• What is Hidradenitis Suppurativa?

    • Hidradenitis suppurativa (HS), also known as acne inversa (AI), is a common, painful, debilitating, and chronic inflammatory skin disease affecting 1-4% of the global population, primarily occurring in the crease areas of the skin, e. g. axillae (armpits) and groin.
    • HS usually produces painful and chronically recurring, deep-seated follicular papules and pustules.
    • They may enlarge to become nodules, may form abscesses that discharge foul-smelling pus, leading to nodular scars and distortion of the skin.
    • The tendency of the process to cause tunnels ultimately leads to inter-connected sinuses and attempts to heal these leads to thickened scars.
  • What are the causes of Hidradenitis Suppurativa?

    The search for the cause of HS has been difficult. Suggested causes include:

    • Hormones/hormone imbalance
    • Local factors including heat and humidity, sweating, rubbing of skin-to-skin
    • A reaction to deodorants or other topical chemicals
    • Abnormal inflammatory responses to follicle rupture
    • Abnormal responses to normal bacteria in the skin
    • Abnormal healing responses to follicular injury
    • Diet
    • Heredity, and
    • Abnormal control of growth factors within the follicle/pore.

    Ratio: F:M is 3:1

  • Manifestations of HS

    Local Lesions:

    • Individual lesions may consist of inflammatory bumps, similar to pimples, usually occurring in the creases: the underarms, groin, under breasts, and between buttocks. Small pimple-like lesions may progress to become nodules, pustules, or soft tender reddish-purple masses that look like boils.
    • With repeated inflammation and scarring, there may develop sinus tracts, inter-connected tunnels under the skin where pressure on one area may express pus from a pore distant from the original point of pressure. Lesions are typically painful, and may drain a foul-smelling material. Large amounts of pus are common, and may lead to staining of clothing, lesions will fill with a gelatinous substance and extend further under the skin, especially in pressure areas. These look like a large boil but are purplish-red instead of hot red, are broad-based instead of localized, and do not ‘point to the surface and rupture and discharge and heal like a true infected boil.
    • Although early lesions may come and go, these gel-filled cavities, the tunnels, and the scars that develop will often persist for months or years. Similarly, drainage and/or pain may occur intermittently, or be continuous.

    Other Associations:

    • Other body inflammations may occur. HS may be seen in some patients with inflammatory bowel disease, and especially Crohn disease.
    • In other patients, rheumatoid arthritis-like joint aching may occur. Additionally, several other rare inflammatory conditions of the skin – Sweet’s syndrome, Behçet’s disease, or Pyoderma Gangrenosum – may be seen with HS.
    • The metabolic syndrome, with its tendencies toward diabetes; or hormone imbalances such as polycystic ovaries, are often found in patients with HS.
  • Impact on Patients

    • HS is recognized to be significant in interfering with social interaction, job performance and attendance, and intimate relationships. Hidradenitis causes pain, itching, drainage, odor, and scarring, and may lead to marked embarrassment. There is, therefore, frequently significant emotional impact on patients and their families
    • Our skin is the most visible part of our body. It is important for our interpersonal relationships, self esteem and self image. Hidradenitis suppurativa causes painful malodorous sinuses, swollen abscesses and disfiguring scarring with unpredictable drainage that results in debilitating depression and embarrassment. For women starting with painful draining nodules at puberty or in their early teens, it ruins their confidence, resulting not only in depression but self destructive behavior. This is often made worse by inadequate or poor care.
    • Early signs and symptoms:
      When people first get hidradenitis suppurativa (HS), they often see: 

      • One (or several) breakouts that look like pimples or boils.
      • Breakouts may stay on the skin; sometimes, they clear and reappear.
    • Later signs and symptoms:
      Without treatment, HS can worsen. If this disease progresses, the person may develop: 

      • Painful, deep breakouts that heal and reappear.
      • Breakouts that rupture and leak a foul-smelling fluid.
      • Scars that form as breakouts repeatedly heal and reappear.
      • Scars that become thicker with time.
      • Skin that begins to look spongy as tunnel-like tracts form deep in the skin.
      • Serious infections.
      • Skin cancer (rare).
    • Signs and symptoms can change:
      • The signs and symptoms of HS can change quickly. One week, a person may have a foul-smelling fluid leaking from breakouts. The next week, the breakouts have cleared and scars are the only sign of HS.
      • Some people always have breakouts on their skin.
    • Skin cancer risk:
      HS develops on skin that tends to get little or no direct sunlight. Yet, a few people have developed squamous cell carcinoma, a common type of skin cancer, where they had HS breakouts and scarring for years. Most cases developed in men who had long-standing HS on their genitals or around their anus.
    • Quality of life affected:
      Without treatment, HS can continue its cycle of breakouts and healing. As the breakouts clear, scars form. Continual healing and scarring can cause hollow passages called fistulas to develop inside the body. Fistulas can be painful and require surgery to repair.
  • How do dermatologists diagnose Hidradenitis Suppurativa?

