treatment for rheumatoid arthritis

As one of the hosts and the signature voice for American Ninja Warrior, Matt Iseman regularly interacts with athletes at the top of their game in a role tailor made for the Los Angeles-based fitness aficionado and celebrity. However, many of Iseman’s fans are surprised to learn that the former physician, stand-up comedian and 2017 The New Celebrity Apprentice winner is also dealing with his own personal physical challenges—those associated with rheumatoid arthritis.

“It was in the summer of 2000, and I was living in Venice, working out in Gold’s Gym,” Iseman says, recalling when he first developed symptoms. “I had pain in my right index finger, and I remember thinking that it was related to how I was working out. It waxed and waned over the course of the next year and a half, but I was a 30-year-old physician and so I just started to rationalize the pain, even as it gradually got worse. Eventually, the pain and inflammation were so intense that I could only turn my neck about 15 degrees in any direction, and I had no energy. I was sleeping 10 to 12 hours a day, and I gained 55 pounds. I felt like an old man.”

Despite his medical training, Iseman did not suspect rheumatoid arthritis as the culprit of his symptoms. He says it was hard to put RA at the top of the list of possibilities since his profile did not match that of the usual rheumatoid arthritis patient.

“Rheumatoid arthritis tends to affect women; somewhere around two-thirds of all diagnosed patients are female,” he continues. “And people with RA are usually in the 40-, 50- or 60-year-old age range. So you start to play the demographics game, and as my symptoms progressed, the blood work and X-rays were negative. When I was actually diagnosed, it was a relief.”

When the blood work and X-rays finally revealed rheumatoid arthritis in 2002, nearly two years after his initial symptoms, Iseman had already seen numerous physicians in an effort to determine what was causing his pain. Post diagnosis, he began seeing a rheumatologist who worked at the same hospital as his father, also a physician, and he credits his subsequent successful treatment for rheumatoid arthritis to a strong and ongoing patient-physician partnership.

“It’s hard to have one person trying to put all of the pieces together when you’re experiencing pain of unknown origin, but I was very lucky in finding a good rheumatologist,” Iseman says. “No one cares about your health as much as you do, and you always want to find someone who will take good care of you throughout the treatment process, so a good partnership between the doctor and patient is imperative.”

A Multifaceted Approach in Treatment for Rheumatoid Arthritic

Noting that “sometimes the body doesn’t read the textbook,” Iseman says that despite an unconventional demographic profile for the disease, his rheumatoid arthritis was diagnosed as a fairly aggressive case. He started a biologic treatment that had been approved in 1998, eventually adding exercise and holistic health practices to his treatment toolbox. Today, he continues to combat his RA with a multi-faceted therapy approach.

“My disease has largely been checked, arrested, and I realize how fortunate I am that these unbelievable treatments have come up in the past few years,” Iseman says. “While I am hoping we find a cure for rheumatoid arthritis, there are many new treatments that have been developed since my diagnosis.”

In addition to infusions every eight to ten weeks, Iseman’s treatment regimen includes swimming, yoga and Pilates. The personalized routine allows him to work long hours on American Ninja Warrior and to spend additional hours on awareness and research funding efforts for rheumatoid arthritis via activities like being a contestant on The New Celebrity Apprentice.

“When people look at me, they don’t know I have RA,” Iseman says. “I think that so often we focus on what we can’t do instead of what we can, and that’s counterproductive. I work 14 hours a day on the show, and it’s important for me to remember that the better care I take of my body, the better I am going to feel.”

From MD to Comedian: Becoming the Voice for American Ninja Warrior

Surprisingly, Iseman’s journey to one of the most popular reality shows currently on television began in medical school, an unlikely starting point on the path to celebrity status and one that would eventually aid him in battling rheumatoid arthritis. An honors graduate of Princeton University and the Columbia College of Physicians and Surgeons, Iseman completed his residency in internal medicine at the University of Colorado and then decided to rethink his professional path. He recalls that the transition from physician to American Ninja Warrior involved unexpected personal revelations.

“For me, medicine was the perfect career on paper, but I realized that I wasn’t as passionate about it as I wanted to be,” Iseman says. “I took a year off to reevaluate my life and decided to try something completely different—stand-up comedy.”

The stage “felt like home” to Iseman and eventually led to work as the host of several cable television shows and then American Ninja Warrior. He says that he never regretted going to medical school and also never regretted leaving medicine, noting that he continues to be inspired by the contestants competing on the show.

