health risks that you need to know about Rheumatoid arthritis carries additional risks, so read on to find out how to minimise your chance of developing other health conditions WOrds: Louise Ramsay top tips G iven that the pain and fatigue associated with rheumatoid arthritis (Ra) are challenging enough, it seems doubly unfair that the disease can also raise your chances of developing other health conditions, ranging from heart disease to osteoporosis. But the good news is that most of them can be treated or prevented. Bone thinning An activity such as walking should help maintain bone health, and going out in the sunshine can improve your levels of vitamin d, says dr Bernstein. Ask yourself whether you might be depressed when you feel unwell, and work with your rheumatologist to agree a target for treatment of your arthritis and your overall health, says dr Bernstein. If you smoke, stop, says dr Ioannou. It will be better for your heart and for your rA. If you are uncertain whether or not a vaccine is live, ask your GP and tell him which treatment you are on, says dr Ioannou. A dry mouth raises the risk of infections and dental decay, so make sure you maintain your teeth-cleaning routine. Research shows that Ra increases the risk of bone loss and fracture. People with Ra may be more inactive, which makes it difficult to maintain and build bone mass, says Dr Robert Bernstein, a consultant rheumatologist at the alexandra Hospital in manchester. Rheumatoid inflammation can cause bone loss, and damage bone around affected joints, while glucocorticoid medications, or steroids, can reduce these bad effects of Ra. Butthey can also be harmful if used toomuch. Prevention and treatment Techniques to counteract bone fragility in people with Ra are not that different to those advised for the general population. most importantly, ensure you eat a well-balanced diet, packed with lots of calcium-rich foods such as dairy and leafy greens and that you get enough vitamin D. supplements canhelp ensure an adequate daily intake of vitamins. Dr Bernstein adds: There are treatments to protect the bones against the effects of steroid medicines when needed. Depression Ra doesnt specifically cause mental health issues, but dealing with a chronic, painful condition that affects many aspects of your life including your family and colleagues can be difficult, says Dr Bernstein. indeed, people who were judged by their doctors as having worse self-care ability were more than twice as likely to get the blues than the general population. Prevention and treatment Treating your arthritis may improve your mood, but if not dont suffer alone. Talking can help, particularly to your doctor, who can advise on strategies to cope with your feelings, such as counselling and medication, says Dr Bernstein. Being depressed can make the symptoms of Ra seem worse than they actually are, so your doctor needs to know how you feel. Recognising that feeling low or angry could be making your pain worse is a step towards treating the problem. Heart attack and stroke Ra patients have twice the risk of cardiovascular events as healthy people. Long-standing inflammation is the arch villain in this instance because it increases the risk of artery-clogging atherosclerosis, says John ioannou, consultant in adolescent and adult rheumatology at university College London Hospitals. some Ra medications can also increase your risk of cardiovascular disease for instance, by raising blood pressure or cholesterol but others may be protective. Prevention and treatment Going out in the sunshine can improve your levels of vitamin D The main advice is to keep your Ra under control if you can reduce inflammation, you can lower your risk ofcardiovascular disease, says Dr ioannou. Beyond that, its important to live a heart-healthy lifestyle, which includes eating a wellbalanced diet andgetting enough exercise, he says. make sure,too, that your doctor or rheumatologist gives you an annual heart-health check. Infections Ra has long been associated with increased risk of infections, some of which can be life-threatening, such as tuberculosis (TB). more commonly though, ordinary infections may need more effective treatments, or take longer to clear. in Ra, the immune system is in overdrive, so the aim of medication is to suppress it, which affects the bodys ability to deal with infections, says Dr ioannou. Prevention and treatment The best thing you can do is keep up to date with all the appropriate inactivated jabs [where the microbes have been killed], such as flu and pneumococcal vaccinations, says Dr ioannou. However, steer clear of live vaccines such as yellow fever if you are on treatments that suppress the immune system, including biologic drugs. Sjgrens Syndrome sjgrens syndrome is a condition by which the immune system attacks fluidproducing glands, such as the tear and saliva glands, making the mouth and eyes feel dry. Theres an overlap between sjgrens syndrome and Ra people who have one have a higher chance of developing the other, says Dr ioannou. The condition is also more common in women with Ra. Prevention and treatment it isnt certain what causes sjgrens syndrome and, currently, theres no cure, but over-the-counter eye-drops and frequent sips of water can help relieve symptoms. if not, drugs such as hydroxychloroquine are often beneficial. Research into rituximab, which is already used to treat Ra, is also looking promising, says Dr ioannou.
