system makes to fight foreign substances, such as viruses and bacteria” (x). While having some is normal – vaccines trigger your body to create antibodies for specific illnesses so you can fight them in the future – having too many is a sign of an autoimmune disease (x).
Anemia of Chronic Disease
The Arthritis Foundation says, “Up to two-thirds of people with arthritis have a condition called anemia of chronic disease, which occurs when inflammatory chemicals interfere with the body’s production of red blood cells” (x).
This is a form of chronic anemia that happens as a result of having a chronic disease, and it’s often caused by an autoimmune disease (x).
Anemia itself “happens when you don’t have enough red blood cells” (x). When you have this form of chronic anemia, you generally have long-term inflammation, which “can affect your body’s ability to use iron needed to make enough red blood cells” (x).
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Ankylosing Spondylitis
Ankylosing spondylitis is “an inflammatory disease and long-term form of arthritis” that generally affects the spine (x). However, it also affects other joints connected to or near the spine, such as the “buttocks, and neck, and sometimes in other areas like the hips, chest wall, or heels” (x).
This is a condition that is similar to RA in that it’s an inflammatory autoimmune disease. If you talk to other autoimmune arthritis patients, you’ll know some AS patients.
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Arthritis
Arthritis is an umbrella term for over 100 different conditions (x). The term refers to joint pain or disease, and the suffix “-itis” refers to inflammation. So colitis is inflammation of the colon, meningitis is inflammation of the membranes around the brain, etc.
The Arthritis Foundation says, “People of all ages, races and sexes live with arthritis, and it is the leading cause of disability in the U.S.” (x). So, despite what I really wish was true, it’s not possible to be “too young” for arthritis.
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Autoimmune Disease
As I describe it, my immune system is broken and mistakenly attacks my body. But more specifically, the National Institute of Health says that “if the immune system malfunctions, it mistakenly attacks healthy cells, tissues, and organs,” which is an autoimmune disease (x).
Autoimmune diseases can destroy body tissue, cause abnormal growth of an organ, change organ function, and more (x). Basically, any part of your body can be affected by an autoimmune disease, even if it starts in one specific part of the body.
In my personal experience with my personal autoimmune diseases, not treating the disease from the start can lead to more parts of the body being affected. If my RA had been treated earlier, I wouldn’t have most of my illnesses, and it would (maybe) just affect my joints. Many people think RA only impacts the bones, which is very much not the case.
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AIP Diet
If you have an autoimmune disease, you may have heard about the autoimmune protocol. Basically, there are some common foods that autoimmune patients tend to be sensitive to, which is why trying AIP can help you figure out if you are one of those patients with food intolerances.
Healthline says, “The AIP diet focuses on eliminating these foods and replacing them with health-promoting, nutrient-dense foods that are thought to help heal the gut, and ultimately, reduce inflammation and symptoms of autoimmune diseases” (x). When following AIP, you eliminate the common foods for a while and then add them back one at a time to test your body’s reaction to them (x).
While there are some foods that autoimmune patients commonly react negatively to, which ones your body responds to will be different than the ones my body does.
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B
B cells
B-cell inhibitors are drugs that go after, well, B-cells. B-cells are a type of white blood cell, and they’re actually the part of the immune system that build antibodies (x). While many of the other medications go after inflammation specifically, B-cell inhibitors go directly after a whole cell in the immune system (x).
These medications are given via infusion at a doctor’s office. You are only ever on one B-cell inhibitor at a time.
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Biologics
GoodRx says, “Biologics are powerful medications that can be made of tiny components like sugars, proteins, or DNA or can be whole cells or tissues. These drugs also come from all sorts of living sources — mammals, birds, insects, plants, and even bacteria” (x).
Biologics are generally given as injections or infusions. Some examples that you’ll see in this series include Humira, Enbrel, Rituxan, and Remicade.
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Biosimilars
Like biologics, these are medications made from living organisms. PhRMA.org says, “A biosimilar is exactly what its name implies — it is a biologic that is “similar” to another biologic medicine (known as a reference product) which is already licensed by the U.S. Food and Drug Administration (FDA)” (x).
While it’s easy to say that biosimilars are like generics, this isn’t technically true. “Biosimilars are highly similar to the reference product in terms of safety, purity and potency, but may have minor differences in clinically inactive components” (x).
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Bone Erosion
Bone erosion is a key symptom of RA as it’s a direct result of untreated (or undertreated) inflammation (x). Healthline says, “Bone erosion and RA are linked because chronic inflammation stimulates osteoclasts, which are cells that break down bone tissue […] The process, however, becomes unbalanced in people with RA, resulting in the rapid breakdown of mineralized tissue” (x).
