How do Lung nodules form from RA?

Thanks Peggy for asking this question!  I was curious myself as to if RA could affect our lungs, and how. I figured I'd make this blog on RA in the lungs, and all the complications it could possibly cause, not just nodules.  I read that although RA primarily affects our joints, it can also affect our lungs.  There are four common complications to lungs, due to RA.  They include:






- Painful breathing. Rheumatoid arthritis can cause inflammation of the lining of the lungs (pleurisy). The inflammation can cause sharp pain while breathing.

- Shortness of breath. Fluid due to inflammation of the lining of the lungs may accumulate around the lungs (pleural effusion). This accumulation can cause shortness of breath.

- Lung nodules. Small lumps may form in the lungs (rheumatoid nodules), as well as in other parts of the body. Lung nodules usually cause no signs or symptoms, and they don't pose a risk of lung cancer. In some cases, however, a nodule can rupture and cause a collapsed lung.

- Scarring of the lungs. Rheumatoid arthritis can lead to scarring within the lungs. Signs and symptoms may include shortness of breath, chronic dry cough, fatigue, weakness and loss of appetite.

Now let's take a look at each complication. In the last blog I wrote about rib pain and RA and I explained pleurisy, so instead of repeating myself, I will skip that one.  If you'd like to read more about pleurisy, please look back at the previous blog "Can you get RA in your Ribs?!"  It includes an email from my Rheumatologist explaining this very question, and information about pleurisy as well as Costochondritis.

A Pleural effusion is an accumulation of fluid between the layers of tissue that line the lungs and chest cavity.  Your body produces pleural fluid in small amounts to lubricate the surfaces of the pleura, the thin tissue that lines the chest cavity and surrounds the lungs. A pleural effusion is an abnormal, excessive collection of this fluid.  Transudative pleural effusions are caused by fluid leaking into the pleural space. This is caused by elevated pressure in, or low protein content in, the blood vessels. Congestive heart failure is the most common cause.   Exudative effusions usually result from leaky blood vessels caused by inflammation (irritation and swelling) of the pleura. This is often caused by lung disease. Examples include lung cancer, lung infections such as tuberculosis and pneumonia, drug reactions, and asbestosis.  Symptoms include sharp chest pain that is usually worse with a cough or deep breaths, cough, fever, hiccups, rapid breathing, shortness of breath and sometimes there are no symptoms at all.  Call your health care provider if you have symptoms of pleural effusion.

Lung nodules are small round growth on the lung that should be considered serious because it could be a type of early stage cancer. As precaution, every doctor will observe these growths as malignant (cancerous), until they have sufficient proof that it is benign (not cancerous).  People will usually not experience any specific symptoms that suggest that a lung nodule might be present. The majority of cases are discovered by chance during chest x-rays or CT scans.  Lung nodules can form from:

-Hamartomas (the abnormal formation of normal tissue is the most common – 75% of benign nodule cases). 
-Bacterial infections (Tuberculosis, round pneumonia, atypical mycobacteria). 
-Fungal infection (coccidioidomycosis known as Valley fever, histoplasmosis known as darling’s disease)
-Anthracosilicosis (Accumulation of carbon and silica in the lungs from inhaled coal dust)
-Fibrosing alveolitis ( a chronic, progressive form of lung disease characterized by fibrosis of the supporting framework (interstitium) of the lungs)
-Rheumatoid arthritis
-Bronchogenic cysts (rare) (Bronchogenic cysts are small, solitary cysts or sinuses, most typically located in the region of the suprasternal notch or over the manubrium)
-Hemangiomas of the lung (benign tumour)
-Lymph node hyperplasia (Known as Castleman’s disease - rare benign tumour)
-Wegener’s granulomatosis (rare)
-Parasitic infection (prevalent in temperate, tropical and subtropical regions of the world)

Since this is an RA blog, and it's the question that Peggy asked, let's take a further look into how RA can cause lung nodules.  Roughly one percent of RA patients show signs of pulmonary rheumatoid nodules in conventional X-rays, according to the Johns Hopkins Arthritis Center. However, high resolution computed tomography (CT) scans reveal signs of nodules in roughly 22 to 28 percent of patients.  Rheumatoid lung nodules appear most frequently in men with active RA who also have high blood levels of the autoimmune antibody called rheumatoid factor, Johns Hopkins reports. Women and individuals with low blood levels of rheumatoid factor may also be affected. Smoking may be a risk factor for these nodules. Typically, rheumatoid lung nodules do not cause symptoms and do not develop into lung cancer, the Mayo Clinic reports. Potential complications include erosion of a nodule through the lung, infection and pneumothorax (collapsed lung).  Additional potential effects of rheumatoid lung disease include pulmonary fibrosis (lung scarring), pulmonary hypertension (localized high blood pressure) and pleural effusion (fluid buildup inside the chest). Nodules are usually found in patients who have been suffering from RA for quite some time. Cigarette smoking in patients who have RA increases the chance that nodules will form. Methotrexate, a medication used to manage the symptoms of RA, has been found to increase chances that nodules will form.

