If you’ve recently been diagnosed with osteoporosis, you’ve likely asked yourself a common set of questions:
“What caused this to happen?”
“What does this mean for my future?”
A new diagnosis can be daunting, scary, and even isolating. But moving forward with confidence and clarity starts with educating yourself about osteoporosis and its secondary causes, or other conditions that exacerbate the progression of osteoporosis.
One lesser known secondary cause is rheumatoid arthritis, an autoimmune disorder that affects over 1.3 million Americans. Let’s explore how rheumatoid arthritis affects bone health and how you can live the life you want while managing both conditions.
Overview
Rheumatoid arthritis (RA) is a chronic autoimmune condition that occurs when your body’s immune system mistakenly attacks its healthy cells. In the case of RA, the body targets synovium, the soft membrane that lines the inner surface of your joints. This immune response leads to inflammation, which ultimately can cause cartilage damage, bone erosion, and the loss of bone mineralization around the affected joints.1
Considered a “silent disease,” rheumatoid arthritis can progress for years in unsuspecting individuals until symptoms appear. While RA affects all demographics, women are two to three times more likely to develop the disease than men. Most are diagnosed with RA in middle age, between 30 and 50 years old.2
Symptoms of Rheumatoid Arthritis
Rheumatoid arthritis is more than the stereotypical symptoms most people associate with the disease, like joint swelling and painful movement. In fact, it’s considered a systemic condition, meaning it affects the entire body. Symptoms may include, but are not limited to:
- Numbness, tingling, and pain in wrists, fingers, hands, toes, ankles, knees, feet, chest, and shoulders
- Joints that are warm, inflamed, stiff, and discolored
- Fatigue and muscle aches
- Weight loss
- Firm lumps called rheumatoid nodules near joints
- Dry eyes and mouth
- Difficulty breathing (if the inflammation spreads to the lungs)
- Morning stiffness for at least the first 30 minutes after waking
Risk Factors for Rheumatoid Arthritis
Doctors are not certain about what causes individuals to develop rheumatoid arthritis. However, a handful of factors seem to increase the risk of developing the disease.
Gender: Due to the staggering proportion of women that develop RA, some experts believe there is an association between hormonal shifts and the onset of the condition. The decrease in estrogen and progesterone that women experience over their lifetimes, particularly during menopause, may be a disease trigger.3
Genetics: While RA is not considered a hereditary condition, it does appear to run in families. Some researchers believe there may be a gene that makes certain people more susceptible to developing the condition, as is the case with many autoimmune disorders.
Many studies suggest that variations in human leukocyte antigen (HLA) genes, especially the HLA-DRB1 gene, present a significant risk factor for developing RA.4 HLA genes produce proteins that help the immune system differentiate between the body's own friendly proteins and enemy proteins like viruses and bacteria. Thus, certain variations in HLA genes can create increased susceptibility to autoimmunity and synovium attack.
Smoking: It is well established that cigarette smoking increases the risk for developing both rheumatoid arthritis and osteoporosis. More specifically, a history of smoking is said to increase the risk of developing RA by as much as 2.4%, and it also decreases the likelihood of achieving RA remission once the condition develops.5
Obesity: Individuals who are obese and overweight have a higher risk factor for rheumatoid arthritis, and are more likely to experience the onset of the condition before age 55.6
Environmental factors: Though the mechanism is not fully understood, some environmental factors appear to trigger the development of RA among high-risk individuals. These factors include:
- Exposure to or inhalation of pesticides, mineral oil, or silica
- Exposure to certain types of bacteria and viruses, particularly those associated with Periodontal disease
- Experiencing a traumatic event or injury
Gut health: The gut microbiota is thought to be an agent affecting the development of RA. The abundance of the gut bacteria species Prevotella is increased in some early RA cases.7
Diagnosing Rheumatoid Arthritis
Rheumatoid arthritis can be challenging to diagnose during the early stages because the signs and symptoms mimic those of other diseases. It may take multiple healthcare visits, including lab and imaging tests, to determine if you have RA. Your healthcare provider will likely use several diagnostic tools:
Annual Physical Exam
During your annual physical exam, your healthcare provider may check for signs of joint inflammation, swelling, tenderness, and pain. He or she may also consider your medical history and self-reported symptoms. If your healthcare provider has any suspicion that you have RA, he or she will likely refer you to a rheumatologist for more diagnostic testing and treatment.
Rheumatoid Arthritis Biochemical Marker Tests
Many of the tests used to diagnose RA measure changes in the immune system and antibodies that may attack joints. Other tests look for the presence and severity of inflammation. The most commonly used diagnostic tests for RA are all collected and measured via blood work.
