Rheumatoid Arthritis: A Personal Story


Today rheumatoid arthritis is not only one of the most common autoimmune diseases, but it is also considered a disease that until recently threatened imminent damage to the joints and led to severe disability. Contrary to popular belief that only old people suffer from arthritis, in recent years people in the prime of life suffer from joint damage in the prime of life from 30 to 50 years. In our country, 850 thousand people were diagnosed with rheumatoid arthritis, among them several times more women than men. This is due to the fact that women are more prone to obesity, and overweight people are most likely to develop rheumatoid arthritis.

Symptoms of Rheumatoid Arthritis everyone knows - this is constant pain in the joints, difficulty in moving, especially in the morning. The more the disease is started, the more joints are deformed and destroyed. But with arthritis, not only joints are affected, but also irreversible changes occur in the spine, blood vessels, lungs, kidneys, and even in the skin. Arthritis is one of the most insidious diseases, along with pathological changes in the joints, atherosclerosis of the vessels also develops rapidly. Therefore, very often rheumatoid arthritis is accompanied by various diseases of the heart and blood vessels, which greatly increase the risk of stroke, heart attack and heart failure.

Data medical statistics on the fate of patients with rheumatoid arthritis are very sad, about half of patients with this disease die every year from diseases of the cardiovascular system, and in our country every year about 80 thousand people with rheumatoid diseases become disabled. The reason for this is that rheumatoid arthritis is a very rapidly progressing disease, in the absence of proper and timely treatment, the patient may become disabled after 5 years from the onset of the disease. Therefore, it is very important to consult a doctor at the first symptoms of the manifestation of the disease, early diagnosis and proper treatment of rheumatoid arthritis makes it possible to suspend the development of the disease and maintain working capacity for many years.

Many sick mistakenly believe that the diagnosis of "rheumatoid arthritis" is a sentence, as this disease is not treatable. Indeed, for many years, doctors were powerless before this ailment, and arthritis therapy was aimed at alleviating the patient's condition by using painkillers and anti-inflammatory drugs. In recent years, the capabilities of rheumatologists to diagnose and treat arthritis have improved markedly. Today, using immunological blood diagnostics, rheumatoid arthritis can be detected at an early stage, and ultrasound and computed tomography of the joints can detect changes even when the x-ray still does not show them.

Early diagnosis of arthritis extremely important, it allows the doctor to win valuable time and begin treatment at the very beginning of the development of the disease. But treatment is no less important, here the therapy should be chosen correctly. The most effective modern drugs for the treatment of rheumatoid arthritis are considered genetic engineering biological products, which are often called "biological agents". Only 10 such biological products are registered in the world, of which 7 are already sold in our country. Biologics are innovative drugs that act point-wise and suppress inflammation of a particular cell, without harming the immune system.

In connection with the appearance of effective drugs for the treatment of rheumatoid arthritis today it has become possible to control this disease, to maintain the normal functioning of the joints and patient performance. Biological products are prescribed only in the form of injections and they are not cheap. They should be used in combination with the basic methods of basic therapy, which consists in the use of non-steroidal anti-inflammatory drugs and corticosteroids.

Unfortunately, we all do not we care about your health until "until the thunder strikes." Few people think about the prevention of arthritis until an example of a loved one sees for themselves how dangerous and insidious this disease is. Meanwhile, everyone should undergo an early diagnosis of arthritis:

- someone with a parent or relative has rheumatoid arthritis,
- who for a long time is forced to stand on their feet because of the specifics of work,
- who is engaged in professional sports,
- who is overweight,
- who has had a sore throat and other infectious diseases, including the genitourinary system.

If you’ve been diagnosed withrheumatoid arthritis", then strictly follow the therapy prescribed by your doctor, increase physical activity, normalize weight and give up bad habits. For example, you need to quit smoking and not drink a lot of coffee. The basis for the prevention of arthritis is proper nutrition. From a young age, do not consume large amounts of fatty ones, sweet, canned, and other unhealthy foods. Give more preference to vegetables, fruits, and berries. Limit your intake of sweets, pastries, and salt. Natural foods are good for our health, and not refined and processed in an industrial way.To prevent the development of rheumatoid arthritis, your diet should always be useful and weight constant.