Scarring of the lungs Chronic inflammation can lead to scarring of lung tissue, swelling of the tissue lining the lungs, constriction of arteries that feed blood to the lungs, airway restriction and pulmonary fluid buildup. Though some of these effects are treatable, others can cause irreversible damage.  Rheumatoid arthritis can lead to scarring of lung tissue and a group of conditions referred to as interstitial lung disease (ILD) that make breathing difficult and prevent sufficient oxygen from reaching the bloodstream. It's estimated that clinical significant ILD occurs in about 3 percent to 5 percent of RA patients. Interstitial lung disease can cause dyspnea (breathlessness), dry cough, wheezing, chest pain and clubbed fingernails (nails that curl over the ends of the fingers). Scarring is usually irreversible, and symptoms are typically progressive. Scarring can also occur in the connective tissue of the alveoli (air sacs) of the lungs, causing a condition called pulmonary fibrosis. Pulmonary fibrosis leads to symptoms such as chronic dry cough, shortness of breath, fatigue, weakness, loss of appetite and rapid weight loss.  Some arthritis medications can also lead to scarring of the small airways in the lungs, leading to shortness of breath or other breathing problems.

In the future, I plan on writing a blog all about RA nodules, because that can form anywhere on the body.  It seems that RA can affect just about anything.  If you are having any complications with your lungs, please be sure to tell your Rheumatologist in case there is something going on.  Never be afraid to tell your doctor of any symptoms you are experiencing, even if you think it's something small.

 

 

Can you get RA in your Ribs?!

I've had my JRA since I was 3, it started in my left knee, but by the time I was 8 it had spread throughout my entire body.  I think the oddest place that I've had my RA pain, are my ribs.  I wasn't sure if you could even get RA in the ribs, so I decided to do some research about this.  I also emailed my Rheumatologist, asking him if you could get RA in the ribs.  Here is his response:

Hi Mallory,

RA affects joints (connections between bones) and only certain kinds of joints (the ones that we call synovial joints). Ribs and their connections to the spine in the back or the sternum (breast bone) in the front are usually not affected. However, pleurisy (inflammation in the space between the inside of the chest wall and the lungs) is is not uncommon in RA and is experienced as pain of the chest wall. This pain may seem to come from the ribs but really comes from the inside of the chest. Not sure whether this is what you had but it is possible. Does that make sense ?

Best,

JE

So, it seems that RA itself does not affect the ribs directly.  In doing research I found that rib pain can be associated with Pleurisy, as my rheumy stated and also Costochondritis. 

Pleurisy is also known as pleuritis, is a condition that results from the swelling of the linings of the lungs and chest. The pleural cavity (area between lungs and inner chest wall) is created by two lubricated surfaces called pleura, the inner pleura lining the lungs and the outer lining the chest wall.  Pleurisy is a common complication of several different medical conditions, the most pervasive being a viral infection of the lower respiratory system.  It can also be affected by autoimmune diseases like Lupus or RA. The main symptom of pleurisy is a sharp, stabbing pain in the chest. This pain can affect the shoulders and back as well, but is often on one side of the chest only. A person with pleurisy will sneeze, cough, and exercise shallow breathing due to the pain caused by deep breathing.

Costochondritis is a condition that causes chest pain due to inflammation of the cartilage and bones in the chest wall. Also called Tietze's Syndrome, costochondritis occurs when there is inflammation at the junction of the rib bone and breastbone (sternum). At this junction, there is cartilage joining these bones. This cartilage can become irritated and inflamed. Depending on the extent of the inflammation, costochondritis can be quite painful. Most patients with costochondritis experience pain over the front of the upper chest (the area of the sternum). Because of serious conditions, most importantly conditions related to heart problems, costochondritis should only be diagnosed after excluding other more serious problems. Costochondritis pain is usually worsened by activity or exercise. Often the pain is worsened when taking a deep breath. This stretches the inflamed cartilage and can cause significant pain. Touching the area involved by costochondritis can be extremely painful for the patient. Because of the many nerves that branch away from the chest, pain may be experienced in the shoulder or arms as well. When called Tietze's Syndrome, the pain from costochondritis is accompanied by redness and or swelling in the areas most tender.

So in conclusion, it seems that rib pain is not associated RA directly, but there could be an underlying cause.  Costochondritis and Pleurisy can both be associated with RA.  If you are having chest pain at all, please contact your doctor because you never know what could be causing it. 

The right shoes, for the wrong feet

I've seen many posts and questions about finding the right shoe that is comfortable for our sore ankle joints.  I am curious myself, as I seem to have a hard time finding one that isn't too expensive and has the right support for us.    I've given up wearing sexy heels, and wear flats instead.  It's hard find a shoe that is not only comfortable, but stylish as well.  I've seen some great comfortable shoes, but were made for older women's style.  I'm 25 and still want to look some-what stylish!  Are there any shoes out there like this? After doing some research, I found a few different options.



The first is this great website called The Healthy Feet Store, and they make custom shoes specific for arthritis sufferers.  This quote was taken from their website:

"As the disease progresses rheumatoid arthritis sufferers are likely to be prescribed custom orthodtics. A good rheumatoid arthritis shoe would be an extra depth shoe with removable insoles. Since rheumatoid arthritis is frequently present in the hands as well as the feet an adjustable strap shoe may be preferred to a lace-up style. Another option is to fit a lace-up shoe with a no-tie lacing system. A shoe with a rocker bottom out sole can help reduce stress to the ball of the foot where rheumatoid arthritis pain is often present. Many people with rheumatoid arthritis are drawn to very cushy shoes thinking that will improve their walking comfort. While some cushioning can be present, effective rheumatoid arthritis shoes should prioritize support over cushioning. Proper arch support and progressive shock absorption decrease foot joint strain, thus helping to prevent new damage and subsequent new inflammation. It is also imperative that rheumatoid arthritis shoes provide a roomy fit, especially in the toe box, as pressure points in a shoe's fit can be excruciating for already tender arthritic feet."Their shoes are a little pricey, but they have a very good selection of sneakers, clogs, and some stylish shoes! You can view their site HERE 