Rheumatoid Factor
Rheumatoid factor is an autoantibody, or protein, present in your blood that’s produced by your immune system. These proteins attack healthy joints, tissue, glands, and normal cells by mistake. When a person’s rheumatoid factor levels are above a normal range (>20 IU/mL), this can be an indication of an autoimmune disease.8
Despite the name, rheumatoid factor is not exclusive to RA and elevated rheumatoid factor can be a result of a number of chronic conditions. It’s also important to note about 20% of people with RA have little or no rheumatoid factor in their blood.9 In other words, testing for rheumatoid factor can be a helpful test, but it’s not considered definitive; most healthcare providers recommend this test be run in combination with others.
Anticyclic Citrullinated Peptide (anti-CCP)
Anticyclic citrullinated peptides are antibodies produced by the immune system that target joint proteins. Not everyone with a positive anti-CCP test will have rheumatoid arthritis. However, when a person tests positive for anti-CCP antibodies, she has a very good chance of having RA. The higher the levels of anti-CCP antibodies, the higher the likelihood of RA.
Sedimentation Rate
Sedimentation rate (also known as ESR) is a blood test that reveals the level of inflammation in your body. This is measured by the rate at which your red blood cells clump and collect at the bottom when placed in a test tube. Inflamed blood cells are denser and tend to clump and fall faster.10
A sedimentation rate test is not a definitive diagnostic tool, but it can help your healthcare provider determine how much inflammation is present, and, in combination with other tests, what could be causing it.
C-reactive Protein
C-reactive protein is produced in the liver when there is severe inflammation or infection present in the body. High numbers on a C-reactive protein test (>1.0) can indicate there may be inflammation in the synovium, which is why it can be helpful in diagnosing RA.
Complete Blood Count
A complete blood count test measures the number of red blood cells, white blood cells, and platelets in your blood. Abnormal numbers in either type of cell could indicate a chronic condition:
- Red blood cell counts that are lower than normal could indicate anemia, which is commonly found in those with RA.
- White blood cell counts that are higher than normal could indicate inflammation, infection, or immune system overactivity, which could point to RA.
While these are not the only lab tests important for identifying root cause issues associated with osteoporosis, it’s a great starting point for rheumatoid arthritis.
Imaging Tests
In addition to blood tests, your healthcare provider might also recommend imaging tests to assess the damage and severity of rheumatoid arthritis.
X-rays
X-rays are used to monitor the progression of RA and to assess cartilage, tendon, and bone damage. X-rays may not be able to capture early signs of rheumatoid arthritis, so this test is better suited to monitor the progression of the condition and inform your treatment plan once you have a positive diagnosis.
Magnetic resonance imaging (MRI)
MRI is a medical imaging technology that uses magnets to create images of your soft tissues. In cases involving RA, MRI scans can detect inflammation in the synovium, or joint membranes. When compared to X-rays, this imaging test is better at capturing early signs of RA, including bone erosion, bone marrow fluid, inflammation, and tendon abnormalities.
Osteoporosis and Rheumatoid Arthritis: Implications of Both Conditions for Bone Health
Research indicates that active joint inflammation and systemic inflammation, the quintessential symptoms of RA, increase the risk of developing osteoporosis and fracturing. In fact, individuals living with RA have a 30% higher risk of osteoporotic fractures and 40% greater risk of hip fractures than those without rheumatoid arthritis.11 And while bone loss is most pronounced around inflamed joints, like the hip, many RA patients experience overall bone loss as a result of the condition.
It’s also important to consider the other health variables impacted by having both osteoporosis and rheumatoid arthritis:
- Physical Activity
Rheumatoid arthritis causes joint pain and swelling, which can make it very challenging to be physically active. It can be even more difficult for RA patients to engage in weight-bearing exercise due to joint discomfort. Unfortunately, individuals with both osteoporosis and rheumatoid arthritis face the daily dilemma of determining what safe and effective exercise to engage in; it must not exacerbate joint pain, while including weight-bearing activities and resistance training to build muscle and bone.
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Stress Management & Sleep
Both health conditions can cause stress, affect your mental health, and lead to other health concerns. A study found that 72% of individuals with rheumatoid arthritis experienced disruptions in sleep due to insomnia, pain, and disease intensity.12 Another study found that women who sleep five or less hours per night have a 22% higher risk of low bone mineral density and a 63% greater risk of osteoporosis of the hip compared to women who sleep for seven hours each night.13
- Medications
A number of common medications used to treat RA have negative effects on bone density, all of which must be considered when building a treatment plan for individuals with osteoporosis and rheumatoid arthritis. A category of powerful anti-inflammatories called corticosteroids are effective for reducing RA inflammation, but are known to increase bone loss, reduce bone formation, and significantly increase the risk of fracture.14 One study found individuals were nearly twice as likely to experience hip fracture and nearly three times as likely to experience vertebral fracture after as few as 90 days of corticosteroid use.15
Biological disease-modifying anti-rheumatic drugs (bDMARDs) are another class of drug used to inhibit inflammation and slow the progression of RA. Although several studies reported favorable actions of biologic therapies on bone protection, there are still unmet needs for studies regarding their actions on the risk of bone fractures.16
Treatment of Rheumatoid Arthritis
Although a cure does not yet exist for rheumatoid arthritis, a well-rounded treatment plan can help you manage your symptoms while still supporting your bone health.