I have had bone erosion in both of my feet, as well as my right TMJ. Both of my feet have had synthetic bone grafts to deal with it, but the erosion in my TMJ is so severe – and the joint works so differently than the bones in my feet – that if I have TMJ surgery, it will almost definitely be a TMJ replacement.
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C
Cartilage Damage
The Cleveland Clinic says, “Uncontrolled inflammation damages cartilage, which normally acts as a ‘shock absorber’ in your joints” (x). Essentially, this happens before bone erosion does.
A 2016 study said, “Even successful treatment with complete resolution of synovial inflammatory processes does not lead to full reversal of joint functionality, pointing to the crucial contribution of irreversibly damaged structural components, such as bone and cartilage, to restricted joint mobility” (x). Basically what this means is that even if your RA improves, if it has already damaged your cartilage or bone, there is still pain and difficulty using it.
This study found that “cartilage damage and bone erosion, but not synovial inflammation, are the most important determinants for progressive functional impairment in this chronic erosive arthritis model” (x). This means that, for people who have cartilage damage and bone erosion, those things are bigger factors in the day-to-day use of the joints than synovial inflammation itself.
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CBC
The CBC is a Complete Blood Count blood test (x). This is basically your standard blood work.
The Mayo Clinic says,
A complete blood count test measures the following:
- Red blood cells, which carry oxygen
- White blood cells, which fight infection
- Hemoglobin, the oxygen-carrying protein in red blood cells
- Hematocrit, the amount of red blood cells in the blood
- Platelets, which help blood to clot
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Chron’s Disease
The Chron’s and Colitis Foundation says, “Crohn’s disease is an inflammatory bowel disease that causes chronic inflammation of the gastrointestinal tract” (x).
Crohn’s is an autoimmune disease, and the mechanism behind Crohn’s is similar to rheumatoid arthritis, which is why it’s in this post.
If you’re American, pay attention to the commercials for Humira or Enbrel next time they play. Depending on the ad, you might see it being addressed to RA patients, psoriasis patients, Crohn’s patients, or all three. There is actually a history of Crohn’s on both sides of my family.
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Comorbidity
According to the Cleveland Clinic, “Comorbidities are medical conditions that coexist alongside a primary diagnosis and affect your health” (x). For example, rheumatoid arthritis is my primary illness, but some of my comorbidities are asthma, fibromyalgia, and chronic anemia.
A comorbidity might also known as an associated condition, coexisting condition, or related condition.
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Compression
This is the C part of the RICE method (rest, ice, compression, elevation), which is used to help reduce inflammation and pain (x). It generally is used for injuries, but since inflammation is a key part of rheumatoid arthritis, it can help RA patients.
University of Michigan Health says, “Compression, or wrapping the injured or sore area with an elastic bandage (such as an Ace wrap), will help decrease swelling” (x). You can also tools and sleeves that are specifically designed to help with specific joints or parts of your body; I wear compression gloves to help my hands when working.
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Cortisone Injection
This is when a doctor, PA, or NP gives an injection of a steroid directly into the joint.
Versus Arthritis says, “Some steroid injections start to relieve pain within hours and the effects should last about a week […] Other steroid injections take around a week to become effective but can ease your symptoms for two months or longer” (x).
Depending on the problem, the injection can be done into the joint, into the soft tissue around the joint, or into the nearby muscle (x). I’ve had them done to break up inflammation as well as break up scar tissue caused by inflammation.
These are treatments that can be used directly in a problem joint. Unlike some of the other treatments included in this post, cortisone injections treat problems already happening instead of preventing them in the first place. (By 2008, I lost count of how many I’ve had.)
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Costoconchritis
This. Shit.
I hate it. I hate it so much. It’s so annoying and so painful and there’s so little you can do for it.
The Mayo Clinic says, “Costochondritis (kos-toe-kon-DRY-tis) is an inflammation of the cartilage that connects a rib to the breastbone (sternum). Pain caused by costochondritis might mimic that of a heart attack or other heart conditions” (x).
Inflammation in the cartilage? Sound familiar? While there are lots of different possible reasons for costochondritis happening, if you have RA, it’s probably the culprit.
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CRP
This is another blood test done if you have rheumatoid arthritis. CRP, or C-reactive protein, is “a protein that is produced by the liver and released into the bloodstream in response to inflammation,” so this helps figure out if you have an inflammatory condition (x).