“We are headed into season nine, and so far, only two people on the show have ever completed the entire course,” Iseman says. “American Ninja Warrior is all about hard work and pushing yourself, and that’s a good message for people.”

A few of the contestants who have made a lasting impression on Iseman include Michael Stanger, a competitor whose wife is wheelchair bound, and Steven Moul, a 21-year-old with autism. Both contestants’ stories resonated with Iseman and with the audience.

“Michael and his wife have two young kids, and he wanted to make her smile; she wanted him to do something for himself,” says Iseman. “Steven started going to the gym to train and kept telling himself that he couldn’t fail. Just by getting on the course, he had already won. They are what American Ninja Warrior is all about and why the lessons that come out of the show are amazing.”

From American Ninja to Apprentice

The 2017 season of The New Celebrity Apprentice has a familiar face replacing Donald Trump in the boardroom, a fellow fitness buff whom Iseman admits he was thrilled to meet. Arnold Schwarzenegger was in the chairman’s seat this year, and Iseman joined celebrities including Boy George, Carnie Wilson, Laila Ali, Carson Kressley, Vince Neil and Jon Lovitz to complete tasks and earn money for their chosen charities.

“For me, working on the Celebrity Apprentice was like hanging out with an idol of mine,” Iseman says. “I had a poster on my wall from Predator in 1986, and I worshiped him as a kid, and now I’m working with him. Everyone on the show has just been great, and it’s been a really fun experience.”

Advocating for Rheumatoid Arthritis

As the winner of The New Celebrity Apprentice, Iseman was proud to raise arthritis awareness and almost a million dollars for the Arthritis Foundation. He hopes his appearance and advocacy will help individuals battling the disease, as well as contribute to progress toward a cure. By sharing his story through various public forums, he also hopes to underscore some of the practices that help him control the effects that RA has on his daily life and offer options to others fighting the disease.

“I’m competing for the Arthritis Foundation because I want to bring together people with similar stories, especially those like mine,” Iseman says. “Unless someone has this disease, it’s hard to understand it, and when you find someone going through the same thing, you can share the struggle. We all remember what the day was like when we were diagnosed, and organizations and online communities and blogs offer valuable support.”

Part of telling his story is showing others with rheumatoid arthritis that little changes can add up to make a big difference in stemming the pain associated with the disease. Although his professional commitments prevent a “typical” day most weeks, Iseman says he makes his health a priority and stresses to other rheumatoid arthritis patients the importance of doing the same. Above all, he wants to let people know that there is life—a rich, full life—beyond diagnosis.

“With my career, it is a challenge to make sure I am working out the way I need to, but I pay for it if I neglect my body,” Iseman says. “I manage my rheumatoid arthritis with a combination of medicine and exercise, and this allows me to continue to do what I do. I love the sense of potential—the feeling that anything can happen. I love the adventure, the sense that everything is possible. That’s what I want to share.”

CAUSES OF RHEUMATOID ARTHRITIS

The cause of RA is not yet fully understood, although doctors do know that an abnormal response of the immune system plays a leading role in the inflammation and joint damage that occurs. No one knows for sure why the immune system goes awry, but there is scientific evidence that hormones and environmental factors are involved.

Researchers have shown that people with a specific genetic marker called the HLA shared epitope have a fivefold greater chance of developing rheumatoid arthritis than do people without the marker. The HLA genetic site controls immune responses. Other genes connected to RA include STAT4, a gene that plays important roles in the regulation and activation of the immune system; TRAF1 and C5, PTPN22, two genes relevant to chronic inflammation; and PTPN22, a gene associated with both the development and progression of rheumatoid arthritis. Yet not all people with these genes develop RA and not all people with the condition have these genes.

Researchers continue to investigate other factors that may play a role. These factors include infectious agents such as bacteria or viruses, which may trigger development of the disease in people whose genes make them more likely to get it; female hormones (70 percent of people with RA are women); obesity; and the body’s response to stressful events such as physical or emotional trauma. Research also has indicated that environmental factors may play a role in one’s risk for rheumatoid arthritis. Some include exposure to cigarette smoke, air pollution, insecticides and occupational exposures to mineral oil and silica.