Another website I found is FootSmart, which has an entire section where you can "shop by condition".  Not only do they sell shoes, but they sell gloves for our hands, shoe aids, accessories (like socks & slippers) even their own version of Biofreeze, called DynaFreeze!  It has a great selection and vary in all kinds of prices.  I really enjoyed looking through this site, they have so many aides like a hair-dryer holder which I know would help me out! So many times my elbows bother me, and I just don't blow-dry my hair because it's too sore to hold my arms up for so long.  This site is so worth looking through.  Another favorite, which is shown in the photo to the right, are Cool Soles, which "Kick off your shoes and let these temperature sensitive Cool Soles work their cold / hot magic. Use cold therapy to reduce foot pain and swelling, while heat helps improve circulation, and soothe sore muscles and joints. Simply fasten straps to feet and wear in slippers or directly on a flat surface." You can view their site HERE 

A women on RA Chicks suggested Alergria Shoes, she said her doctor and nurse recommended them, and they are well worth the price!  These shoes are very cute, colorful and comfortable! The sole is called "Mild Rocker"  the site describes this as: "Engineered to roll naturally, Alegria Shoes' rocker bottom out sole induces a normal walking motion while naturally toning leg muscles. It also benefits users by promoting a perfect posture, reducing stress on muscles, joints and back, giving you energy all day long."   The inside of the shoe has a perfect fit sole: "Alegria creates comfortable shoes with an anatomically correct patented interlocking foot bed system with arch support loaded with latex, memory foam & cork to yield a "perfect fit" every time by forming to the natural contours of the foot, giving each user their own customized fit. Foot bed is removable and available in medium and wide widths."   They have clogs, boots, professional shoes, and sandals.  Pictured left is a photo of one of their clogs, which is available in many different colors. You can view their site HERE

The last shoe I am going to talk about are Merell Hiking Boots.  I know you're going to say, hiking shoes?! I've know a lot of women and men with RA who rave over these shoes.  They are great, because they have excellent support for the ankles, and are long-lasting.  They have a variety of boots, sneakers and casual shoes.  The sneakers are actually stylish, and come in many colors. Again, they are expensive, but I've heard they are well worth the price.

You can view their website HERE

There are many, many shoes out there to choose from.  Sketchers make cheaper shoes, that I've had luck with in comfort, they just won't last as long as these more expensive shoes.  If you're like me, and can't afford these shoes, buy a comfortable cheaper pair and also look into buying a shoe insert, like Dr. Sholls.  You can also talk to your doctor who can recommend you to a foot doctor and have them make a special-made insert made just for you and your needs.  Your shoe taste is just that, yours and everyone person have different tastes and styles of what they like.  It make take you some time to find the proper shoe, but hopefully some of these site will help keep you on the right track.  The site FootSmart website is great, because it has other aids and tools that can help ease our troubles a bit.  (((pain-free hugs to all)))

Total knee replacement - do they cause swollen ankles?

Thank you again Kristen for this one! :)  This blog is about total knee replacement and what are some of the aftermaths/ side effects of  this. 

First, what is total knee replacement? I always try to explain everything I am writing about first, in case anyone reading this doesn't know what I'm talking about.  Sometimes, like in this case, I don't know first-hand anything about it, so it's good to start off with the definition.

Total knee replacement surgery is the most extreme type of surgery of the knee. It is usually the last resort and performed only when there’s progressive damage or serious distress. This type of surgery is found to be highly effective and can significantly relieve pain and improve joint function.  After a total knee replacement surgery, it’s normal to experience some degree of swelling in the lower legs which can last up to about 2 to 6 months.

Swelling after knee replacement surgery is considered normal and can be easily avoided or treated. The objective of knee replacement surgery is to elevate the pain in the knee caused by over use, arthritis, infection, or normal wear and tear. Knee replacement surgery is the replacement of the joints in the knee with artificial joints. This surgery is common but it does require the patience to follow the doctor's instructions to ensure that the knee will heal properly.

 

Normal swelling after knee replacement surgery is reduced the next morning. The swelling will continue to gradually go down as you become more active. Activities that will leave your feet in still position or on the floor for a long period of time such as walking or sitting in a chair may cause further swelling. Swelling can persist for three to four months after surgery and your replaced knee will always be slightly larger than your other knee.

 

Swelling after knee replacement surgery can happen in your knees, legs, ankles and toes. Blood clots in your leg vein after joint replacement surgery is the primary cause of swelling. If they block blood from flowing from the leg to the heart or if they move to the lungs they can be dangerous. People who are overweight, elderly, suffered from previous blood clots or those who have cancer are at an increased risk to have swelling after knee replacement surgery due to blood clots.

To help prevent swelling after knee surgery it is important to follow the doctor's rehabilitation instructions. There are a few exercises to reduce swelling such as placing ice in a cloth, elevating your leg above your heart and icing your knee for up to 20 minutes. Ankle pumps are a great exercise to improve circulation, reduce swelling and prevent blood clots. Ankle pumps are the flexing of the ankle so that the foot moves back and forth, repeat this routine 10 to 30 times per hour.

It is helpful to move the foot and ankle after surgery while in bed to increase blood flow to the muscles in your leg. Some patients may receive blood thinners such as Coumadin (warfarin), heparin or Lovenox to ensure proper blood flow. Support hose and compression boots may also be required to protect against blood clots and swelling of the knee after surgery. During your stay in the hospital you may be encouraged to use a continuous passive motion machine that is used to move the knee slowly while you are in bed.

I hope this blog post helped those who have had, or are going to have knee replacement surgery.  I consider myself lucky for not having to go through this yet. 