Medications
Many individuals with RA are able to use natural remedies to manage joint pain, swelling, and discomfort, and report significant improvement in symptoms and quality of life. In other cases where medication is necessary, doctors may recommend…
- Over-the-counter, non-steroidal anti-inflammatory drugs (NSAIDs)
- Corticosteroids
- Disease-modifying anti-rheumatic drugs (DMARDs)
- Biological disease-modifying anti-rheumatic drugs (also called biologics)
As mentioned in the previous section, RA drugs are powerful inflammation fighters, but some can have consequences for your bone density.
Finally, when it comes to medications, continue to be your own best advocate. As a patient, you can embrace your opportunity to hold an active role in determining a treatment plan that’s right for you.
Surgery
Your healthcare provider may recommend surgery if you experience severe joint deformities and disabilities. During total joint replacement surgery, the surgeon will remove the damaged section of the joint and insert a metal or plastic replacement. He or she will also remove the inflamed joint linings during synovectomy. Then, a joint fusion will help fuse bones together to increase your stability.
Hip and knee replacements are the most common types of operations on large joints. Fortunately, by adhering to your prescribed treatment and integrating natural remedies, you may be able to decrease your need for surgery.
Natural Remedies & Pain-Reducing Techniques
Natural remedies can help you alleviate your pain and manage inflammation without medication or in supplement with it. Consider implementing the following alternative treatments if you have rheumatoid arthritis and osteoporosis.
- Eat an anti-inflammatory diet
Studies show that a healthy diet may slow RA’s progression and the rate of joint damage, while reducing joint stiffness, pain, and tenderness.17 As you prepare meals, focus on eating antioxidant and anti-inflammatory rich foods, such as leafy greens, seasonal fruits, probiotic yogurt, turmeric, and ginger; and avoiding inflammatory foods.
- Stay physically active
How you live everyday and how active you choose to be will affect your symptoms, health, and quality of life. Exercising can help to reduce bone loss and risk of fractures, conserve remaining bone tissues, manage RA inflammation, preserve joint mobility, and improve your overall physical fitness and balance. That said, when you’re living with both conditions, it’s important to balance incorporating regular, bone-boosting activity with periods of rest and light stretching when your joints are in pain.
- Manage stress
A number of studies have found stress-reducing activities and relaxation techniques, especially in combination, can be very effective in diminishing the pain and discomfort that comes with RA. These include yoga, acupuncture, massage therapy, mindfulness exercises, and peer support groups.18 19 20 21 22
- Get enough sleep
Getting at least 7 hours of sleep each night (versus 5 hours or less) is a protective factor against fracture risk and osteoporosis of the hip.23 However, getting quality sleep can be a challenge for many people. Take the time to design your sleep environment to be a sleep-only sanctuary where you can rejuvenate your mind, body, and soul. Keep your room as dark, quiet, and cool as you can for the best quality sleep.
- Consider journaling
Journaling, or writing down your feelings and thoughts, can be a powerful self-awareness and mindfulness tool for many individuals with chronic conditions. Celebrate the victories you’ve experienced, no matter how small, in living with RA and osteoporosis. Without judgement, acknowledge the areas for improvement you could make in your treatment plan adherence. Keep focused on the aspects of your health that you can control, and embrace the resources and support team at your disposal to help manage your symptoms.
Summary
- Over 1.3 million Americans have been diagnosed with rheumatoid arthritis, two-thirds of which are women.
- Rheumatoid arthritis causes localized and systemic inflammation; sleep disruptions; and can present physical activity challenges, all of which increase the risk of decreased bone mineral density, osteoporosis of the hip, and other associated health concerns. Individuals with RA have a 30% higher risk of osteoporotic fractures and 40% greater risk of hip fractures than those without RA.
- For those with rheumatoid arthritis and osteoporosis, treatment plans must reduce inflammation while preserving bone density. Your healthcare provider can help make recommendations for how to manage your RA without worsening your bone health.
- Natural remedies for rheumatoid arthritis and osteoporosis include eating an anti-inflammatory diet, staying physically active, managing stress, getting enough sleep each night, and incorporating journaling into your daily routine.
Managing any chronic condition - let alone more than one - is a challenge for the even the educated, disciplined, and well-intentioned individuals. Chronic conditions put a strain on every aspect of life, whether its impacts are acknowledged or not. The good news is that you don't have to do it alone - if you've recently been diagnosed with osteoporosis, we've got a free resource just for you. Sign up for our FREE Stronger Bones Masterclass and learn the exact 3-step process osteoporosis “thrivers” use to build stronger bones and lead active lives.