What is rheumatoid arthritis

Modern diagnostics can now easily determine rheumatoid arthritis even in the initial stages. However, often in district consultations it is suggested at the very last moment, when there is already a deformation of the joints.

Rheumatoid arthritis refers to systemic diseases of the connective tissue. A disease of chronic, infectious and inflammatory origin, in which peripheral small joints and large joints such as our spine are affected. In addition, the destructive processes are so strong that the joints can cease to fulfill their function to complete immobility. Among other things, rheumatoid arthritis can be considered as an autoimmune disease. That is, the protective system of the body perceives its cells as foreign. She reacts to her own cells, like viruses and bacteria, directing her aggression to her own body.

Over the years, both in our country and abroad have been looking for ways to combat rheumatoid arthritis. It can have both an acute onset and flow in a sluggish form. It has no seasonality, i.e. occurrences can be expected at any time of the year. Rheumatoid arthritis cannot be infected.

Symptoms of Rheumatoid Arthritis

  • The disease begins in different ways in each case. Rheumatoid arthritis can begin acutely or subacutely (when one or 2 joints suddenly swells).
  • Appears joint painespecially when walking. It can occur in the morning and especially in the evening.
  • Often joints inflame symmetrically. It happens that the pain appears in one or the other joint, while in the first it stopped.
  • Muscle pain with rheumatoid arthritis are prolonged aching in nature. The patient often tries to rub the muscles with warming ointments, but the effect of this is negligible.
  • In the latent period of rheumatoid arthritis manifests itself severe tiredness, weakness, malaise. In the morning stiffness in movements. A man with difficulty can clench his hand into a fist.
  • May appear fever (presence of unmotivated jumps in body temperature).
  • Sweating.

In the later stages of rheumatoid arthritis appear:

  • Joint stiffnessfor example brushes. On the finger in many cases there are "bumps". Tenosynovitis of the hand may occur - inflammation of the membrane within which the tendon passes (pain on palpation, swelling, thickening of the tendon).
  • Carpal tunnel syndrome (tunnel syndrome) - numbness of several fingers.
  • Lesions of the wrist, elbow joints.
  • Damage to the spine and shoulder joint occurs in even later stages of rheumatoid arthritis.

Extraarticular lesions in rheumatoid arthritis

Rheumatoid arthritis is not only a joint disease. When he is amazed connective tissue, that is, problems arise in all organs and systems where it is present. These are muscles in any organ, and vessels. That is, the respiratory, cardiovascular system, kidneys suffer.

It happens that doctors rarely pay attention to extra-articular lesions. I must say that it is in vain, because very often these disorders are more serious for the patient than joint lesions.

  • Lesions of the skin appear - brittle nails, dry skin, rheumatoid "nodules" (small subcutaneous peas that are not attached to the joints).
  • Excessive tension appears in the muscles. If a joint is affected, then a pathological process is also going on in the muscles next to it.
  • Damage to the gastrointestinal tract with rheumatoid arthritis does not have specific manifestations. But the constant use of analgesics by patients has a devastating effect on the digestive organs and liver.
  • Very often, rheumatoid arthritis causes heart complications. These are endocarditis, myocarditis, pericarditis. Rheumatoid nodules can even be attached to the heart valves, causing malformations, circulatory disorders and heart failure.
  • There may be damage to the respiratory system - pleurisy, damage to the lung tissue in the form of pneumonia.
  • Rheumatoid nodules can also affect the kidneys - inflammation of the glomeruli of the kidneys (glomerulonephritis) occurs in the late stages of rheumatoid arthritis.
  • Rheumatoid arthritis causes anemia (a decrease in hemoglobin in the blood), which leads to tachycardia. The patient develops fatigue, fatigue, pallor of the skin, tachycardia and high blood pressure due to a violation in the kidneys.

Thus, with rheumatoid arthritis, one violation is superimposed on another. It seems that the body crumbles, which is not far from the truth. The problem is that a person believes that these are different diseases. In fact, these are manifestations of the same disease - rheumatoid arthritis.

Why is rheumatoid arthritis terrible - secondary amyloidosis. Amyloid is a pathologically altered protein. When amyloid is deposited in various organs, it destroys them. The most formidable complication is renal amyloidosis. Most often, this leads to renal failure.

