When you have rheumatoid arthritis, your immune system attacks your joints and other organs, causing an array of symptoms including pain and swelling. RA is a more complex condition than the more common osteoarthritis, and though it often requires multiple medications and lifestyle adaptations to control it, treatment for RA has come a long way in the past 15 years. Here’s what three women told us about how RA has affected their lives. 1. An RA diagnosis can be scary. Merle Smith, 67, remembers being “terrified” when she found out she had RA in 1998. “I knew my grandfather had it and he was in a wheelchair and I thought, ‘This is my future.’” Her friend, Sheila Adelman, 64, also remembers her 2008 diagnosis as deeply unsettling. “When you find out something that could be life-changing, you’re very, very anxious.” Today, both women lead active lives in Atlanta, but they have faced many treatment and lifestyle decisions along the way. 2. Rheumatoid arthritis and osteoarthritis are very different beasts. RA is a systemic condition that inflames the lining around the joints, causing pain, damage and, often, deformity. It can also affect the eyes, skin, lungs and blood. Osteoarthritis, on the other hand, is caused by wear and tear on the joints and affects them directly. “People say ‘I have arthritis too,’” Smith notes, “and they show me one little finger that’s a bit swollen and I think, ‘That’s not what I have.’ People don’t realize all the complications.” 3. Early intervention is important. An early diagnosis may stave off some of the joint damage posed by RA. Doctors often suggest aggressive treatment from the beginning, with the goal of stopping inflammation and putting the disease into remission. “Mine’s under control,” says Smith, “but some of the disfigurement I have came right at the beginning.” 4. The pain and stiffness can be debilitating until RA is under control. RA usually comes in painful episodes called “flares,” which can last a day, weeks or even months. But discomfort can also be a constant. Barbara Moore (who asked that we not use her real name) is a healthcare provider outside Boston who has RA. She is currently on disability and says, “My entire body aches. There are days when my jaw hurts so much I can’t open it to eat. I use crutches to get around and I still fall because I can’t maneuver my joints anymore.” 5. Treatment has come a long way and there are many options. Newer medications have radically changed the way RA is treated, but patients often need multiple drugs to control their disease. These include: NSAIDS to control pain. Sometimes doctors also prescribe opioids. Other anti-inflammatories including corticosteroids to reduce swelling and pain DMARDS (disease modifying anti-rheumatic drugs), including methotrexate, which can slow or stop RA. Biologics, which are a particular type of DMARD that can be taken with other drugs and can work quite quickly. A JAK inhibitor, the newest RA treatment approved by the FDA, which is a pill that may stop the disease from progressing. 6. RA can cause severe fatigue and other complications. A common symptom of RA that can be hard for others to understand is extreme tiredness. Moore, a former college gymnast, feels that people minimize the fatigue, which frustrates her. “Yesterday, I could hardly move at the end of the day.” Anemia, which is common in rheumatoid arthritis and may be severe, has also contributed to her lack of energy. Lung complications are typical, too. Both Smith and Adelman have had them. “I have nodules on my lungs that my doctors have been following for years with CT scans,” Smith says. “I get infections and I’m prone to pneumonia. As a preventative, I’m doing a nebulizer twice a day and that has helped a lot.” 7. Living well with RA involves more than medication. Exercise can be a key to addressing RA symptoms. All three women we spoke with exercise weekly, including swimming and stretching. Complementary and alternative therapies may be beneficial; both Moore and Adelman get acupuncture treatments periodically. Support, whether it is from loved ones, professionals, or a community, is also important. Both Moore and Adelman have had counseling. Says Adelman, “I don’t think I would try to conquer a chronic disease without it—without people who can understand what you are facing.” Smith is a member of the Arthritis Foundation and from the start has kept a notebook of her symptoms and treatments that she takes to every doctor’s appointment. She highly recommends all RA patients do the same. 8. You may have to modify your environment. Because it can make movement difficult, people with RA can require help with chores or adaptive devices for routine tasks. Moore has a walk-in tub and, in her kitchen, two grabbers and three stools of different heights. And, she adds, “I use a computer with a light touch keyboard or voice-recognition software.” You may also need to adjust to an increased risk of infection. Biologics, which can be extremely effective, suppress the immune system and make exposure to sick people risky. That can mean tough choices. “We have our first grandchild,” Smith says. “It’s wonderful, but babies get sick, so that’s a conflict—do I kiss him all over his face or not? It’s hard.” (Smith went with the kisses.) All three women have gone from feeling initial dismay at discovering they have RA to finding many of the tools they need to handle the ups and downs of this chronic disease. Though it can be challenging at times, it’s still very possible to lead a well-lived and fulfilling life with RA.