‘My Rheumie says my RA is controlled, but I still have pain’ What could be the cause? let’s solve the puzzle…

1) First & foremost, let us differentiate RA -related & RA-unrelated pain. Let us not confuse & blame any pain in the body on RA.

RA would cause joint pain & swelling.
Headache would not be caused by RA itself.
If it is only the knee that hurts (& is not so swollen) this can be osteoarthitis.
Neck pain & backache are less likely to be caused by RA. They are more commonly caused by spondylosis rather than RA.
Please speak to your Rheumie & clear these issues.

2) If you are better in the morning & worse in the evenings & better on weekends: Well, are you over exerting yourself? Over exertion may be the cause of your persistent joint pain. That’s also the reason why you are better on weekends. RA related pain is generally worse in the morning. Why not sit down, chalk out a plan to limit your exertion? If the body does not get sufficient rest, the joint pain may be out of proportion to the RA activity. How long do you sleep each night? With RA, you require at least 7- 8 hours sleep.

3) Little pain when you work but worsening especially in the night. This is a tricky situation especially if you are not able to sleep due to pain. There is no reason why joints with active RA should not hurt while working & hurt at rest. Is there anything else on your mind? Is mental stress/ tension adding to your pain? Are you depressed? Sit down, take your own time, think about the other things on your mind & discuss the same with your Rheumie.

Let us look at the other questions down the line & solve the puzzle fully.

‘My Rheumie says my RA is controlled, but I still have pain’ What could be the cause?

As Rheumatologists, we try and assess the RA activity every time a RAer consults us. There are times when we feel that the RA is well controlled while the RAer keeps having pain. I’m sure many amongst you must have faced a similar situation on the other side of the table. Ever wondered what could be the cause of this situation?

Simply speaking, if none of the joints seem inflamed, your Rheumie would always consider the RA activity to be controlled. (Of course, it is not as simple as that!) You can help him help you with this little questionnaire. So take a paper, pencil & start marking…

1.      Where do you have persistent pain?

a.      Knee

b.      Back/ neck

c.      Headache

d.      All over the body

e.      All the joints

2.      Are you better on Sundays/ holidays? Are you OK in the morning & experience tiredness/ pain especially in the evening after office hours.

3.      Are you ok during the day & have pain especially in the night? ‘Nights are horrible & I just cannot sleep’ situation?

4.      Can you mark the painful areas of your body on a body diagram? Is it localized to joints/ muscles/ around the joints.

5.      Is the present pain similar to the joint pain you had when your joints were swollen?

6.      Do you have swelling in the joints off & on? Does the same settle by the time you reach your Rheumie’s clinic?

7.      Are you a pure vegetarian?

8.      Do you suffer from hypothyroidism?

We would discuss the relevance of each question in the subsequent blogs & this would enlighten you more about yourself/ your body & help your Rheumie fix the problem for you.


Are you grappling to come to terms with your arthritis? Is your arthritis incapacitating you?
Read on…

All of us have been talking how aggressive & early treatment with DMARDs is the best way to achieve conquest over RA. However, this is just a part of the jigsaw, definitely a major one. However, that’s not all for success. There is that additional piece of the jigsaw forgotten by many– the healing power of positive thinking.

The Law of attraction states that you will attract whatever your energy, attention & thoughts are focused on. Whatever vibes you send out will come back to you in a similar form. This law explains the healing power of positive thinking.

How do you start your day? Here is the concept of the ‘Morning Power questions’. I still remember one of my patients mentioning the pain she has due to RA in the morning. She compares the pain to hundreds of leeches all over her body & sucking blood. Yes, no doubt, this is precisely the pain & morning stiffness associated with RA. But then look at the effect it would have on her morale. If you get up in the morning with such a thought, how good would your entire day be? Even if things improve, will you really do well with such kind of a thought process? This, I am sure, is not the best thing to do in the morning. Why not change it to a more positive approach? When you get up in the morning why not hold your head high, chin up, take a deep breath & tell yourself that you are improving every other day. Tell yourself repeatedly that you will conquer your RA.

Trying a new drug? May be Methotrexate or a new biologic. If you are overwhelmed by the thoughts about its side effects, you will always be anxious & devote your thoughts & energy to the side effects rather than the effects. Law of attraction may just spoil the future for you. Why not change to a more positive approach? Tell yourself repeatedly that Methotrexate is the best drug for RA & I will conquer my RA with Methotrexate. You should definitely find out more about the effects & side effects of Methotrexate but don’t let this information make you anxious & uncertain about the effects of Methotrexate. Same for biologic… in fact you should first thank heaven for the fact that you have been able to afford a biologic. There are so many others who, despite in bad need of a biologic, are not able to afford it. Here in India, most of the medical expenditure is out of pocket, & many patients are waiting for affordable generics for years purely because they cannot afford the present ones. So, don’t you think that you consider yourself lucky, thank heavens & tell yourself that you are getting one of the best medicines on the planet for RA & it should help you conquer your RA.

Many RAers are very positive about RA but as soon as a flare comes, they panic. Flares are a part & parcel of any chronic disease. Why don’t you chalk out a plan for a flare with your Rheumatologist. Instead of panicking & slipping into depression, put the plan into action immediately. Anxiety & depression can worsen your flare. Once the flare action plan is in action, you can better tell yourself that medicines will act & flare will settle soon.. I will conquer my RA.

Whether one believes in the Law of attraction is a different proposition, but positive attitude & thoughts should definitely help. One of the best examples is the placebo effect. Placebo effect is a phenomenon wherein patients’ symptoms are alleviated by an ineffective treatment. In clinical trials, patients are divided into two groups. One receives the medicines (eg. In tablet form); while the other group receives the placebo (tablets of inert substance that look exactly like the active medicine tablet- eg sugar pill). Many of the patients who receive the placebo do well with it. The explanation for this effect is that these patients must have taken this placebo with a lot of hope/ faith & positive thinking.

Now if a placebo effect is possible with inert substances like sugar pills, then why not with active medicines like Methotrexate. So, throw those negative thoughts out of the window & start thinking positively. Every morning when you get up, hold your head high, chin up, take a deep breath & tell yourself that you will do well & will conquer your RA.