RHEUMATOID ARTHRITIS SYMPTOMS

In the early stages, people with RA may not initially see redness or swelling in the joints, but they may experience tenderness and pain. The following joint symptoms are clues to RA:

  • Joint pain, tenderness, swelling or stiffness for six weeks or longer
  • Morning stiffness for 30 minutes or longer
  • More than one joint is affected
  • Small joints (wrists, certain joints of the hands and feet) are affected
  • The same joints on both sides of the body are affected

Along with pain, many people experience fatigue, loss of appetite and a low-grade fever. The symptoms and effects of RA may come and go. A period of high disease activity (increases in inflammation and other symptoms) is called a flare. A flare can last for days or months.

Ongoing high levels of inflammation can cause problems throughout the body. Here are some ways RA can affect organs and body systems:

  • Eyes. Dryness, pain, redness, sensitivity to light and impaired vision
  • Mouth. Dryness and gum irritation or infection
  • Skin. Rheumatoid nodules—small lumps under the skin over bony areas
  • Lungs. Inflammation and scarring that can lead to shortness of breath
  • Blood Vessels. Inflammation of blood vessels that can lead to damage in the nerves, skin and other organs
  • Blood. Anemia, a lower than normal number of red blood cells

treatment for rheumatoid arthritisDIAGNOSING RHEUMATOID ARTHRITIS

A primary care physician may suspect RA based in part on a person’s signs and symptoms. If so, the patient will be referred to a rheumatologist—a specialist with specific training and skills to diagnose and treat RA. In its early stages, RA may resemble other forms of inflammatory arthritis. No single test can confirm RA. To make a proper diagnosis, the rheumatologist will ask questions about personal and family medical history, perform a physical exam and order diagnostic tests.

MEDICAL HISTORY

The doctor will ask about personal and family medical history as well as recent and current symptoms (pain, tenderness, stiffness, difficulty moving).

PHYSICAL EXAM

The doctor will examine each joint, looking for tenderness, swelling, warmth and painful or limited movement. The number and pattern of joints affected can also indicate RA. For example, RA tends to affect joints on both sides of the body. The physical exam may reveal other signs, such as rheumatoid nodules or a low-grade fever.

BLOOD TESTS

The blood tests will measure inflammation levels and look for biomarkers such as antibodies (blood proteins) linked with RA.

INFLAMMATION

Erythrocyte sedimentation rate (ESR, or “sed rate”) and C-reactive protein (CRP) level are markers of inflammation. A high ESR or CRP in not specific to RA, but when combined with other clues, such as antibodies, helps make the RA diagnosis.

ANTIBODIES

Rheumatoid factor (RF) is an antibody found in about 80 percent of people with RA during the course of their disease. Because RF can occur in other inflammatory diseases, it’s not a sure sign of having RA. But a different antibody—anti-cyclic citrullinated peptide (anti-CCP)—occurs primarily in patients with RA. That makes a positive anti-CCP test a stronger clue to RA. But anti-CCP antibodies are found in only 60 to 70 percent of people with RA and can exist even before symptoms start.

IMAGING TESTS

An X-ray, ultrasound or magnetic resonance imaging scan may be done to look for joint damage, such as erosions—a loss of bone within the joint—and narrowing of joint space. But if the imaging tests don’t show joint damage, that doesn’t rule out RA. It may mean that the disease is in an early stage and hasn’t yet damaged the joints.

RHEUMATOID ARTHRITIS TREATMENT

The goals of treatment for rheumatoid arthritis (RA) are to:

  • Stop inflammation (put disease in remission)
  • Relieve symptoms
  • Prevent joint and organ damage
  • Improve physical function and overall well-being
  • Reduce long-term complications

To meet these goals, the doctor will follow these strategies:

Early, aggressive treatment. The first strategy is to reduce or stop inflammation as quickly as possible—the earlier, the better.

Targeting remission. Doctors refer to inflammation in RA as disease activity. The ultimate goal is to stop it and achieve remission, meaning minimal or no signs or symptoms of inflammation. One strategy to achieve this goal is called “treat to target.”

Tight control. Getting disease activity to a low level and keeping it there is what is called having “tight control of RA.” Research shows that tight control can prevent or slow the pace of joint damage.

MEDICATIONS FOR RA

There are different drugs used in the treatment of rheumatoid arthritis. Some are used primarily to ease the symptoms of RA; others are used to slow or stop the course of the disease and to inhibit structural damage.

DRUGS THAT EASE SYMPTOMS

Nonsteroidal anti-inflammatory drugs (NSAIDs) are available over the counter and by prescription. They are used to help ease arthritis pain and reduce inflammation. NSAIDs include such drugs as ibuprofen, ketoprofen and naproxen sodium, among others. For people who have had or are at risk of stomach ulcers, the doctor may prescribe celecoxib, a type of NSAID called a COX-2 inhibitor, which is designed to be safer for the stomach. These medicines can be taken by mouth or applied to the skin (as a patch or cream) directly to a swollen joint.