Rheumatoid arthritis treatment

Timely treatment started helps prevent the irreversible effects of rheumatoid arthritis. Currently, there are many good drugs that are successfully used for arthritis. There is one important rule in the treatment of rheumatoid arthritis: if such a diagnosis is made, treatment and prevention of exacerbations need to be dealt with constantly, once every six months, turning to a rheumatologist.

Drug treatment is prescribed by a doctor and only him.

Phytotherapy will help support the body with rheumatoid arthritis. Meeting with a competent herbalist greatly facilitated my condition. I now share this information with you, dear readers.

Herbs for Rheumatoid Arthritis

Tinctures that take a course of 21 days are very effective:

  • Tincture of elecampane 25%, 30 drops 3 times a day.
  • Burdock tincture 20%, 30 drops 3 times a day.
  • Tincture of Scutellaria baicalensis 25% 10 drops 3 times a day.
  • Calamus tincture 20%, 20 drops 3 times a day
  • Thyme tincture 10% 10 drops 3 times a day

Water extracts (infusions and decoctions) of lingonberries, lemon balm, St. John's wort, bearberry, string, orthosiphon, repeshka, sweet clover, astragalus, elderberry support the body well. Separately, tansy can be distinguished, with infusions of which they take baths and take 5% infusion inside. Tansy has an immunomodulatory, antibacterial and anti-inflammatory effect. But do not forget that tansy is poisonous, so it is important not to overdo it in doses.

Cranberry juice, lemon juice with tea with the addition of honey are useful.

Herbs are used to make fees that are even more effective than herbs alone. These fees should have an anti-inflammatory effect, they can be taken during the period of inpatient treatment.

With rheumatoid arthritis, many herbs are used that can be combined with each other in fees:

  • Meadowsweet (meadowsweet) - immunomodulator, reduces blood viscosity, cholesterol, improves blood circulation, antiviral and antibacterial agents.
  • St. John's wort - A good antiseptic and at the same time a sedative, relieves pain.
  • Sporysh (mountaineer bird) grass - cleans the kidneys.
  • Birch leaves (especially May ones) - puts the kidneys in order, cleanses the body.
  • Stinging nettle (May leaf) - a source of vitamins, affects blood circulation, relieves inflammation, but all infusions with nettle should be applied on the day of manufacture, because become toxic during storage.
  • Ledum shoots - a potent tool, so it is added to the fees a minimum amount. Ledum is a powerful pain reliever.
  • White Willow Bark contains aspirin. The shavings of this bark can even replace cardiomagnyl or aspirin-cardio.
  • Wormwood, grass - cleanses the body, in particular the liver, restores normal metabolism. This is a very important component, since many drugs used for arthritis are very aggressive on the liver. Wormwood in this case acts as a detoxification component, i.e. removes poisons.
  • Also effective in rheumatoid arthritis juniper fruit in the form of a decoction, sage, strawberry grass, silverweed (goryanka).
  • It has a good anti-inflammatory effect. creeping wheat grass (cat grass roots).
  • Licorice naked acts as a hormone-like remedy. Burdock is useful for rheumatoid arthritis both in the form of infusion and tincture. Forest geranium (joint, saber - not to be confused with saber!) Is used in tinctures. But saberfish is a powerful anti-inflammatory drug and is widely used for the manufacture of dietary supplements and ointments for arthritis.
  • Among other things, plants containing vitamins are very useful. (dogrose, common mountain ash, sowing buckwheat, wild strawberry, creeping clover). These plants are well added to the fees for rheumatoid arthritis.
  • Can be used pine needles and heather. A little bit about heather: it calms the nervous system, relieves inflammation, heals kidneys, and relieves pain.
  • Using horse chestnut in the form of tinctures for grinding has long been used for rheumatoid arthritis.

I must say that Chinese medicine, unlike European medicine, considers rheumatoid arthritis a treatable disease. For this, an extract of mountain ants is used, which is designed to regulate the immune system in autoimmune disorders, and a fungus called cordyceps.

In conclusion from the author

If you have a suspicion of rheumatoid arthritis, if you feel that you are not sick with the flu, but are in a fever, there may be joint pain, the heart is “foolish”, the pressure rises, you should definitely consult a specialist. I was convinced from my own experience that a rheumatologist should be visited by one of the first doctors, and not the last, as in my case.Procrastination leads to the fact that we lose the time it takes to stop rheumatoid arthritis in the initial stage, not to bring to its more complex manifestations and complications.

