If you were recently diagnosed with arthritis or one of the other rheumatic diseases, you are not alone. An estimated one crore people in India of all ages and genders have arthritis or other rheumatic conditions. Many rheumatic diseases are chronic conditions. They are unlikely to go away. There may not be a cure for your condition, but effective management is available for most. Many people with rheumatic disease lead happy, satisfying lives year after year. You may be feeling anxious, even a little overwhelmed. This is a natural response to an unexpected turn in the road.

How do you handle your very real concerns? By knowing the facts. 

First, the reality. With proper treatment, you can manage this condition and still have a good and productive life. There are numerous medications that have been proven effective and Rheumatology experts who will help. However, you also have to take control of the situation. That means making sure you get adequate exercise, ample rest and good nutrition. It also means learning about this disease and taking steps to address your own needs. The knowledge you acquire and the positive approach you take to your new lifestyle will make the difference between just coping with rheumatic disease and living well, despite your diagnosis.

 What is rheumatic disease?

Arthritis and other rheumatic diseases are a family of illnesses that can cause inflammation (redness, swelling and pain), changes in the joints and pain in the surrounding structures.They also may make it difficult to do daily activities. In fact, there are more than 100 different rheumatic conditions including, but not limited to, osteoporosis, rheumatoid arthritis, gout, fibromyalgia, osteoarthritis, systemic lupus erythematosus, and scleroderma. While the symptoms may vary, as a rule, these conditions target the musculoskeletal system, including the bones, joints, muscles, and tendons that contribute to function. Some people also can have internal organ involvement or even more than one of these conditions at the same time. Therefore, it may take time for your primary care physician, rheumatologist, or other healthcare professional to determine your particular diagnosis and the best treatment approach for you. Your participation in this effort―and your patience―will make a substantial contribution to a successful diagnosis and your comfort levels.

What can you do? Make your medical visit count!

Plan ahead for your visits with your health care provider and, above all, communicate. Arrive with a list of your specific concerns. Consider bringing someone with you who can listen to the health care provider and take notes as appropriate. Respond to the medical professional's queries honestly and directly. Talk about your emotions, stress or discomfort if they are interfering with your lifestyle. Ask for a clearer explanation if you don't you understand any recommended treatment, including benefits, instructions and duration. Identify the team of medical professionals who will be of the most benefit to you. Initially,your rheumatologist, who has special training in the diagnosis and treatment of rheumatic diseases, will probably work closely with your primary care provider. Once you are diagnosed,a number of other medical care providers are available to help you manage your condition,Orthopedic surgeons, Nurse practitioners/physician assistants, Physical therapists, Occupational therapists, Pharmacists, Health educators, Psychologists. Make it a point to learn more about your medications. Rheumatologists only prescribe or recommend treatments to help patients manage their arthritis. The real key to living well with the disease lies with the patients themselves. Research shows that people with arthritis who take part in their own care fare much better. An important fact not shared openly by many doctors is that they go a mile extra to help patients who are interested in themselves and work more and more on patients who want to get better and resume their normal activities. So don’t resign yourself to fate. Only you, with the help of medicines, good understanding about arthritis and good scientific strategies can fight the disease effectively. 

It is very important that you take these medicines regularly and only as prescribed. You have to follow these important instructions while taking treatment for effective remedy

 1)Start the medications –Early start of treatment is very important in preventing joint damage. Due to ignorance and apprehending side effects of drugs prescribed, patients do not start medications. The rheumatologist aptly takes care of patients and administers drugs as per the requirements only. If the patients do not comply and do not take the medicines prescribed by the rheumatologist, joints may get damaged permanently and one is compelled to go for surgeries to repair them, which is very costly.

2) Do not give in to illogical fears about medications –Side effects are like accidents. They occur rarely and individual patient specific. If the patient follows up regularly and gets some basic tests done at regular intervals, as advised, most side effect can be identified at the earliest and corrected. Fortunately all these side effects are rare and can be managed very easily provided they are reported at the earliest possible time. Follow contraception as advised by your rheumatologist if you need to be on methotrexate, cyclophosphamide, leflunamide and mycophenolate mofetil. However after a certain washout period of these drugs, you can try to conceive again.Discuss all your concerns with your doctor.

