30+ things doctors wish you knew about arthritis

“In psoriatic arthritis, erosive joint changes can begin within six months of first symptoms,” says rheumatologist Dr Sergio Schwartzman. “But for many people, there can be a five-year delay in receiving a diagnosis.”

“There’s a lot of exciting work being done in personalised medicine,” says Dr Marchetta. The goal: “To see if a person responds better to drug A than drug B.” In a new multisite study published in the journal Arthritis & Rheumatology, researchers analysed joint tissue from 41 rheumatoid arthritis patients to determine which gene variations each individual had and how they responded to each type of drug. Next, they hope to predict which patients will respond best to specific drugs based on their genetic signature, saving time and money.

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A recent study of 8,189 women in the journal Rheumatology confirms something women with RA have long experienced: Joint degeneration speeds up after menopause. Early menopause can trigger the disease too.

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Lung cancer, lymphoma, and multiple myeloma are more common in people with RA, partly due to inflammation and partly because RA drugs suppress the immune system. The link could also be less cause-and-effect, notes Dr Marchetta. Smoking is known to increase the risk for both RA and certain forms of lymphoma, she notes.

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In one small study, when patients with rheumatoid arthritis were zapped with mild electrical current to the vagus nerve (which passes through your neck to your abdomen), the charge reduced their levels of TNF, the same inflammatory protein targeted by TNF inhibitors. Some also had less swelling and tenderness. “This research is still in clinical trials, but it’s very exciting,” says Dr Marchetta.

Psoriatic arthritis is a form of inflammatory arthritis often misdiagnosed as rheumatoid arthritis, but the cause and many treatments are different. “The key distinction is that only patients who have psoriasis develop psoriatic arthritis,” says Dr Marchetta. Also, RA symptoms tend to be symmetrical – you have the same joint pain on both sides – while psoriatic arthritis symptoms can be asymmetric. Until 2013, the medications approved by the FDA to treat psoriatic arthritis were RA drugs. Since then, several new treatments for those with PsA have become available.

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Psoriatic arthritis sufferers are six times more likely to have the inflammatory bowel disease (IBD) known as Crohn’s disease, according to a study of more than 174,000 women. Chronic inflammation underlies both Crohn’s and PsA, and some of the medications used to treat arthritis may lead to or exacerbate IBD symptoms. (Other PsA drugs, though, can help IBD symptoms.) People with PsA are also at higher risk for diabetes, osteoporosis, kidney disease, other autoimmune diseases, and many other conditions.

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The number of people diagnosed with gout doubled between 1960 and 1990, and rates have risen about 25 per cent since. The use of certain medications for high blood pressure – especially loop and thiazide diuretics – are among the top reasons for the increase. “Gout also has a genetic component,” notes Dr Marchetta. And interestingly the problem isn’t that people produce too much uric acid (the compound that crystallises in the joints and causes pain). It’s that their kidneys under excrete it, says Dr Marchetta.

Dietary habits can raise the amount of uric acid in the blood to a level where the kidneys just can’t get rid of it. Foods and drinks rich in compounds called purines (such as bacon and sweets) also contribute to the formation of uric acid crystals, as does being overweight and sedentary. Alcohol, especially beer, is also purine-rich. “Beer can double the risk of a gout attack,” says Dr Marchetta.

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In a recent study of more than 6,000 people with gout, those who took febuxostat were 34 per cent more likely to die from heart disease than people who took allopurinol, another common gout drug. But allopurinol can cause liver problems, while another older gout drug, colchicine, can cause severe diarrhea. “Every drug has side effects, so it’s important to discuss with your doctor which one might be best for you,” advises Dr Marchetta.

Tomatoes, which can increase uric acid levels, could be a gout trigger for some people, a study from 2015 found. They were the fourth most common food trigger after seafood, alcohol, and red meat. Another theory why they can be irritating: “Tomatoes are high in lectins, compounds that can irritate the gut and raise inflammation,” says Dr Blum.

Learn about 18 anti-inflammatory foods you should eat to reduce pain