Is Rheumatoid Arthritis a Bone Disease?

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Evaluate your rheumatoid arthritis (RA) medications!

It’s important to follow the treatment properly in order to make sure the disease is under control. Appropriate treatment can help put the disease into remission (period with little /no symptoms) for months or even years.

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Remission is the goal of RA treatment since there is still no curative therapy. With more years of remission you have, the complications of the disease (such as RA-related bone loss) are less likely to occur.

But while controlling the disease is crucial in determining the prognosis and preventing the complications, again some RA medications can hurt your bone.  Steroid RA medications, such as prednisone or glucocorticoid, are some common culprits for a significant bone loss.

Methotrexate (a kind of DMARDs, Disease-Modifying Antirheumatic Drugs), is another widely used medication for treating RA and other chronic inflammatory diseases. This medication can also have to do with the natural process of the body’s bone remodeling, the way of the body to break and rebuild bone.

Furthermore, be careful when you need to take PPI (proton pump inhibitors)! It is usually taken with NSAIDs or other anti-inflammatory medications to help protect your stomach lining. But it can interfere with calcium absorption.

In general, every medication for people with RA should outweigh the risk. But for those who are also at high risk of osteoporosis and other bone diseases, their RA medications should not impact their bones!

If necessary your doctor can prescribe low-medium dose of steroid medications. Even sometimes you may have an option to switch the medication. Some RA medications are now designed to NOT hurt bones. Biologic class of medication that uses TNF inhibitors, for example, can help soothe the inflammation without affecting the function of bone-forming cells.

Go with bone-healthy lifestyles!

Education, including lifestyle changes, is an important part of management of RA-related bone density loss. Remember, prevention is the key – even preventive measures are recommended at a younger age! So it’s much better to immediately MODIFY any risk factors as much as you can!

Some of these modifiable risk factors are as follows:

  1. Get plenty of vitamin D and calcium every day. People over 30 years of age need about 600 mg of vitamin D and 1,000 mg of calcium per day! Even after the age of 50, the body requires more calcium (about 1,200 mg /day). Foods high in calcium include low-fat milk, low-fat yogurt, sardines, kale, and broccoli. But sometimes it’s hard to get all you need from what you eat. In such a case, your doctor may prescribe vitamin D and calcium supplements.
  2. Do exercise regularly and have adequate exposure to sunlight! Weight-bearing exercise (such as weight training, gardening, and jogging), is a good way to improve and preserve your bone strength. Also, exercise can help preserve joint mobility.
  3. Avoid smoking. Tobacco smoke can hurt many parts of your body, including bone. Avoid second-hand smoke, too!
  4. Quit or cut down alcohol! Too much alcohol consumption can worsen your bone loss.
  5. If necessary, ask your doctor whether you need to take particular preventative medications. For example, sometimes alendronate (a kind of bisphosphonate) or estrogen therapy might be suggested to help reduce the risk of bone loss.
What else?

Talk with your doctor whether you need to take bone density test! A simple bone density test is generally recommended for elderly people (men over 70 years of age and women older than 65). But people with certain conditions that increase the risk of bone loss, such as rheumatoid arthritis, may benefit to take this test early!

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