DRUGS THAT SLOW DISEASE ACTIVITY

Corticosteroids. Corticosteroid medications, including prednisone, prednisolone and methylprednisolone, are potent and quick-acting anti-inflammatory medications. They may be used in RA to get potentially damaging inflammation under control while waiting for NSAIDs and DMARDs (below) to take effect. Because of the risk of side effects with these drugs, doctors prefer to use them for as short a time as possible and in doses as low as possible.

DMARDs. An acronym for disease-modifying antirheumatic drugs, DMARDs are drugs that work to modify the course of the disease. Traditional DMARDs include methotrexate, hydroxychloroquine, sulfasalazine, azathioprine. These medicines can be taken by mouth, be self-injected or given as an infusion in a doctor’s office.

Biologics. These drugs are a subset of DMARDs. Biologics may work more quickly than traditional DMARDs, and are injected or given by infusion in a doctor’s office. Because they target specific steps in the inflammatory process, they don’t wipe out the entire immune response as some other RA treatments do. In many people with RA, a biologic can slow, modify or stop the disease—even when other treatments haven’t helped much.

JAK inhibitors. A new subcategory of DMARDs known as “JAK inhibitors” block the Janus kinase, or JAK, pathways, which are involved in the body’s immune response. Tofacitinib belongs to this class. Unlike biologics, it can be taken by mouth.

SURGERY

Surgery for RA may never be needed, but it can be an important option for people with permanent damage that limits daily function, mobility and independence. Joint replacement surgery can relieve pain and restore function in joints badly damaged by RA. The procedure involves replacing damaged parts of a joint with metal and plastic parts. Hip and knee replacements are most common. However, ankles, shoulders, wrists, elbows and other joints may be considered for replacement.

RHEUMATOID ARTHRITIS SELF-CARE PRACTICES

Self-care, or self-management, means taking a proactive role in treatment and maintaining a good quality of life. Here are some ways you can manage RA symptoms (along with recommended medication) and promote overall health.

ANTI-INFLAMMATORY DIET AND HEALTHY EATING

While there is no specific “diet” for RA, researchers have identified certain foods that are rich in antioxidants and can help control and reduce inflammation. Many of them are part of the so-called Mediterranean diet, which emphasizes fish, vegetable, fruits and olive oil, among other healthy foods. It’s also important to eliminate or significantly reduce processed and fast foods that fuel inflammation.

BALANCING ACTIVITY WITH REST

Rest is important when RA is active and joints feel painful, swollen or stiff. Rest helps reduce inflammation and fatigue that can come with a flare. Taking breaks throughout the day conserves energy and protects joints.

PHYSICAL ACTIVITY

For people with RA, exercise is so beneficial it’s considered a main part of treatment for rheumatoid arthritis. The exercise program should emphasize low-impact aerobics, muscle strengthening and flexibility. The program should be tailored to fitness level and capabilities, and take into account any joint damage that exists. A physical therapist can help to design an exercise program.

HEAT AND COLD THERAPIES

Heat treatments, such as heat pads or warm baths, tend to work best for soothing stiff joints and tired muscles. Cold is best for acute pain. It can numb painful areas and reduce inflammation.

TOPICAL TREATMENTS

These treatments are applied directly to the skin over the painful muscle or joint. They may be creams or patches. Depending on the type used, it may contain nonsteroidal anti-inflammatory drugs (NSAIDs), salicylates or capsaicin, which help reduce pain.

NATURAL AND ALTERNATIVE THERAPIES

Relaxation techniques, such as deep breathing, guided imagery and visualization can help train painful muscles to relax. Research shows massage can help reduce arthritis pain, improve joint function and ease stress and anxiety. Acupuncture may also be helpful.

SUPPLEMENTS

Studies have shown that turmeric and omega-3 fish oil supplements may help with rheumatoid arthritis pain and morning stiffness. However, talk with a doctor before taking any supplement to discuss side effects and potential interactions.

POSITIVE ATTITUDE AND SUPPORT SYSTEM

Many studies have demonstrated that resilience, an ability to “bounce back,” encourages a positive outlook. Having a network of friends, family members and coworkers can help provide emotional support. It can help a patient with RA cope with life changes and pain.

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