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CT Scan
A CT scan, also known as a Computed Tomography Scan, is a type of imaging done that “uses X-ray technology to produce images of the inside of the body” (x).
Johns Hopkins says,
“In CT, the X-ray beam moves in a circle around the body. This allows many different views of the same organ or structure and provides much greater detail. The X-ray information is sent to a computer that interprets the X-ray data and displays it in two-dimensional form on a monitor. Newer technology and computer software makes three-dimensional images possible” (x).
One of the things that CT scans are good at showing is bony erosions before they show up on standard X-rays (x).
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D
DMARD
DMARDs are disease-modifying anti-rheumatic drugs. These are frequently the first medication taken when someone is diagnosed with autoimmune arthritis.
As a whole, “DMARDs help preserve joints by blocking inflammation. Without DMARDs, inflammation would slowly destroy joint tissue over the years to the point where the joint would become misshapen and unusable” (x). How do these work? “Traditional DMARDs restrict your immune system broadly. Targeted DMARDs block precise pathways inside immune cells” (x).
These drugs can be either pills or injections, and some can be both. DMARDs are the first line of treatment that you take. You can be on a bunch of DMARDs at once; I personally take 2.
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E
Enbrel
This is one of the injectable TNF-inhibitor medications. It is commonly used for rheumatoid arthritis, psoriasis, psoriatic arthritis, and Crohn’s disease.
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ESR
This is another blood test that rheumatoid arthritis patients get. ESR – or Erythrocyte Sedimentation Rate – evaluates inflammation in the body (x).
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F
Fatigue
Fatigue isn’t “just” being tired; it’s “exhaustion that disrupts your daily life and doesn’t get better after a good night’s sleep” (x).
Many arthritis patients experience fatigue, which can be caused by a variety of different things. One is just that being in constant pain is exhausting. Especially because chronic pain can affect your sleep, and if you’re like me, not getting enough sleep messes up your pain, and then you go in circles.
Additionally, the Arthritis Foundation says that one cause of fatigue in inflammatory arthritis patients is inflammation itself: “The body undergoes stress as it tries to cope with the release of inflammatory cytokines (proteins) in the blood. That can cause fatigue, especially when disease activity is high or low-grade inflammation remains for a long time” (x).
There are other factors in fatigue for arthritis patients. One is the medication you’re on. Some medications have the direct side effect of fatigue and others, like corticosteroids, make it harder for you to sleep (x).
Plus, like I said earlier, arthritis patients can get a form of chronic anemia, the biggest symptom of which is fatigue.
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Flare Up
The Arthritis Foundation says, “A flare is a period of increased disease activity or worsening symptoms – a time when the medications you normally rely on to control your disease don’t seem to work” (x).
Similarly, verywellhealth defines a flare as “an episode of increased disease activity or worsening symptoms. People with arthritis typically recognize a flare by the sudden intensity in joint pain accompanied by other characteristic symptoms such as fever, fatigue, malaise, stiffness, or joint swelling” (x).
For RA specifically, “a flare can be related to natural variations in the processes that cause inflammation. This means flares can vary in intensity, duration and frequency, but they’re usually reversible – if treated promptly” (x).
It’s also important to remember that – as RA can affect many areas of the body, as well as joints – RA flares can involve multiple joints, organs, etc. So while increased joint pain is miserable on its own, flares can involve many different areas of the body. If you have moderate symptoms normally, a flare will exacerbate them, regardless of the affected area of the body.
Learn more about flares here.
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Fibromyalgia
Fibromyalgia involves “widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues” (x). For me, the keywords in that definition are widespread musculoskeletal pain. But something to keep in mind, and this is true of all chronic illnesses, is that every patient is different. Some people are affected more by fatigue, more by sleep issues, or another symptom altogether (x).
For example, the Cleveland Clinic says that some other symptoms include anxiety, GI issues, face or jaw pain, headaches, or tingling or numbness in extremities (x). There are some patients who experience all of those with some musculoskeletal pain. Essentially, not one patient is exactly like another.
In addition to widespread muscle pain and fatigue, a key fibro symptom is something called “fibro fog”. This is when someone struggles with “the ability to focus, pay attention and concentrate on mental tasks” (x). While this in general is also called “brain fog,” brain fog affects people with a wide variety of conditions. It can be called fibro fog when it affects someone with fibromyalgia specifically.
I also want to say that a hallmark of fibromyalgia is what was called “trigger points” and is now more likely to be called “regions of pain” (x). Healthline says, “The pain in these regions feels like a consistent dull ache,” and if you have pain in 4 of 5 of them, you might have fibro (x).