    • To diagnose this skin disease, a dermatologist looks closely at the skin and asks some questions.
    • If your breakouts are leaking fluid, your dermatologist may swab a bit of the fluid onto a slide to find out if you have an infection. You also may need a blood test.
    • How do dermatologists treat hidradenitis suppurativa?
      Dermatologists offer patients who have hidradenitis suppurativa (HS) many treatment options, including many different medicines. Surgery may be an option when HS is severe or fails to respond to other treatment.
      Treatment can help patients with HS: 

      • Clear or reduce breakouts.
      • Get rid of scars and tunnels beneath the skin.
      • Prevent new breakouts.

      Dermatologists frequently use the treatments listed below, so they have in-depth knowledge and experience using them.

      Medicines used to treat HS: If you have HS, your dermatologist may include one or more of the following in your treatment plan:

      • Antibiotics: This is often part of the treatment plan. These drugs can reduce inflammation, fight infection, prevent HS from worsening, and stop new breakouts.
      • Acne washes and medicines: Acne treatments that you can buy without a prescription may be helpful. Using these products alone usually will not clear HS.
      • Bleach baths: If certain bacteria colonize (found on the surface of your skin) you, your dermatologist may recommend taking 5- or 10-minute bleach baths. You’d take this bath in your own bathtub at home. If a bleach bath is right for you, your dermatologist will tell you how to make one.

      Biologic is the first FDA-approved treatment for HS

      The U.S. Food and Drug Administration (FDA) approved the first treatment for HS in 2015. It is a biologic called adalimumab (a dal aye’mu mab). In studies, the patients who received adalimumab had noticeably fewer abscesses and nodules.

      The FDA has approved adalimumab for adults who have moderate (Hurley stage II) or severe (Hurley stage III) HS.

      • Biologics: These work on the immune system. Some, such as adalimumab, you inject yourself. Others require an infusion at a hospital or clinic. Some patients have seen long-term clearing of their HS with a biologic. Due to possible serious side effects, you should discuss the risks and benefits with your dermatologist.
      • Corticosteroid injection into a breakout: Your dermatologist may inject this into a painful cyst to reduce pain and swelling.
      • Corticosteroid pills: This medicine reduces inflammation, which can help clear HS and prevent new breakouts.
      • Diabetes drug: Metformin has been approved to treat adult-onset diabetes. It may also help people who have HS and a condition called metabolic syndrome.
      • Hormone therapy: Some women who have HS get relief by taking birth-control pills, a medicine called spironolactone, or another medicine that regulates hormones. These medicines can decrease pain and the amount of fluid draining from the breakouts.
      • Methotrexate (severe HS only): This medicine is used to treat cancer and certain other medical conditions, such as severe psoriasis. It works on the immune system and may help control HS in some patients.
      • Oral retinoid: A few patients with HS are helped.
      • Radiation therapy: This treatment exposes the body to radiation, so it is used less often today than in the past. Some patients have seen their HS clear. Be sure to talk with your dermatologist about the short- and long-term risks to your body.
      • Wound dressings: If the HS causes tunnels beneath your skin, you will need to treat these as you would wounds.
    • Surgical treatment for HS: When HS grows deep into the skin, medicine alone may not be effective. Your dermatologist may recommend a surgical procedure. The following can be performed in a dermatologist’s office or clinic:
      • Laser surgery: This treatment is showing promise. Some patients clear after several treatments. Lasers are proving effective at clearing new and deep HS breakouts. This treatment may be helpful because it destroys the hair follicles.
      • Deroofing: This surgery may be an option for patients who have painful HS that repeatedly returns. The surgeon turns deep, painful HS into scars.
      • Drain or incise: During the surgery, the dermatologist drains 1 or 2 lesions or cuts them out. This can bring short-term relief, but the HS can return.
      • Excision: This involves surgically cutting out the HS and some normal-looking skin. Because the wound is deep, the area needs to be covered with a skin graft (skin removed from another part of your body) or skin flap (skin from nearby is pulled over to cover the wound). HS does not return to the treated area, but it can develop nearby.