 

 

Rosacea - Does is coincide with RA/JRA?

Thank you Kristen Bryant from RA Chicks for asking this!  First, what is Rosacea? Personally, I don't know much about it, so for those like me, let's explain what it is.  Rosacea is a skin disease of adults (more often women) in which blood vessels of the face enlarge resulting in a flushed appearance.  It is a chronic and potentially life-disruptive disorder primarily of the facial skin, often characterized by flare-ups and remissions. There are four types of Rosacea:

• Subtype 1 (erythematotelangiectatic rosacea), characterized by flushing and persistent redness, and may also include visible blood vessels.

• Subtype 2 (papulopustular rosacea), characterized by persistent redness with transient bumps and pimples.

• Subtype 3 (phymatous rosacea), characterized by skin thickening, often resulting in an enlargement of the nose from excess tissue.

• Subtype 4 (ocular rosacea), characterized by ocular manifestations such as dry eye, tearing and burning, swollen eyelids, recurrent styes and potential vision loss from corneal damage.

Experts are not sure what causes rosacea. It tends to affect people who have fair skin or blush easily, and it seems to run in families. Rosacea is not caused by alcohol abuse, as people thought in the past. But in people who have rosacea, drinking alcohol may cause symptoms to get worse (flare).  Rosacea often flares when something causes the blood vessels in the face to expand, which causes redness. Things that cause a flare-up are called triggers. Common triggers are exercise, sun and wind exposure, hot weather, stress, spicy foods, alcohol, and hot baths. Swings in temperature from hot to cold or cold to hot can also cause a flare-up of Rosacea.

The question comes to play... does Rosacea coincide with RA/JRA?  I honestly had a realllly hard time trying to finding any information on this topic. I did find one study that was done on the drug Hydroxychloroquine sulfate (Plaquenil), which is used to treat Rosacea and RA.  The study was done with women aged 40-60+, who had Rosacea and how the drug helped.  The top condition that they also shared was RA.  You can read more about it HERE.  It seems there hasn't been much research done into this topic, but the two are treated with similar drugs and both go through flare-ups.  The one advantage I did find, is that they are treated with the same medications, so it will help eliminate taking a bunch of medications for different illnesses, and eliminating it down to one. 

I did a poll in RA Chicks and asked how many of them who's suffered from RA, also have Rosacea and do they seem to coincide with one another.  Out of the 9 ladies who responded who have Rosacea and RA, they were diagnosed separately and years apart.  Here are some of their claims:
One woman said: "I have Rosacea and RA. My rosacea is controlled..no flares..unlike my RA". 
Another woman said: "I have RA and Rosacea (pretty bad at the mo - more than just red patches). I think medications and some foods do not help the Rosacea but it also gets worse when I am stressed. Nothing seems to have worked for me of a topical nature and some days it looks worse than others". 
One more said: "I have had Rosacea for 15 years. Diagnosed with RA 3 years ago. I keep it under control with RX creams and Anti Biotics. Lots of stress will bring on a break out." 
They don't believe they coincide with one another, they claimed that when stressed they both seem to flare.  However, when the Rosacea flares on it's own the RA doesn't seem to be affected, and vice versa. 

I also looked into to see if Rosacea and Lupus are connected.   The answer to that, is also, NO.  Rosacea is not a symptom of lupus. Rosacea and lupus both can cause a red rash on the face, but the rashes are very different. The rosacea rash can be all over the face, while the lupus rash is normally seen in the butterfly pattern.

I apologize if this article wasn't more helpful, there just doesn't seem to be ANY research out there between Rosacea and Rheumatoid Arthritis.  I researched online for days, and tried asking around.  As of now, it doesn't seem like the two coincide with one another.  On a note, it does seem that once you're diagnosed with one auto-immune disease, it seems somewhere down the line, you will end up being diagnosed with more.  That is just my personally opinion, based on what I have seen in the past.  Hopefully in the future more can be done about this, so those who do suffer from both have some answers. 

Top 5 Herbs & Spices for Colds

Feeling under the weather and are trying to avoid going on any more medications? I love using natural supplements when I can, so since I'm feeling under the weather, I researched some herbs and spices that have been proven to help soothe your sniffles, and may even help you get better faster. 
Note: Always discuss with your doctor before taking large supplements of herbs in case of any reaction with a medication.

1. Garlic: If any spice has been shown to help soothe colds, it's garlic. Not only does garlic have healing properties, it's a must to keep in your anti-cold arsenal. Studies have found that garlic has antimicrobial, antiviral, antifungal, and antiprotozoal properties.  This stinking rose can top toast with olive oil and chopped raw garlic. Try soothing Garlic Tonic Soup at the first signs of a cold, or add lots of garlic to chicken soup. Skip supplements and go for fresh garlic - it's cheaper, tastier, safer, and likely to be more effective. Safety tip: If you're on anticoagulant drugs or are scheduled for surgery, talk to your doctor before consuming large amounts of garlic.

2. Ginger is warm & spicy that kick makes it a favorite culinary spice throughout the world. Long appreciated as an aid to digestion, numerous studies have shown that it is effective against nausea. Ginger has also been shown to have antimicrobial and antiviral properties, so consuming it while you're sick may help knock out whatever is ailing you. Add minced fresh ginger root to soup, or blend it into a Vitamin C-rich fruit smoothie. Feeling too low-energy to cook? Try prepared ginger teabags, or nibble on a piece of crystallized ginger. I personally love ginger tea, I add a little bit of cinnamon to mine to make it even tastier. Safety tip: If you are on anticoagulant drugs or are scheduled for surgery, talk to your doctor or registered dietitian before consuming large amounts of ginger.