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G
Gluten-free Diet
A lot of RA patients go on a gluten-free diet and I’m one of them.
Some people, like me, are intolerant of it. This means that it’s not an allergy or Celiac disease, but that my body doesn’t tolerate it. But saying that my body doesn’t tolerate gluten is like saying Mt. Everest is a bit of a hike – sure, it’s true, but it’s also a gross understatement.
On the other hand, celiac disease is an autoimmune disease like RA, and some RA patients also have Celiac. As the Cleveland Clinic says, “When you have celiac disease, gluten damages the small intestines. If you have a non-celiac gluten sensitivity, your body has a harder time digesting gluten” (x).
Whether or not cutting out gluten and/or wheat will help rheumatoid arthritis varies from person to person. It’s just common anecdotally.
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H
Humira
This is one of the injectable TNF-inhibitor medications. It is commonly used for rheumatoid arthritis, psoriasis, psoriatic arthritis, and Crohn’s disease.
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I
IL-6 Inhibitors
IL-6 inhibitors are drugs that go after the interleukin-6 receptors (x).
As Rheumatology Advisor says, “Numerous proinflammatory cytokines are involved in the disease process, and studies have suggested that IL-6 also has a significant impact on the development of RA” (x). Essentially, IL-6 does inflammation stuff.
These medications are usually taken via a shot that you give yourself or an infusion that you get at a doctor’s office. You are only ever on 1 anti-IL-6 drug at a time.
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Immunosuppression
Immunosuppression is when you consciously do something to reduce the immune system’s efficacy, aka you suppress your immune system.
Sometimes it’s a side effect, but sometimes it’s intentional, like for people like me who take medications specifically to suppress my immune system. These meds are used for a variety of conditions like autoimmune diseases (such as Crohn’s, rheumatoid arthritis, and MS).
In this case, the immune system doesn’t work correctly and is focused on trying to destroy the body. This can only be prevented by medications that shut down or severely compromise the immune system. Chemotherapy is the most well-known immunosuppressant, but that’s not the only kind. As you’ve already seen in this post, DMARDs like sulfasalazine and Arava are also immunosuppressants, as are corticosteroids like prednisone.
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Inflammation
This is the million-dollar definition.
The Cleveland Clinic says
Inflammation is your body’s response to an illness, injury or something that doesn’t belong in your body (like germs or toxic chemicals). Inflammation is a normal and important process that allows your body to heal. Fever, for example, is how you know your body’s inflammatory system is working correctly when you’re ill. But inflammation can harm you if it occurs in healthy tissues or goes on for too long (x).
If you haven’t already noticed, inflammation is the primary problem with rheumatoid arthritis. Because while inflammation for short periods is normal, inflammation for longer ones is not. Inflammation is an immune response, so you get sick and your body deploys inflammation. With autoimmune diseases, your body mistakenly thinks itself – in this case your joints – is the problem and attacks.
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Infusion
An infusion is simply a method of receiving medication. This is when an IV is put into a patient and the patient receives medication through that IV.
The National Home Infusion Association says, “Diseases commonly requiring infusion therapy include infections that are unresponsive to oral antibiotics, cancer and cancer-related pain, dehydration, gastrointestinal diseases or disorders which prevent normal functioning of the gastrointestinal system, and more. Other conditions treated with specialty infusion therapies may include cancers, congestive heart failure, Crohn’s Disease, hemophilia, immune deficiencies, multiple sclerosis, rheumatoid arthritis, and more” (x).
There are several medications for arthritis patients that are received via IV. Some of them are medications that are only administered via IV, and some are medications that can be taken through injection or IV.
Getting an infusion is simply a way of receiving medication. If you’ve ever been in the ER, had an IV, and gotten fluids through the IV, you’ve had an infusion. IV fluids are the best, especially if you’re a POTS patient.
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As mentioned, this is a 3-part series. Check out Part 2 and Part 3 (Coming Soon).
Like this post? Share it! Then check out:
Helping Someone with RA, My Rheumatoid Arthritis Treatment + How I Got There, Problems from My Inflammatory Arthritis + How To Deal with Them, Chronic Illness and Mental Health
Kate Mitchell is a blogger, chronic illness patient, and advocate who helps people understand chronic illness and helps chronic illness patients live their best lives.
Such a comprehensive guide! Thanx for sharing!
I love how detailed and informative this guide is! I have a relative who suffers from rheumatoid arthritis, so I really appreciate the time and effort you’ve put into covering so many aspects.