      No one treatment works for everyone who has HS. Sometimes, a patient needs to try a few different treatments to find one that works.

  • Outcome: Lifestyle changes can be effective

    Many people have HS for life. Studies continue to show that making certain lifestyle changes can help tremendously. Weight loss has proven so effective that some patients say maintaining a healthy weight prevents HS breakouts.

  • What is Exemptia?

    EXEMPTIA is a prescription medicine that can be self-injected. It is used to treat moderate to severe rheumatoid arthritis (RA). EXEMPTIA is grouped within a class of medications called biologic response modifiers, or biologics. By working on the immune system, biologics block proteins that contribute to the disease process. Because EXEMPTIA suppresses the immune system, patients are at a greater risk for getting serious infections.

    The science behind EXEMPTIA

    Tumor necrosis factor (TNF) is a substance made by your body’s immune system. People with inflammatory diseases such as rheumatoid arthritis, plaque psoriasis, psoriatic arthritis, juvenile idiopathic arthritis, and ankylosing spondylitis have too much TNF in their bodies. EXEMPTIA reduces levels of the active form of TNF.

  • How Exemptia works?

    Usually, your immune system protects your body from many of the things that can be harmful. But when the immune system doesn’t work properly, it can attack one’s own healthy tissues and organs. This is an autoimmune disorder. A protein called as tumor necrosis factor, also known as TNF, produced naturally by the body is one part of your immune system. But in certain autoimmune diseases, some people produce too much TNF. This often leads to inflammation (Inflammation is the body’s attempt at self-protection; the aim being to remove harmful stimuli, including damaged cells, irritants, or pathogens – and begin the healing process. However, sometimes inflammation can cause further inflammation; it can become self-perpetuating.). EXEMPTIA (contains adalimumab) is a medication called a TNF blocker. It works by binding to TNF molecules and blocking them from attaching to and attacking healthy cells. In this way, EXEMPTIA helps reduce the damaging effects of excess TNF. Remember no treatment can stop your body’s overproduction of TNF, but a medication like EXEMPTIA can help reduce its effects.

    Mechanism of Action (MoA) of Exemptia

    The pain, stiffness, and swelling of rheumatoid arthritis can make it difficult for you to perform daily activities such as:

    • Combing your hair
    • Buttoning a shirt
    • Opening a jar
    • Walking up stairs

    For many adults, EXEMPTIA is proven to help reduce pain, reduce joint swelling and stiffness, and help stop further joint damage. EXEMPTIA is a prescription medicine used alone, with methotrexate, or with certain other medicines to reduce the signs and symptoms of moderate to severe rheumatoid arthritis in adults, may prevent further damage to your bones and joints, and may help in increasing your ability to perform daily activities. EXEMPTIA works by targeting and blocking a specific source of inflammation that contributes to symptoms of rheumatoid arthritis.

  • Results with Exemptia

    Clinical Trial of EXEMPTIA in Indian Patients:

    Globally Adalimumab is available as HUMIRA. A clinical study was conducted in India to assess if efficacy and safety of EXEMPTIA is similar to HUMIRA A total 162 subjects were screened at 11 investigational sites in India, of which, 120 subjects were enrolled in the study, 60 subjects in each group viz. EXEMPTIA and Innovator’s Adalimumab. This trial was conducted for a period of 12 weeks.

    How well did EXEMPTIA work in this trial?

    After treatment with EXEMPTIA, at Visit 5 (on day 84), 82% patients had 20% improvement in rheumatoid arthritis (RA) symptoms, 46% patients had 50% improvement in RA symptoms and 14% patients had 70% improvement in RA symptoms. These results were similar to those with Innovator’s Adalimumab.

    How safe was EXEMPTIA in this trial?

    Overall, EXEMPTIA was safe and well tolerated in this study. The safety profile of both EXEMPTIA and HUMIRA was similar.

    What were the commonly observed side- effects with EXEMPTIA in this trial?