Nature has given us a large amount of funds that can support the body with rheumatoid arthritis, protect against the negative effects of drug therapy, which cannot be dispensed with. About the disease "rheumatoid arthritis" we must not forget how it happened to me, you need to try to use all means for rehabilitation to prevent further destruction of the joints and other organs. And yet, of course, you can’t give up and be lazy to brew all this and take it in a disciplined manner.

To everyone who has faced the same ailment as I, I wish to persistently act in the prevention of complications and exacerbations of rheumatoid arthritis.

Honey. sister Lyudmila Karpova, Vladimir

Causes of Rheumatoid Arthritis

Surprisingly, but despite such a solid age of this disease, the causes leading to the development of the disease are still not identified.

Although, of course, modern scientists still have some assumptions:

Autoimmune diseases. A variety of diseases that "confuse" the body's immune cells are considered one of the reasons for the development and progression of the disease. Instead of fighting bacteria and viruses that infect humans, immunity begins to attack healthy tissues, and joints suffer first. Lymphocytes actively attack them, trying to destroy them, like something alien to the body. Any disease can cause such aggression, but rheumatologists note that almost half of the patients had persistent acute respiratory viral infections, frequent tonsillitis and flu. There is a version that particles of viruses can accumulate in articular bags, and immunity, taking them for enemies, is trying to fight them.

Rheumatoid arthritis can become a logical “continuation” of infectious arthritis or reactive in nature, which is formed against the background of injuries or hypothermia.

There is a version of the fact that the ailment can occur against the background of a strong emotional shock. So half of patients diagnosed with rheumatoid arthritis note that the disease arose after suffering stress (death of a loved one, divorce, or other factor). Scientists also noticed some similarities in most patients. These people are very emotional and impulsive. That is why, the disease most often affects women, with their hormonal changes in the body. In addition, it was noticed that in those people in whom arthritis started against the background of colds and emotional shocks imposed on them, the ailment is much more difficult to administer therapy and progresses faster.

Some scientists believe that the cause of arthritis can lurk in the intestines when the immune system tries to eliminate the conditionally pathogenic bacteria that live in it. As a result of this struggle, this disease can develop.

Do not, as a reason, ignore genetics. So children whose older relatives suffered or suffer from the disease are also more prone to the development of rheumatoid arthritis in the future. Moreover, several genes were even isolated.

Environmental factors are also conditional causes of the ailment. Smoking and food consumption of plants treated with chemicals, in particular silica, leads to diseases of the oral cavity, as well as to arthritis.

Some experts are of the opinion that certain viruses cause rheumatoid arthritis, which at the time of diagnosing the disease are already eliminated from the body. But so far this version has not found its confirmation. Therefore, the main risk factors are considered to be genetic predisposition, infectious diseases, severe emotional upheaval and adverse environmental effects.

Stages of Rheumatoid Arthritis

There are several criteria that can be used to classify the stages of development of rheumatoid arthritis, but the most informative ones are those that are based on x-ray readings.

They are usually divided into four categories:

At the initial stage, the first signs of thinning of the bone are visible, this is almost the only manifestation that can be seen in the picture. The soft tissues around the joints of the fingers become denser and become somewhat thicker. Sometimes there are noticeable bright spots on the bone tissue - these are formed cysts. When the joint spaces are narrow, then we can say that the disease is progressing and will soon move to the next stage. A characteristic feature of this stage of the development of the disease is that it can occur at any age and take a fairly long time, practically without manifesting itself. Sometimes such conditions are found even in childhood, and the disease first manifests itself after many years.

The second stage is characterized by the fact that in addition to the thinness of the bones, localized mainly around the joint, the bone itself begins to be affected by an erosive type. First of all, the hands in the elbows and wrists are affected. If erosion is located near the cartilage, then in this case there is a limitation of mobility. At the same time, the cartilage tissue itself may not be deformed, but the muscles begin to atrophy, primarily those that surround the diseased joint itself. Synovial bags are swollen and slightly inflamed. During an exacerbation, they can be hot, and patients, at the second stage of the development of the disease, complain of pain and aches. The more erosion on the bone, the closer the third stage of disease progression.

