Dr. Santiago-Casas joined Drs. Kahn and Riskin’s practice (South Florida Rheumatologist) after serving as an attending physician and Associate Professor of Medicine in the Department of Rheumatology at the University of Puerto Rico Medical Sciences Campus in San Juan, Puerto Rico.
You can book an appointment with Dr. Santiago-Casas in Hollywood, Florida here:
What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is a disease that produces pain, swelling and stiffness in the joints. The specific cause of this condition remains unknown, however genetic, hormonal, infectious and environmental factors have been linked to its development. It a type of autoimmune disease, meaning there is an error in the system that protects us from infections, where the system now attacks the joints. Approximately 1.3 million adults in the United States have RA. This type of arthritis is more common in women. It usually starts around the fourth and six decade of life, however it can occur at any age.
What are the symptoms of RA?
RA usually affects the small joints in the fingers, wrists and feet. It predominantly affects both sides of the body at the same time. Although it usually starts in the small joints of the fingers and toes, it can affect any of the joints. In addition, it may also begin in a single joint such as the knee or the shoulder. The onset of joint symptoms is usually gradually. These symptoms include joint pain, redness, warmth to the touch, and joint swelling. The joint stiffness is usually worse in the mornings and tends to last longer than 1 hour. Other symptoms of RA include tiredness, low grade fevers, loss of appetitive, nodules in the skin, and dryness of eyes. RA affects not only the joints, but other parts of the body as well, such as the eyes, heart, and lungs.
How is RA diagnosed?
The diagnosis of RA is based on a composite of factors including the characteristic signs and symptoms of the condition, the findings on physical examination, the results of the laboratory tests and the imaging results (including x-rays, ultrasound, and MRI). The initial symptoms of the condition may be very subtle making it especially difficult to diagnose in its early stages.
What is the treatment for rheumatoid arthritis?
The course of RA is variable. In the majority of the people the symptoms fluctuate for weeks or months. However, it is generally impossible to predict the course of RA or how it will affect a particular individual. Studies have shown however that the treatment of this type of arthritis must be initiated early in its course as to reduce the symptoms of arthritis, improve the quality of life, preserve physical function, and prevent joint damage.
The treatment in general of this condition involves three classes of medications: non-steroidal anti-inflammatory drugs (or ‘NSAIDs’), steroids, and disease modifying anti-rheumatic drugs (or ‘DMARDs’). The specific type of medications depends on the patient’s individual characteristics and their side effect profile. However, once the diagnosis of RA is made the patient must start therapy with a DMARD promptly. DMARDs include methotrexate, sulfasalazine, leflunomide, hydroxychloroquine, and the biologic agents. Response to treatment usually requires several weeks, depending on the medication used.
The biologic agents include etanercept, adalimumab, infliximab, certolizumab pegol, golimumab, abatacept, tocilizumab, rituximab, and the newer agent tofacitinib. In contrast to non-biologic DMARDs, the biologic agents begin to work rapidly within 2 weeks for some medications and four to six weeks for others. Biologics are usually used in combination with methotrexate; however some of them may also be used alone.
Of note, studies have shown that patients with RA have a higher risk of heart disease and stroke, thus starting appropriate therapy for this type of arthritis is crucial not only for the joints, but for the rest of body.
Lifestyle changes are also important including eating a healthy diet, with plenty of fruits and vegetables. Also it is very important to stay active. However, during the episodes of flares of the arthritis, rest is advised and active exercises are avoided because symptoms might worsen. During these periods, mostly stretching and range of motion exercises are maintained. Evaluation by a physical therapist might be warranted to tailor a specific exercise program.
Several studies have shown that smoking is a risk factor for RA and that quitting smoking can actually improve the symptoms of this condition. People with RA who smoke need to quit doing so promptly.
Surgery might necessary in patients with long term RA who do not exhibit ongoing inflammation, but rather present joint damage. In these cases where pain originates from joint damage and long term effects of arthritis, surgery might be indicated to replace the damaged joint.
The rheumatologists are the specialists best suited to diagnose this condition, especially in the early stages of the condition where it can mimic other diseases, and offer the best therapy available.
The structure of the normal joint is shown on the left. On the right side is the joint with rheumatoid arthritis. RA causes pain and swelling of the synovium (the tissue that lines the joint). This can make cartilage (the tissue that cushions between joints) and bone wear away (erosion).
Rheumatoid arthritis affects the wrist and the small joints of the hand, including the knuckles and the middle joints of the fingers.