3. Chili Peppers:  Ever get that teary-eyed, runny-nosed, throat-clearing sensation after eating hot peppers? Next time you're miserably congested and scratchy-throated, put those peppers to work! Try a little cayenne in soup, or add hot sauce to stir-fried veggies served over soothing rice. Chili's appear to have anti-inflammatory properties, too, so they may give you a little respite if you're feeling achy. 

4. Mint is a natural source of menthol, so a steaming cup of mint tea can actually help open clogged nasal passages and soothe sore throats, at least temporarily. Drinking it throughout the day may even help offset the need for dehydrating decongestants. If you're running a fever, menthol's cooling sensation may help you feel a little more comfortable. Mint is also a great stomach soother. If you get tired of tea, try adding chopped mint leaves to fruit salad.

5. Chamomile: Feeling crummy can make it hard to sleep just when you need rest the most. Some medications can make you jumpy, others might be upsetting your stomach. Enter chamomile. This little floral herb soothes the stomach, and relaxes both mind and body. Because it has mild muscle-relaxing properties, it may help alleviate aches and pains, too. Try a cup of chamomile tea before bedtime, and get the healing rest you need.

Exercise: Is it good or bad to still do when you're sick?

Well I've contracted a virus, and it upsets me in more ways than one!  My rheumatologist had told me I needed to start exercising more, especially to strengthen the muscles in my thighs.  I started a routine and have been doing so great sticking to it, I could start to feel the difference. I woke up today feeling sick, however.  Today would be a day for me to exercise, yesterday was a day off.  I wondered whether or not I could still exercise.  Before just jumping into it and possibly making things worse, I figured I'd do some research into the matter and see for myself. 

According to WebMD, it states that it depends on what you have, and how sick you are.  For example, if you have a cold it may be okay for you to continue with your workout routine, but if you have a fever, exercise is a definite no-no.   According to Lewis G. Maharam, MD, a New York City-based sports medicine expert, "The danger is, exercising and raising your body temperature internally if you already have a fever, because that can make you even sicker."

It's honestly going to depend on how you feel, obviously if you can't even lift your head off the pillow due to the flu, you aren't feeling up for a run around the block.  A rule of thumb that was founded is the neck rule.  If your symptoms are below the neck, say high fever, chest congestion, muscle and joint pains, as experienced in flu, you should not exercise until you recover. Why? Training in this condition will not give you any any real training effect, so you are wasting time and energy. In fact, it may worsen your illness. A bad infection could turn into pneumonia (a serious illness in which one or both lungs become red and swollen and filled with liquid). Exercising with a fever can cause your body temperature to rise even higher. When your body temperature is high, body fluids are diminished, thus increasing the risk of dehydration. If your symptoms are all above the neck, more like having cold, you can still train as long as your body can take it. However, be prepared that you might feel lousy during and after your workout. A light workout may help you feel better. However, please be aware that exercising will not help you get better faster. No, you can’t “sweat out” a cold.

If you want to exercise when your sick, listen to your body! If you have asthma and a cold, make sure you talk with your doctor before you exercise. If your asthma symptoms are worse with a cold, you'll need to use caution. Exercising with a cold and asthma may cause increased respiratory symptoms such as coughing, wheezing, and shortness of breath. These symptoms may require you to use more asthma medications to open your airways. Overuse of asthma drugs can also cause your heart rate to increase.

One good exercise to do while being sick is Yoga! I personally love it, these relaxing poses will help to circulate the blood in your body and increase your energy level.  There is also some cardiovascular activity involved with yoga, and this type of exercise helps to remove toxins through sweat.  Yoga cold remedies have proven to be very effective throughout history, since this is an ancient exercise that has improved and maintained the health of individuals of Indian and Chinese for years. Yoga trend is much more popular in the United States, and people are starting to realize that many conditions, including backaches and anxiety, can be cured as a result of practicing yoga on a regular basis. There are 7 poses that are actually aimed to help you feel better! I got the following poses from Yoga Journal

1. Head wrap: Before you begin, wrap your forehead to relieve tension in the head. Take a wide ace bandage (about 4 inches) and wrap it snugly around the head, tucking the free end in. You can also wrap it over the eyes, taking care not to wrap the eyes too tightly. The bandage will comfort your congested sinuses while you do the poses that follow. (see photo below for example)

2. Standing Forward Bend: Brings energy to the head and respiratory area; helps clear the sinuses. Stand with your feet hip-width apart and rest your forearms on a chair seat. You can also place a blanket on the chair seat for extra padding. Hold two to five minutes.

3. Supported Bridge Pose: Opens up the chest and increases circulation to the upper torso.  Align two bolsters or two to four blankets on the floor running the entire length of your body (the height of the support can vary from 6 to 12 inches). Sit on the middle of the support and lie back. Slide towards your head until your shoulders lightly touch the floor. Open your arms out to the sides, palms turned up. Rest with your legs stretched out on the bolster or with your knees bent and your feet on the floor. Relax for a minimum of five minutes.

4. Legs Up the Wall Pose: Brings energy to the groin and opens the chest area to facilitate breathing. With the back of the pelvis on a bolster placed 4 to 6 inches from the wall, swing the legs up the wall. Drop your sitting bones into the space between the blanket and the wall and open your arms out to the sides. If your hamstrings feel tight, try turning the legs slightly in, or move the bolster further away from the wall. Hold for a minimum of five minutes.