    Dyspnoea (difficulty in breathing), Fungal infection, Gastritis, Headache, Injection site reaction, Oligomenorrhoea(menstrual periods occur at intervals of greater than 35 days, with only four to nine periods in a year),Pollakiuria(an excessive frequent urination),Polymenorrhoea (occurrence of menstrual cycles at frequency that is higher than normal),Pulmonary tuberculosis, Fever, Rash, Urinary tract infection, Vomiting, Abdominal discomfort, Abdominal pain, Accelerated hypertension (rapid and sudden increase in blood pressure ), Asthenia (abnormal physical weakness), Chest pain, Cough, Diarrhoea and Dyspepsia (indigestion) Majority of adverse events were mild in intensity and not related to the study drug. There were no persistent changes from baseline in laboratory parameters in both treatment groups.

  • Injection demos

    Do not try to inject EXEMPTIA yourself until you have been shown the right way to give the injections and have read and understood this Instructions for Use. If your doctor decides that you or a caregiver may be able to give your injections of EXEMPTIA at home, you should receive training on the right way to prepare and inject EXEMPTIA. It is important that you read, understand, and follow these instructions so that you inject EXEMPTIA the right way. It is also important to talk to your doctor to be sure that you understand your EXEMPTIA dosing instructions. To help you remember when to inject EXEMPTIA, you can mark your calendar ahead of time. Call your healthcare provider if you or your caregiver has any questions about the right way to inject EXEMPTIA.

  • Dosing Information

    • Administered by subcutaneous injection

    Dose for Rheumatoid Arthritis (RA), Psoriatic Arthritis, Ankylosing Spondylitis:

    • 40 mg every other week
    • Some patients with RA not receiving methotrexate may benefit from increasing the frequency to 40 mg every week.

    Dose for Juvenile Idiopathic Arthritis:

    • 10 kg to < 15 kg: 10 mg every other week
    • 15 kg to < 30 kg: 20 mg every other week
    • ≥ 30 kg: 40 mg every other week

    Dose for Plaque Psoriasis:

    • The starting dose of Exemptia for adult patients with plaque psoriasis is 80 mg (2 PFS) on day-1
    • The maintenance dose is 40 mg (1 PFS) on day-8 and 40 mg every other week thereafter

    Dose for Hidradenitis Suppurativa:

    • 160 mg (4 PFS) initial dose on day-1(four 40 mg injections in one day or two 40 mg injections per day for two consecutive days)
    • Followed by a second dose of 80mg (2 PFS) after two weeks i.e. day-15
    • Follow a maintenance dose of 40 mg every week, commencing from day-29
  • Starting on Exemptia

    What should I tell my doctor BEFORE starting EXEMPTIA?

    Tell your doctor about all of your health conditions, whether you:

    • Have an infection, are being treated for infection, or have symptoms of an infection
    • Get a lot of infections or infections that keep coming back
    • Have diabetes
    • Have TB or have been in close contact with someone with TB, or were born in, lived in, or travelled where there is more risk for getting TB
    • Live or have lived in an area where there is an increased risk for getting certain kinds of fungal infections, such as histoplasmosis, coccidioidomycosis, or blastomycosis
    • Have or have had hepatitis B
    • Are scheduled for major surgery
    • Have or have had cancer
    • Have numbness or tingling (lack of sensation) or a nervous system disease such as multiple sclerosis or Guillain-Barré syndrome
    • Have or had heart failure
    • Have recently received or are scheduled to receive a vaccine. EXEMPTIA patients may receive vaccines, except for live vaccines
    • Are allergic to any of the EXEMPTIA ingredients
    • Are pregnant, planning to become pregnant, breastfeeding, or planning to breastfeed

    Also tell your doctor about all the medicines you take. You should not take EXEMPTIA with abatacept, anakinra, infliximab, etanercept, certolizumab pegol, or golimumab. Tell your doctor if you have ever used rituximab, azathioprine, or mercaptopurine (6-MP).

    What should I watch for AFTER starting EXEMPTIA?