At this stage, not only damage to the bone and its thinning are noticeable, here the atrophy of the muscle, which is extensive in nature, is clearly visible in the picture, the joint itself is already undergoing deformation. If salt deposition begins in the first stage, then in the third, calcification becomes noticeable in the x-ray. In this case, deposits can be of different sizes and shapes. Their structure can also vary from dense to rather loose. The joints at this stage are already significantly limited in movement.

The fourth stage is the stage at which bone disorders are noticeable. An X-ray examination fixes osteoporosis, and erosion is visible, and cysts that are multiple in nature, cracks can grow together, or have extremely narrow gaps. The joint is completely deformed, the muscles and soft tissues around it are atrophied. The disease affects all the limbs, and patients complain of severe ongoing pain.

Depending on the condition of the person and on his functional capabilities, four stages of the development of the disease are also distinguished:

At the first stage, patients are able to independently perform all daily activities, their general condition is not broken, pain symptoms are absent.

At the second stage, people remain efficient, but they cope with everyday activities with difficulty, playing sports becomes difficult to access.

In the third stage, patients are usually limited in their work activities, but are able to cope with self-care.

At the fourth stage, a person cannot fully perform any type of activity.

Diagnosis of Rheumatoid Arthritis

Diagnosis of rheumatoid arthritis is difficult, due to the similarity of its symptoms with a number of other diseases. So, you can confuse this ailment with acute rheumatism, Lyme disease, with gout, osteoarthritis and other joint diseases.

Back in 1997, a board of rheumatologists proposed criteria that are taken as the basis for determining rheumatoid arthritis.

If most of them are observed in the patient who came for examination, then the doctor has the right to make this diagnosis:

More than three joints are affected.

The joints of the hand are affected.

In the morning, a person experiences a feeling of stiffness, which disappears after at least one hour. Such sensations worry the patient for more than 1.5 months.

There are specific nodules.

X-ray displays characteristic changes, regardless of the stage of the disease.

Rheumatoid factor is positive.

As laboratory tests, it is customary to focus on the following indicators:

In the blood test, a decrease in the level of hemoglobin and red blood cells is clearly visible, ESR is accelerated, and the number of platelets is reduced. Gamma globulin and C-reactive protein are above normal.

Blood is examined for the presence of a rheumatoid factor, if this indicator is present, then it can also be understood by how actively the process of developing the disease is started.

Doctors must prescribe an X-ray examination, which is the basis for determining the presence of this ailment.

Sometimes an enlarged spleen may be observed.

For examination under a microscope, doctors can take a joint fluid or nodule biopsy.

Timely diagnosis of the disease will make it possible to use adequate therapy, the sooner it is started, the more effective the treatment regimen and the lower the risk of complications.

Meanwhile, they can be quite serious and are expressed in the following:

Skin diseases such as ulcerative vasculitis, dermatitis and rheumatoid nodules.

Diseases of the pulmonary system, which are expressed in pleurisy and the formation of the same nodules in them.

Diseases of the visual apparatus, which can be expressed as a slight irritation, as well as serious inflammation of the eyeball with subsequent loss of vision.

In diseases of the circulatory system, expressed in anemia and thrombocytopenia.

In the pathologies of cardiovascular activity, which can result in both a heart attack and a stroke.

How to treat rheumatoid arthritis?

As the main modern methods of treating rheumatoid arthritis, it is customary to use:

The use of anti-inflammatory drugs.

Physiotherapy in combination with local treatment.

Diet and traditional medicine.

Depending on the severity of the symptoms of the disease, as well as on the nature of its course and the rate of progression, a variety of treatment methods are used. They vary widely, from ordinary relaxation and good nutrition, which is advisory in nature and ending with potent drugs. But, as a rule, therapy at the initial stage is gentle, if this does not help, then they will switch to more radical methods of treatment.

It is based on the principle of rest at the affected joints, since the additional load leads to increased inflammation. Sometimes for a short time, patients are prescribed bed rest with immobilization of several joints. For this, rheumatologists impose on the affected areas of the tire.