5. Supported Bound Angle Pose: Opens the chest, abdomen, and groins; relaxes the nervous system. Sit on the floor, knees bent towards the chest. Bring the soles of your feet together and let your knees open towards the floor. Support the outer thighs with folded blankets at a comfortable height. You can also place sandbags on each inner thigh to deepen relaxation. Release the arms out to the sides and let go of any tension. Relax in the pose for a minimum of five minutes.

6. Reclining Twist: Releases physical and stress-based tension.
Lie on your back and with an exhalation bend your knees and draw your thighs to your torso. Shift your pelvis slightly to the left and, with another exhalation, swing your legs to the right and down to the floor (if they don't rest comfortably on the floor, support them on a bolster or folded blanket). Turn your upper torso to the left. Rest your right hand on the outer left knee and stretch your left arm to the side, in line with your shoulders. Look straight up or close your eyes. Relax for three minutes. Repeat on the other side.

7. Widespread Forward Bend: Quiets the internal organs; relaxes the mind.
Sit on the floor with your sitting bones on the edge of a folded blanket. Straighten your legs out in front of you and then separate them as far as you comfortably can. Rest your upper torso on a bolster or (if you're more stiff) a chair seat. If you are using a chair, you can fold your forearms on the seat for more height and padding. Hold the pose for three to five minutes.


Again, if you are feeling under the weather, listen to your body and do what you feel is best.  Also, contact your doctor if you are unsure about what to do.  You will feel better in no time to go back to your routine, taking a week off will not disturb your body. 

Why is Chemotherapy used to treat RA, and Why are we told to ignore the side effects?

Thank you Tracie from RA Chicks for asking this question.  I know it blows my friends and families mind when they hear I'm on chemo, and say "do you have cancer now?!"  I then have to explain the best I can that no I don't have cancer, chemo is used to treat RA also.  Taking the chemo comes with severe side effects, and we are usually told to "ignore" or live through them if they are helping our joints.  I decided it was a good time to do research into how and why chemotherapy works with rheumatoid arthritis.

It may sound alarming, but a number of chemotherapy drugs are used to treat rheumatoid arthritis, usually in lower doses than when used to treat cancer.  RA is an autoimmune disease in which an abnormal immune reaction causes the inflammation of the joints. When used to treat cancer, chemotherapy drugs are given to kill off tumor cells, but in cases of RA the drugs are given to slow cell reproduction and decrease the metabolic processes that can lead to the inflammation.

The chemotherapy drugs most often used to treat rheumatoid arthritis include methotrexate, Imuran, and cytoxan. Some of the same side effects can occur as occur during cancer treatment, but they are usually not as severe because the drugs are prescribed at lower doses. 

Some of the less severe side effects of chemotherapy include: Acne; chills and fever; dizziness; flushing; general body discomfort; hair loss; headache; infertility; irregular periods; itching; loss of appetite; lowered resistance to infection; miscarriage; nausea; sensitivity to sunlight; sore throat; speech impairment; stomach pain; swelling of the breast; unusual tiredness; vaginal discharge; vomiting.

Severe side effects include: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black or bloody stools; blood in the urine; bone pain; calf pain/swelling; change in amount of urine; chest pain; confusion; dark urine; diarrhea; dry cough; enlarged glands; fatigue; fever or chills; inflammation of the pancreas (stomach tenderness, nausea, vomiting, fever, increased pulse rate); irregular heartbeat; mental changes; mouth sores; muscle weakness; persistent sore throat; red, swollen, or blistered skin; seizures; serious infection (herpes, hepatitis, blood infection); trouble breathing; unusual bleeding or bruising; unusual pain and discoloration of the skin; vision changes; vomit that looks like coffee grounds; yellowing of skin or eyes.

I am currently on Methotrexate and am experiencing hair loss and low energy.  These are common side effects, and we are given vitamins and are told to live through these minor side effects.  Why are we told to ignore the side effects?! Obviously if you are experiencing anything bring it up to your doctor, so he/she can make sure there isn't an underlying cause or it doesn't get worse. 

After doing research into this, I couldn't find too much, but from experience I know RA is very difficult to treat.  If they find a medicine that seems to be working very well (no pain, inflammation or signs of the RA), it's a good sign.  If the side effects are minimal and livable, in a way, they are worth it.  I know I'd rather live with thin hair or a day of feeling nauseous than weeks and weeks of not being able to move or function in life. 

Overall, there is no cure for RA and for now we learn to live with the medications that do work for us.  If side effects become so bad they are not livable, than you should not be on that medicine anymore.  ANY side effect should be mentioned to your doctor, no matter how minor.  You could wake up with a rash one morning, ignore it, and a week later having difficulty breathing.  Never let anything go without being mentioned, your doctor will not mind, I promise!  If he does, than maybe it's time to find a new doctor! I wish everyone the best of luck and hope you all find medicines that work well for you, without too much side effects. 

Why the incidence of RA in women is increasing, but not in men?

Thanks to Shauna from RA Chicks for asking this question and giving me the topic to my next blog!  It seems that RA is more prominent in women, than in men and the incidence in women seems to be increasing and in men it seems to be stable.  According to a Mayo Clinic Study, after 40 years of decline (during the years 1955 to 1994), the incidence (frequency of occurrence) and prevalence (total number of cases in a given population) of rheumatoid arthritis among women is rising. From 1995 to 2005, the incidence of rheumatoid arthritis among women was 54 per 100,000 compared to 36 per 100,000 for the previous 10 years.  For men, the incidence was stable at 29 per 100,000. Researchers concluded that an environmental factor could explain the reverse in trend for women.