    EXEMPTIA can cause serious side effects, including:

    • Serious infections. These include TB and infections caused by viruses, fungi, or bacteria. Symptoms related to TB include a cough, low-grade fever, weight loss, or loss of body fat and muscle.
    • Hepatitis B infection in carriers of the virus. Symptoms include muscle aches, feeling very tired, dark urine, skin or eyes that look yellow, little or no appetite, vomiting, clay-colored bowel movements, fever, chills, stomach discomfort, and skin rash.
    • Allergic reactions. Symptoms of serious allergic reactions include hives (urticaria), trouble during breathing, and swelling of your face, eyes, lips, or mouth.
    • Nervous system problems. Signs and symptoms include numbness or tingling, problems with your vision, weakness in your arms or legs, and dizziness.
    • Blood problems. Symptoms include a fever that does not go away, bruising or bleeding very easily, or looking very pale.
    • Heart failure (new or worsening). Symptoms include shortness of breath, swelling of your ankles or feet, and sudden weight gain.
    • Immune reactions including a lupus-like syndrome. Symptoms include chest discomfort or pain that does not go away, shortness of breath, joint pain, or rash on your cheeks or arms that gets worse in the sun.
    • Liver problems. Symptoms include feeling very tired, skin or eyes that look yellow, poor appetite or vomiting, and pain on the right side of your stomach (abdomen).
    • Psoriasis (new or worsening). Symptoms include red scaly patches or raised bumps that are filled with pus.Call your doctor or get medical care immediately if you develop any of the above mentioned symptoms.Common side effects of adalimumab include injection site reactions (redness, rash, swelling, itching, or bruising), upper respiratory infections (sinus infections), headache, rash, and nausea.These are not all of the possible side effects with EXEMPTIA. Tell your doctor if you have any side effect that bothers you or that does not go away.

    Remember, tell your doctor immediately if you have an infection or symptoms of an infection, including:

    • Fever, sweats, or chills
    • Muscle aches
    • Cough
    • Shortness of breath
    • Blood in phlegm
    • Weight loss
    • Warm, red, or painful skin or sores on your body
    • Diarrhea or stomach pain
    • Burning when you urinate
    • Urinating more often than normal
    • Feeling very tired

    EXEMPTIA is given by injection under the skin.

  • How to administer?

    Do not try to inject EXEMPTIA yourself until you have been shown the right way to give the injections and have read and understood this Instructions for Use. If your doctor decides that you or a caregiver may be able to give your injections of EXEMPTIA at home, you should receive training on the right way to prepare and inject EXEMPTIA . It is important that you read, understand, and follow these instructions so that you inject EXEMPTIA the right way.

    Gather the material required for your injection:

    You will need the following material for each injection of EXEMPTIA. Find a clean, flat surface to place the material.

    • Alcohol swab
    • Cotton ball or gauze pad (not included in your EXEMPTIA carton)
    • EXEMPTIA prefilled syringe. See Figure A.

    Choose the injection site: wash and dry your hands well. Choose an injection site on:

    • The front of your thighs or
    • Your lower abdomen (belly). If you choose your abdomen do not use the area 2 inches around your bellu button (navel). See Figure B

    • Choose a different site each time you give yourself an injection. Each new injection should be given at least one inch from a site you used before.
    • Do not inject into the skin that is:
      • Sore (tender)
      • bruised
      • red
      • hard
      • scarred or where you have stretch marks
    • If you have psoriasis, do not inject directly into any raised, thick, red or scaly skin patches or lesions on your skin.
    • Do not inject through your clothes.

    Prepare the injection site:

    • Wipe the injection site with an alcohol swab using a circular motion.
    • Do not touch this area again before giving the injection. Allow skin to dry before injecting. Do not fan or blow on the clean area.

    Prepare the syringe and needle:

    • Always hold the prefilled syringe by the body of the syringe. Hold the syringe with covered needle pointing down. See Figure C.

    • Hold the syringe at eye level
    • The top of the liquid may be curved
    • Remove the needle cover
    • Hold the syringe in one hand. With the other hand gently remove the needle cover. See Figure D.
    • Throw away the needle cover.

    • Do not touch the needle with your fingers or do not let the needle touch anything.
    • Turn the syringe so that needle is facing up and hold the syringe at eye level with one hand so you can see the air in the syringe. Using your other hand, slowly push the plunger in, to push the air out throughout the needle. See Figure E.

    • You may see a drop of liquid at the end of the needle. This is normal.

    Position the prefilled syringe and inject EXEMPTIA:

    Position the syringe:

    • Hold the body of the prefilled syringe in one hand between the thumb and index finger. Hold the syringe in your hand like a pencil. See Figure F.

    • Do not pull back on the plunger at any time.
    • With our other hand gently squeeze the area of cleaned skin and hold it firmly. See Figure G.

    Inject EXEMPTIA:

    • Using a quick, dart- like motion, insert the needle into the squeezed skin at an angle of about 45degrees. See Figure H.

    • After the needle is in, let go of the skin. Pull back gently on the plunger.

