Background/Purpose: RA affects all age groups and all occupational settings. I was diagnosed at age 58, while I was still very active at work, at sports and as a grandmother. I had to adapt to this new reality in several ways. Initially, the presentation was atypical (polymyalgia-like), and the disease was difficult to control with steroids. During steroid tapering, severe limitations in my hands, wrists, shoulders, ankles and feet associated with subtle hand synovitis (ultra sound exam negative once) made my rheumatologist suspect RA despite normal biomarkers. I started treatment with a combination of hydroxychloroquine and methotrexate injection, failed an anti-TNF and finally got sustained improvement with the addition of tofacitinib.

Treatment: I can attest how much an interdisciplinary team helps: rheumatologist, nurse, occupational therapist (OT) and physical therapist (PT) working with each other. Their support was especially important at the beginning of my disease, with the possibility to phone and ask questions to the specialized nurse to reduce my stress and improve my adherence to treatment. To overcome physical limitations, an OT provided orthotics for my hands, and several useful tips for energy conservation and activities of daily living. A PT gave me valuable tips and exercises to do at home. It would be particularly helpful if all patients should have access to these services early in their disease, although a supporting team may be important over all the disease stages, and particularly during flares or loss of efficacy of drugs. Our Faculty of Medicine in Sherbrooke developed a special teaching clinic “CURE” (OT and PT services) to give low-cost access to these services for patients without insurance. When receiving a diagnosis of arthritis, a grieving process ensues, a reorganization of daily activities is required and a lot of resilience to accept these changes is needed! I had to stop working temporarily and then returned to work progressively with adaptations and changes. The support of my rheumatologist was most important in this process.

Maintenance: My rheumatologist offered several effective treatments to slow down the progression of the disease, and we found together the winning combination (with trial and error). The availability and support from the interdisciplinary team, family and co-workers is very important, as there are good and bad periods. I need to keep hope, continue to be active, allow for rest periods, eat healthy and take the medication despite sometimes annoying side effects. Daily mindfulness meditation (offered to interested patients in our clinic) helps me a lot.

Quality of Life: It is very encouraging to regain control of one’s life through better control of the disease and to feel better and lead an almost normal life. However, I have to remain vigilant and be careful of infections since my immune system is weaker with the medication. The initial frequent consultations, regular check-ups, discouragement periods over my limitations and the frequent medication adjustments made me realize the importance of working as a team where the patient is a partner in care. Information about the disease and its treatments is important for the patient and health professionals as well.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/living-and-adjusting-to-a-diagnosis-of-rheumatoid-arthritis-ra-with-an-interdisciplinary-team/