The Mayo Clinic also did research as to why it seems to be increasing in women. The incidence and prevalence of RA vary widely across populations, geographic areas, and time periods, probably as a result of an interplay between genes and environment.  One factor that has been considered, and the strongest, is cigarette smoking.
While smoking overall has declined in recent years, the decline has been much slower among women. The percentage of men who smoked fell from 78% in the earlier decade to 59%  whereas rates of smoking among women remained almost unchanged.

Another factor is Vitamin D deficiency.  Which seems to also be rising among women in recent decades, may further contribute, along with other environmental factors such as infections, obesity, and socioeconomic factors.

Another potentially important contributor has been the change in the formulations used in oral contraceptives. Oral contraceptives have been shown to be clearly protective against RA in women, but contemporary pills contain significantly lower doses of estrogen than the older formulations. In this study the researcher stated, "Because these lower doses of synthetic estrogen's confer less protection against the development of RA than higher doses, it is almost certain that the protective effect of birth control has diminished over time."

Estrogen, the hormone, has played a part in RA.  More women develop RA during the months after childbirth, or during the pre-menopause years. A study was done about this in 2003, you can read about it HERE.  It stated that, irregular menstrual cycles correlated with an increased risk of RA. And women who breastfed longer than twelve months were less likely to develop Rheumatoid Arthritis.

Also in the study it stated that certain infections could have played a role in the increase of RA.  An infection called Porphyromonas gingivalis,  a gram-negative organism associated with periodontists. It stated that this bacteria could mediate changes in the body resulting in expression of RA-specific autoantibodies. 

UPDATE:  Here is an email from my Rheumatologist responding to this very question:
Hi Mallory,
Thanks for your email.
The short answer to your question is that we don't know.
Women are more frequently affected not only by RA but also by lupus erythematodes (SLE) and other rheumatic diseases. Differences in sex hormone levels are the most commonly cited reason. In line with this, RA often gets better during pregnancy (which is characterized by drastically changed hormone levels). In contrast, SLE tends to get worse during pregnancy (these things are complicated).
Women have two X chromosome while man have an X and a Y chromosome. It could also be that genes located on the X or Y chromosome increase (or decrease) the risk for getting the disease. And then there are other possible factors such as differences in environmental exposures, eating habits, etc... So the long answer is that there are hypotheses but no conclusive explanation.
Best,
Joerg Ermann

Sadly, it seems that more research needs to be done as to why it is increasing in women, and not in men.  Nothing seems to be definite.  In the study they basically said to not smoke, and to get checked for Vitamin D deficiency, which is only great if you don't already have RA.  My advice to those who don't have RA yet, don't smoke, and make sure you have enough Vitamin D and Calcium in your diet.  Drinking milk, eating yogurt and sunlight are three examples of Vitamin D.  They also sell Vitamin D (with calcium) supplements and your local vitamin stores.  However, even doing that doesn't seem to necessarily help.  I've had JRA since I was 3, never smoked a day in my life and have always been a big milk drinker/yogurt eater and I take 2 Vitamin D pills a day.  Scientists are doing what they can, but are more concerned about finding a cure for RA, which in my book is excellent.  In meantime, us women need to stay strong and stick together, because we are strong, wonderful women who don't need an illness to let us down!

Update!

First, I want to thank all of you who follow my blog.  Usually I write blogs with advice and tips to help all of you out, but I also want to vent and update you on my life with RA. I hope it gives others a way to relate, and it adds another way to raise awareness of what we go through. 

This past Wednesday I had my appointment with my Rheumatologist. First, my Rheumy is an hour and a half a way, which stinks in a way, but so worth it because I really love him! We discuss everything that's been going on and he does his usual checkup on me.  My joints look great (they've been feeling great!), but my energy levels have been really low all of the time.  We figured out they started not long after increasing my MTX dose from 10mg to 15mg.  He's concerned about the low energy and said it could be a possible side effect from the MTX or some underlying cause. We discussed that since I've been on Prednisone for months now, it's time to start weening off again.  I'm only on 5mg, so I will ween off over the next 2 weeks.  He sent me for bloodwork to do some tests, and wants to see me back in one month.  Depending on the blood tests, when I go back in one month we are going to try cutting back on the MTX to hopefully help the energy.  If nothing helps, it will be time to discuss new treatment.  He also wants me to go get a bone density test, since the Prednisone can affect that.

Basically I have a lot of waiting to do.  In a way I would like to stay on the MTX since my joints feel great, but I really dislike this low energy.  I feel so useless and tired all of the time, so maybe a new treatment would be more beneficial.  I want to wait to see how I do off the Pred, and see what the blood tests show. So I go back on February 9th for my appointment with my Rheumy, and my bone density test. 

I wish everyone the best of luck and health in the new year!

Hobbies: Living your life with RA

Well, having RA since I was 3 has really put a damper on my life.  I've been out of work for over a year now, and for a while it made me feel really down on myself.  I used to be a very creative, artsy person, but I was letting the depression of not being able to work take over my life.  One day I woke up and realized I needed to take my life back!  My last blog I did was on depression, and it inspired me to write this one on what I do to help manage my stress and to keep me sane and happy.

My most favorite thing in the world for me, is my photography!  It used to just be a hobby of mine, until I started getting more and more compliments about my photos, and that I should do more with it.  I've been inspired to go forth with my photography and make a career out of it.  It's a job that would be great for me, it's something that I absolutely love to do, and I will be able to make my own schedule with it.  It's something that I can work around my illness and many doctor's appointments.  I am keeping myself moving, and going forth with something that makes me happy. 

I am dedicating this blog to my photography, and want to share some of my photos with all of you.  All photos in this post were taken by me, and I hope you enjoy them. 