    If blood appears in the syringe:

    • It means that you have entered a blood vessel.
    • Do not inject EXEMPTIA.
    • Pull the needle out of the skin while keeping the syringe at the same angle.
    • Press a cotton ball or gauze pad over the injection site and hold it for 10 seconds. See Figure I.

    • Do not use the same syringe and needle again. Throw away the needle and syringe in your special sharps container.
    • Do not rub the injection site. You may have slight bleeding. This is normal.
    • Repeat all the above steps with a new prefilled syringe.

    If no blood appears in the syringe:

    • Slowly push the plunger all the way in, until all of the liquid is injected and syringe is empty.
    • Pull the needle out of the skin while keeping the syringe at the same angle.
    • Remove the syringe from the injection site keeping your thumb on the plunger rod.
    • Orienting the needle away from you and others, activate “Preventis” syringe by firmly pushing the plunger rod. The protective sleeve will automatically cover the needle and an audible “click” will be heard to confirm shield activation. Immediately dispose off the syringe in the nearest sharps collector.

    • Press a cotton ball or gauze pad over the injection site for 10 seconds. Do not rub the injection site. You may have slight bleeding. This is normal.

    Keep a record of dates and location of your injection sites. To help you remember when to take EXEMPTIA, you can mark your calendar ahead of time.

  • Proper storage

    How should I store EXEMPTIA?

    • Store EXEMPTIA in a refrigerator at 36°F to 46°F (2°C to 8°C) in the original container until it is used. Protect from light.
    • When travelling, EXEMPTIA should be stored in a cool carrier with an ice pack.
    • Do not freeze EXEMPTIA. Do not use EXEMPTIA if frozen, even if it has been thawed.
    • Refrigerated EXEMPTIA may be used until the expiration date printed on the EXEMPTIA carton and prefilled syringe.
    • Do not use the prefilled syringe if the liquid is cloudy, discolored or has flakes or particles in it.
    • Keep EXEMPTIA, injection supplies and all other medicines out of the reach of children.
  • Exemptia Care – Patient Support Programme

    We would be happy to help you find the relevant tools and resources to help you in your Exemptia treatment

    Are you just starting with Exemptia? Sign up for EXEMPTIA CARE programme today.

    Patients and their care givers can enrol in our patient care services to avail our services or get responses to their queries:
        1. Email us at care@exemptia.com
        2. Call us at 1800-123-CARE (1800-123-2273) from Monday to Saturday 10 AM – 6 PM IST (Indian Standard Time) (Services will be active from December 10, 2014 onwards)
    Patients and healthcare professionals will be offered the below services:
      1. Support for patient compliance and adherence i.e. medication reminders, status of prescription (Rx) order
      2. Discount coupons from renowned labs after you start on Exemptia therapy
  • How to set medication reminders

    We know that you are very busy and remembering when to take your Exemptia medication isn’t always easy. EXEMPTIA CARE offers medication reminders the way that’s most convenient for you. Messages arrive on one day prior to the date you specify for taking the next dosage of Exemptia and a call comes one day after the date on which you have set up the medication reminder. Plus, you can change your reminder settings at any time by calling. It’s at no additional cost to you.

    Set Up Medication Reminders Now
    1. Calling us at EXEMPTIA CARE toll free number: 1800-123-CARE (1800-123-2273)
    2. E-mail us at: care@exemptia.com
  • FAQs

    Fast facts

    • Medicines for rheumatoid arthritis (RA) can slow down the disease and reduce damage to joints. They can relieve pain and make it easier to do everyday tasks.
    • Most people can find an RA drug that works.
    • If one RA drug isn’t working well enough, you have other options. Switching to a different RA drug or adding another kind of RA drug can help.
    • Steroids are often used along with other RA drugs. They help with joint pain and swelling. But using them for a long time can cause side effects.
    • RA drugs can increase the chance of infections and other side effects. Regular checkups and blood tests are ways to catch these problems early.

    Some commonly asked questions

    I’ve had RA for several years now. Recently I’ve noticed that whenever I have a flare, my joints creak and crack. It’s loud and sometimes embarrassing, but I’m not in any more pain than usual. Should I be concerned?

    The cracking sound is related to the rapid shift of fluid within the joint from one space to another and also to changes within the joint cartilage. During flares, the amount of fluid in the joint space increases; as you move, the snapping of irregular, inflamed tissues can create those cracking and popping sounds. Although it can be annoying, it’s not something to worry about. The best way to put a lid on the noise is to continue to keep RA under control with

    medication and lifestyle changes.