3) Don't stop the medications when you feel better. Medicines for reducing damage and inflammation need to stay in your bloodstream at therapeutic levels. Skipping a dose when you feel better could cause the pain and inflammation to return. It may be more difficult to relieve. Its better to keep it under control than allow it to flare and try to get it under control again. Your doctor will himself reduce and stop medications one by one if your disease is inactive for more than 3­-6 months.

4) Keep up your appointments and do not use medicines on your own. You may not feel the need to see your rheumatologist when your arthritis is less active. Still keeping your appointments is important. Also do not continue the medicines on your own. Self treatment may be dangerous. During your regular planned visits your doctor will monitor the course of disease and determine response to treatment, adjust your treatment if necessary and Look for side effects based on clinical examination and lab tests as well.

5) Do regular physical activity –Regular exercise is one of the best things for overall health. When the disease flares up, as stretching to keep joints flexible. Inactivity can make pain, fatigue and stiffness worse. As your disease becomes less active, increase your exercise. Talk to your physiotherapist about the best and safest exercises for you. Warm water aerobic exercises maybe another choice to consider as­ it relieves stiffness and pain steps down a little. 

6) Quitting smoking and maintaining oral hygiene may reduce the chances of developing severe forms of arthritis according to recent evidence. They also reduce risk of cardiovascular events which is increased in Rheumatoid arthritis.

7) Dietary restrictions ­- There is no clear evidence for any dietary restrictions in Rheumatoid Arthritis. However, for reducing cardiovascular risk, the American Heart Association recommends eating fish twice a week. Fish high in omega­3s are powerful anti-inflammatory foods that offer a multitude of health benefits. Don't eat fish? Other foods rich in omega­3 fatty acids include walnuts, canola oil, and soybeans.

8) Fight Depression ­Living with Arthritis is not easy. It can be painful and unpredictable developments do occur. It may be hard to do normal things you enjoy. It is understandable to become sad at times, but you do not have to accept depression as a part of your disease. Discuss these feelings with your doctor. Family support is also required. Developing motivated and proper frame of mind to fight the disease is of utmost importance. According to recent evidence Individual Patient‘s interest in self care is the most important factor in the treatment of rheumatological diseases

9) Don't log on without a diagnosis: Don't log on to various internet sites describing symptoms and pains to diagnose yourself. Many rheumatic diseases will be associated with elevation in sedimentation rate (so called, ESR test) pain and stiffness of the joints . So better have a documented diagnosis first. Also you should check only valid patient education sites on the web to get trustable information. 

10) Whenever you are in severe illnesses due to infections, you need the opinion of a Rheumatologist available, regarding usage of the prescribed drugs.

11) Pneumococal and annual Influenza vaccines are advised to prevent infections. Discuss with your doctor if you have other comorbidities like COPD,Diabetes and you are aged above 55 years.

12) Get your eyes checked up by an opthalmologist every 6 months to look for steroid induced effects or hydroxychloroquine effects

13) Doctors give you a prescription only after weighing potential benefits against risk. You can have increased hair loss, nausea, burning in the chest, oral ulcers, allergic reactions & skin rashes, increased friability and striae of skin, cataracts, weight gain, increase or decrease in certain cell counts, osteoporosis, avascular necrosis of bones, increase in infections, increase in blood sugars, facial hair, acne, slight increase in blood pressure, etc. while using these drugs. However, in majority of the patients these are easily manageable (Ex: increasing the dose of anti diabetic oral drugs or insulin in case of diabetic patients). It is generally advised to concentrate on the benefits of the drugs, keeping an eye on the side effects. Stopping medications out of illogical or unrealistic fears may lead irreparable damage to bones, joint deformities and serious organ damage in various diseases. Good news is that apart from the traditional anti rheumatic drugs which do work quite well,there are newer drugs in research and some, already into the market. It is possible now to prevent joint damage with these medications.