Black and white is so classic and beautiful! I actually put this pirate ship together myself, it took a while and was a pain to do, but I felt very accomplished after I finished.

Another black and white.... this was taken in Boston, Ma.  I was walking back to the train after seeing a Red Sox game and just snapped the photo. It's simple, but I do love it.

This is my cat, Harley, I love her and she's one of my favorite models! Haha.

This is my kitten, Mrs. Nesbitt. She's young, only 11 months old, so she's very difficult to photograph, she's always moving!

Probably one of my favorite photos I've ever taken. Purple is my favorite color, and I just love how the sun hit the flowers just right.  Nature is so beautiful, and one of my favorite things to photograph.

This was taken right after a rain storm in Rogersville, TN.  I love how you can see the drops of rain on the petals.

Fall is one of my favorite times of the year, the colors are just so wonderful! This was taken at a park.

I love this photo! It was tough to edit, but I'm pleased with the way it came out. This was taken at a pumpkin patch, I did some family portraits there. 

I love using black and white, with just a hint of color, it can make things pop and the photo look so much better.

That's my fiance on the right, and a good friend of ours.  They were jamming, so I took out my camera. Another unplanned event.

Delicious yummy cupcakes that my best friend and I made together :)

These are toothpicks!

Some still life, very fun and let's me get creative.  Those are my glasses.

Okay, last one!  I love the colors in this photo.  It was taken at an abandoned theme park in Dartmouth, MA










I hope you enjoyed the photos, you can see all of my work HERE on my Facebook page. :)  It's important for you to find a hobby that works for you.  To get out there, and keep moving, do what makes you happy.  Photography gives me a reason to want to wake up in the morning, sometimes I just grab my camera and go where the road takes me.  I've taken some of my best photos that way.  Our RA can get us down, making us feel hopeless, and depressed.  Even if you can't work, or have stopped working, finding something that makes you happy and fulfills your life will help make you feel better.  Give yourself a reason to want to wake up in the morning, give yourself a reason to smile.... but best of all, give yourself a reason to be happy.  :o)

Stress and Depression

I've noticed a lot of posts recently on RA chicks about some of you experiencing and asking about depression.  It's definitely hard to be happy and excited about life when you're in so much pain, and your energy level is so low you can't even pull yourself out of bed.  I was reading an article that stated, patients who have RA are 50% more likely to experience depression.   According to the article a study was done at the University of North Carolina at Chapel Hill, and it found that almost 11% of all patients with RA were diagnosed with moderate to severe depression.  The study also found that only 1 in 5 of those patients discussed this with their rheumatologist.

These facts don't surprise me at all, you think about our daily lives, having to take care of our families, ourselves, and deal with everyday life is stressful enough.  Add to it our health,  and realizing we're not able to do all of this, or we do it and it leaves us with no energy, can be depressing.  I know I myself have gone through boughts of feeling depressed.  I'll admit I've never discussed it with my doctor, but it usually doesn't last long and doesn't seem severe.  I am usually capable of getting out of feeling depressed, and having a postive outlook on life. I've also found ways to help deal with my stress, which will be discussed further, later on. 

Past studies have shown that stress causes increased sensitivity to pain. It can cause people to feel helpless and negative. The physical symptoms of both stress and depression also have been shown to cause fatigue, weaken the immune system and cause weight gain- symptoms which in turn cause us to have even more stress.

A way to help deal with all of this, is to help cope with your stress, and recognize signs of depression.  People who have trouble dealing with stress, feel overwhelmed and have negative feelings, leading to depression.  You should discuss any symptoms of depression with your doctor.  To help you not reach the point of depression, it's important to deal with your stress.  Here is a list of some ways of managing your stress:

Identifying the sources of stress (e.g. work, family, health)

Management and stress reduction techniques (e.g. listening to music or relaxation tapes, eating healthy and getting enough sleep, managing time and schedules, accepting help from others, organizing and simplifying your life)

Coping strategies (e.g. focusing on the positive, making time for relaxation, sharing thoughts with family or friends

Meditation

Yoga or Tai Chi

Keeping a journal

Progressive muscle relaxation

Biofeedback

Cognitive-behavioral therapy (changing the way you think and behave in order to reduce stress or depression)

I myself have tried a few of these stress managements, including Yoga, which I love.  Yoga and meditation really help me calm down and destress, also listening to music and reading are two other ways that help me.  Reading is a personal favorite, because it lets me escape life, and live out a fantasy, I usually feel happier when I read.  Managing your stress varies from person to person, but it's important to find something that helps you.  Starting hobbies, for me writing this blog and my photography, have helped a lot.  Find something that works for you.

Recognizing signs of depression is also important.  If it's gotten this far, that you're experiencing the following symptoms, it's time to go see a doctor and get some help.  Here is a list of signs of depression:

1. Depressed mood on most days for most of each day. (Irritability may be prominent in children and adolescents.)
2. Total or very noticeable loss of pleasure most of the time.
3. Significant increases or decreases in appetite, weight, or both.
4. Sleep disorders, either insomnia or excessive sleepiness, nearly every day.
5. Feelings of agitation or a sense of intense slowness.
6. Loss of energy and a daily sense of tiredness.
7. Sense of guilt or worthlessness nearly all the time.
8. Inability to concentrate occurring nearly every day.
9. Recurrent thoughts of death or suicide.

Depression is a serious condition that needs to be addressed, it's also important to discuss how you're feeling with your doctor.  Finding ways to help you cope can make your life so much better.  You don't need to be stuck in the rain for the rest of your life, you just need to find your sunlight to make things better for YOU.