    Is rheumatoid arthritis same as osteoarthritis?

    NO. Rheumatoid arthritis is an autoimmune disease, which means your body attacks itself. The target is the synovium, the soft lining around the joints. The immune system sees the synovium as a threat similar to a virus or bacteria and attacks. As a result, fluid accumulates around the joints. The fluid build up causes pain, stiffness, tenderness and inflammatory symptoms of RA.

    Osteoarthritis, the most common form of arthritis, is a degenerative joint disease. People with OA experience a breakdown of the cartilage that cushions the joints. The wearing down of cartilage causes your bones to rub against each other, which accounts for pain and inflammation. Osteoarthritis does not involve the immune system as in the case of RA.

    Does weather affect arthritis pain?

    If you have arthritis, you may be among those people (and there are many) who feel that their arthritis pain is influenced by the weather specifically, that they experience more arthritis pain on cold, rainy days and less arthritis pain on warm, dry days.

    But research studies on whether climate really does affect arthritis pain have produced conflicting results.

    How to avoid a rheumatoid arthritis flare?

    One of the hardest things about having RA is that you never know when symptoms will flare up. If you’ve gone a long time without one, it can come as a shock. During flares, some people feel frustrated and wonder if they did something wrong.

    So, let’s clear the air at the start. No one can predict when and why flares occur. It’s not your fault. The best way to keep flares at bay is to take your RA medications consistently. But there are some things you can do to reduce the odds of a flare.

    Are you pacing yourself?

    On days when you are feeling good, you may be tempted to catch up on all the things you haven’t been able to get done. But be careful not to overdo it. Overdoing activities can bring on fatigue and trigger a flare. On good days, prioritize what needs to be done and pace yourself. Take frequent rest breaks even if you aren’t feeling particularly tired. Ask for help.

    Do you protect your joints carefully?

    Overusing a joint can trigger painful symptoms and cause more damage. You can help protect your joints in a few key ways.

    • Maintain a healthy weight (lose a few pounds if you need to).
    • Take advantage of adaptive devices like canes, special jar openers, and padded handles.
    • Use good body mechanics — use your largest joints when you lift, carry, or bend.
    • Wear safety gear like knee and elbow pads or wrist guards when you play sports or do outdoor activities.
    • Move your joints through their full range of motion. Use slow, gentle movements. And do specific exercises to strengthen the muscles and ligaments around your joints. You might ask your doctor for a referral to a physical therapist to get some help learning how to do this.

    Do you take your medications on schedule?

    It’s so easy to forget, and yet taking your RA medications at the same time every day is the most important thing you can do to prevent a flare. A regular schedule helps you keep a constant, effective level of medication in your blood. Skipping doses can trigger a flare. So use a pill box, a calendar, or an alarm to help keep you on track.

    If, despite everything, you feel a flare coming on, call your doctor right away. Your doctor may be able to tweak your medications to help keep RA symptoms during the flare under better control.

    Is there a cure for rheumatoid arthritis ?

    NO, there is no cure for RA, but new effective drugs are increasingly available to treat the disease and prevent deformed joints. In addition to medications and surgery, good self-management, including exercise, are known to reduce pain and disability.

    Can i get pregnant if i have rheumatoid arthritis?

    Experts disagree whether rheumatoid arthritis affects fertility, but it’s been proven that women with RA do take longer to conceive. This could be chalked up to the side effects of the disease for women, such as low sex drive, inconsistent ovulation, fatigue, and pain. One thing to be aware of is that the medications you might be on for RA may cause birth defects, so you have to work with your doctor to monitor medication if you’re trying to conceive. The minute you and your partner are ready to start trying for baby, see a rheumatologist. Some medications take a month to two years to wash out of your system before it’s safe to conceive. (By the way, that goes for both men and women being treated for RA.) Your rheumatologist will also work out a treatment plan for you while you’re pregnant. Some patients quit medication.

    Although some women with RA run a slight risk of miscarriage or giving birth to a low-weight baby, the majority of them have normal births without complications. Ironically, 70 to 80 percent of women claim that RA symptoms improved during pregnancy. Another thing to know is that you can’t pass on the disease to your fetus. Though RA has a small genetic component, it doesn’t damage the fetus nor does the baby inherit the disease.

    Do RA symptoms improve during pregnancy ?

