Rheumatoid Arthritis: 8 Top Myths

Rheumatoid arthritis affects about 1% of the population worldwide, but still misunderstanding swirls around this common and severe joint condition.

"There are so many misconceptions out there about rheumatoid arthritis," says Paul Kremer, MD, a rheumatologist and professor of medicine at Albany Medical College in New York.
"Arthritis is common, and rheumatoid arthritis often gets confused with the other kinds of arthritis in people's minds,” he says.

Plus, rheumatoid arthritis is still mysterious in many ways. Research and new treatments are constantly changing the understanding of the disease.

Even the experts still have a lot to learn about rheumatoid arthritis. WebMD teamed up with Kremer to explode a few common myths about this "commonly unusual" disease.

Myth No. 1: Rheumatoid arthritis is just like ‘regular arthritis.’

Fact: Rheumatoid arthritis is not "regular arthritis." What we think of as “regular arthritis” is osteoarthritis, caused by injury or normal wear-and-tear on aging joints. Osteoarthritis is the most common joint disease in middle age to older people.

By contrast, rheumatoid arthritis is a chronic, progressive autoimmune disorder. In response to an unknown trigger, the body makes antibodies that attack its own tissues. The self-attacks mostly affect the joints, although they can also affect other body parts. Disease attacks, called flare-ups, occur periodically, or can be continuous in some people.

"This is the most common confusion -- between osteoarthritis and rheumatoid arthritis. It gets even more confusing, because people with RA often also have osteoarthritis," adds Kremer.

Myth No. 2: Only old people get rheumatoid arthritis.

Fact: In most people who develop RA, the disease starts between the ages of 30 and 55.
"This is the peak age group," says Kremer, "but anyone can get rheumatoid arthritis, even teenagers." At the same time, "older folks may have more severe RA, because it's progressive and they've been living with it longer."

Myth No. 3: Rheumatoid arthritis isn't all that serious.

Fact: Rheumatoid arthritis can threaten your health and independence, especially if it's inadequately treated.

"A lot of people downplay RA as just 'Grandma's rheumatism,' and they miss the boat completely," says Kremer. "They delay seeing a physician, often for months or years, and a lot of joint damage can happen during that time."

Rheumatoid arthritis needs prompt diagnosis and regular treatment to protect joints from harm. In turn, this can protect your independence and long-term function.

Having rheumatoid arthritis also increases the risk for certain other conditions, says Kremer. “Cardiovascular diseases, infections, and lung disease are all more common in people with RA."

Myth No. 4: Most people with rheumatoid arthritis end up in a wheelchair or nursing home because of the disease.

Fact: Rheumatoid arthritis takes a different course in different people, but most people go on living independently.

Because of its progressive nature, rheumatoid arthritis has caused disability in many people. Much of the available information, though, comes from 20- or 30-year-old studies.

"These were done in another era -- before we started treating early with methotrexate, before we had the new biologic agents," says Kremer. "We have made extraordinary strides in the treatment of this disease. Today, the overwhelming majority of people under treatment for rheumatoid arthritis will do very well" in retaining independence and mobility, he says.

A recent study suggests Kremer is right: 94% of people with rheumatoid arthritis continued to perform all their normal activities independently after 10 years with the disease.

Myth No. 5: Most people with rheumatoid arthritis can't work.

Fact: Work tasks or habits may need to change with rheumatoid arthritis. But the diagnosis doesn't equal a lifetime of disability.

"Again, this myth may have been true in an earlier era, prior to the current treatments," says Kremer. "Certainly many people will need allowances at work, or will have to limit some activities during disease flares. But a large proportion of people with RA go right on working."
In fact, in one large study of people who had had rheumatoid arthritis for more than 10 years, their employment rates were no different than those of similar-age people without RA.

Myth No. 6: Because treatments for rheumatoid arthritis can be toxic, it's best to wait until the disease progresses before beginning treatment.

"This may be the most dangerous myth," warns Kremer.

There is now abundant proof that treating rheumatoid arthritis early prevents joint damage and disability. "Ideally, treatment should start as soon as possible after diagnosis," he adds. "Delaying treatment can mean worse outcomes down the road."

Numerous studies suggest that early treatment could delay full-blown rheumatoid arthritis from developing in some people.

It's true, medications used to treat RA can have side effects. Rarely are the side effects worse than untreated rheumatoid arthritis, though. Simple blood tests and doctor's visits can detect many of the serious side effects of rheumatoid arthritis medications.

Myth No. 7: Most people with rheumatoid arthritis get cancer, too.

Fact: People with rheumatoid arthritis are at slightly higher risk for developing lymphoma (blood cancer), but the risk is low overall.

"For lymphoma, the lifetime risk is about twice as high in people with RA. It's not clear why," says Kremer.

However, let’s keep that in perspective. Even with the increased risk, only a small minority of people with RA get lymphoma.

For example, in one study, after following over two thousand people with rheumatoid arthritis for about eight years, 11 of them developed lymphoma. According to population estimates, between three and eight people without rheumatoid arthritis would be expected to develop lymphoma over that same time period.

"Some of this increased incidence may be due to the increased inflammation in rheumatoid arthritis, and some may actually be due to the medications," says Kremer. "Nevertheless, most people with rheumatoid arthritis do not get cancer."

Methotrexate, the new biologics, or both may partially contribute to this increased risk. Nevertheless, rheumatologists stand behind the medicines. "You have to weigh the risks and the benefits," suggests Kremer. Untreated rheumatoid arthritis is frequently devastating, while lymphoma is uncommon, often slowly progressing, and treatable, he adds.

On the bright side: the risk of colorectal cancer is actually reduced by up to 40% in people with rheumatoid arthritis. One theory argues that the frequent use of anti-inflammatory medicines called NSAIDs (including aspirin, motrin, and ibuprofen) by rheumatoid arthritis patients helps to prevent cancer in the colon.

Myth No. 8: Painful, stiff joints from rheumatoid arthritis need to rest most of the day.

Fact: On the contrary; joints affected by RA need stretching and exercise.

"We want to keep these people mobile with medications and with encouraging exercise and physical activity," advises Kremer. Sometimes rest is necessary, but "most people with rheumatoid arthritis should be moving and exercising more, not less."

Immobility can be counterproductive for someone with rheumatoid arthritis. When joints are painful and stiff, it's natural to want to avoid movement. However, immobility sets up a vicious cycle. The muscles around a joint contribute a large part of the joint's strength and stability. All muscles need regular activity to stay healthy -- use it or lose it.

Everyone with rheumatoid arthritis can perform some kind of exercise.
Stretching exercises require minimal exertion and help keep joints flexible.
Low-impact aerobic exercise improves joint health, as well as overall mental and physical health. High-impact exercise, in general, should be avoided.