    YES. Research suggests that RA symptoms improve during pregnancy, but symptoms usually return and flares can occur after the baby is born. If you have been diagnosed with RA and you are pregnant or plan to be pregnant soon, talk to your doctor about your medications. Some RA medications are not considered safe during pregnancy, and you may temporarily have to stop taking them. Some medications can also affect fertility in both men and women.

    Ask your doctor which medications are safe to take when breastfeeding.

    Is there a link between rheumatoid arthritis and heart attack ?

    People with rheumatoid arthritis have a slightly greater chance of having a heart attack or stroke. The risk is probably reduced by controlling the disease, for example with drug treatments. High cholesterol and smoking increase the risk, so it’s a very good idea to eat a balanced diet and stop smoking.

    Do i need any surgery ?

    Surgical treatment for rheumatoid arthritis is used to relieve severe pain and improve function of severely deformed joints that don’t respond to medicine and physical therapy.

    Total joint replacement (arthroplasty) can be done for many different joints in the body. Its success varies depending on which joint is replaced.

    Surgeries considered for people who have severe rheumatoid arthritis include:
    • Arthroplasty, to replace part or all of a joint, such as the hip or knee.
    • Arthroscopy, which uses a small lighted instrument to remove debris or inflamed tissuefrom a joint.
    • Carpal tunnel release, to relieve pressure on the median nerve in the wrist.
    • Cervical spinal fusion, to treat severe neck pain and nerve problems.
    • Finger and hand surgeries, to correct joint problems in the hand.
    • Foot surgery such as phalangeal head resection.
    • Synovectomy, to remove inflamed joint tissue.

    Joint surgery often restores near-normal movement in a person who has osteoarthritis in just one or two joints. But this is not the case for people affected by rheumatoid arthritis.

    I have rheumatoid arthritis (RA) and whenever I have a particularly bad flare, my voice becomes very raspy. Sometimes my throat is so swollen that I actually lose my voice. Could my RA be the blame?

    Hoarseness can indeed be related to your RA. Although many people aren’t aware of it, the throat contains cartilage that can become inflamed during a flare. The swelling can affect your voice and even impair your breathing. Mention this symptom to your rheumatologist, and in the meantime, stay clear of smoky areas and try not to strain your voice.

    Can uv rays ease ra pain?

    There is no evidence whatsoever that tanning beds have a favorable effect on RA symptoms. In fact, depending on what medications you’re taking, your condition may actually be worsened when you’re exposed to UV rays. Besides, certain RA medications may increase the risk of skin cancer.

    What is a good healthy diet to follow?

    It is important to follow a healthy, balanced diet that includes:
    • Whole grains, like oatmeal or brown rice
    • Fruits and vegetables
    • Low or no saturated fat, especially animal fat
    • Low amounts of salt and sugar
    • The daily recommended amount of vitamins and minerals

    Research has also suggested that eating foods rich in omega-3 fatty acids, such as fish, can help reduce inflammation in your body. If you drink alcohol, do so in moderation. If you notice certain foods seem to increase the swelling in your joints, try to avoid them.

    Maintaining emotional health: You can also improve your physical health by improving your emotional health. High levels of stress might increase your tendency to experience flares and might make it more difficult to deal with the challenges of living with RA.

    You can take steps to understand and control your stress:
    • Spend some time to identify what stresses you by keeping a journal or diary.
    • Try to avoid things that contribute to your stress.
    • Develop positive ways to cope, like making time for hobbies you enjoy or simply relaxing in a quiet space each day.

    Sometimes, you might find yourself feeling frustrated or sad about some of the challenges you

    face when living with RA. Tasks that used to be simple might now be difficult or might require the help of others. Some days, pain and fatigue might leave you feeling helpless or overwhelmed. It’snormal to feel this way, especially at first. It can help to seek support from friends and family ortake extra time to do things that make you happy. You might want to find a support group or online message board for people with RA.

    Protecting your bones

    Together with your doctor, you will want to track the health of your bones. You may want to ask your doctor whether you should take a bone density test. Many people with RA develop osteoporosis, a condition in which the bones become brittle and easy to break.

    This is especially true if you take large doses of corticosteroids, such as prednisone, over a long period of time. There are several steps you can take to help prevent osteoporosis:

    • Get enough calcium and vitamin D in your diet.
    • Do gentle, weight-bearing exercise, like walking, as recommended by your doctor.
    • Do not smoke.