As modern medicines, doctors prescribe several groups of drugs, when there are indications for this:

Ibuprofen and aspirin are used as non-steroidal anti-inflammatory drugs. They are able to relieve swelling and swelling in the tissues, and also significantly reduce the pain symptom. Aspirin is a rather outdated treatment for rheumatoid arthritis and has a lot of side effects, so in recent years, doctors have been trying to replace with modern medicines such as ibuprofen. It does not irritate the stomach to such an extent, but nevertheless it cannot be called absolutely harmless.

If NSAIDs do not bring relief and do not give the desired effect during their regular intake of 3 months, then doctors supplement the treatment regimen with long-acting drugs. These include sulfasalazine, penicillamine, plankvenyl and gold compounds. They most often have a pronounced effect on the course of the disease, but their significant drawback is that the side effects that occur as a result of taking these drugs can be very serious. They have a negative effect on the kidneys, liver, cause skin itching and diarrhea, and can lead to bone deformation. If similar side effects begin to appear, then the medicine is immediately canceled. But in some cases it is possible to restrain the development of rheumatoid arthritis for a rather long time, while the drugs are used in a low dosage and do not give serious complications to other organs and systems.

Prednisolone, which belongs to the class of corticosteroids, is also used to treat rheumatoid arthritis. They are effective, but their minus is that after a short time, the drugs cease to affect the course of the disease. Since this ailment is chronic, corticosteroids are used only for short-term relief of diseased joints.

Drugs such as azathioprine, methotrexate and cyclophosphamide belong to the class of immunosuppressants and are effective in case of severe illness. They are very effective, but their significant drawback is serious side effects, which include damage to the internal organs (lungs and liver), impaired hematopoiesis, an increased risk of bleeding, and even oncology.

Drug therapy gives the best therapeutic effect when they are combined with therapeutic exercises, physiotherapy and exposure to both high and low temperatures (cryotherapy). Surgery may sometimes be required. Water procedures are very effective when, when practicing in the pool, the joints actively move, but do not experience stress.

As for surgical treatment, modern medicine has the ability to completely replace a diseased joint with a similar but artificial one. They are used to restore mobility in the knee or in the hip joint. Sometimes the operation is aimed at fusion of the joints, especially often it is used to defeat the feet with rheumatoid arthritis. In this way, you can achieve a significant reduction in pain attacks when walking.

Also for those people who are overtaken by this ailment, modern medicine offers various auxiliary means, for example, special shoes or means for gripping objects. All this greatly improves their quality of life and alleviates pain symptoms.

Diet plays an important role for the treatment of the disease, since in such a situation the body needs more than ever the full intake of all the nutritional components. With regard to restrictions, it is necessary to reduce the intake of salts, protein foods and fats of animal origin. At the time of exacerbation of the disease, it is important to completely abandon the use of sugar and alcohol.

It is imperative to eat cottage cheese and drink sour-milk drinks. An exception to the table should not be fresh fruits and vegetables, as well as greens. Grain and fish dishes will be useful. Rheumatologists claim that following a strict diet contributes significantly to recovery.

Video: Live great! Rheumatoid arthritis that binds hands:

There are no specific preventive measures, however, doctors give some recommendations, observing which you can slightly reduce the risk of the disease:

Elimination of foci of inflammation in the body, which lead to a decrease in immunity, namely: timely treatment of tonsillitis, tonsillitis, sinusitis and carious teeth.

Avoid hypothermia.

Avoid prolonged exposure to stress.

Refuse bad habits, in particular smoking.

Pay attention to the possible presence of hereditary factors, and if any, then more carefully treats your health.

Treatment of viral infections under the supervision of a physician.

The use of vitamin complexes in especially dangerous periods.

The doctor should be consulted immediately if such characteristic symptoms as bilateral inflammation of the joints and their pain occur. With deformation of the bones, as well as the detection of small subcutaneous nodules. An ambulance should be called immediately if the temperature joins these symptoms, painful sensations appear in the sternum, breathing becomes difficult, and cardiac activity is impaired.

It is worth remembering that if rheumatoid arthritis is not characterized by a rapid and aggressive course, then this disease can be completely dealt with, converted into a chronic form and continued to live a full life, which in the end will not lead to disability.

There are contraindications. It is necessary to read the instructions or consult a specialist.

There are contraindications. It is necessary to read the instructions or consult a specialist.

Education: diploma in "General Medicine" was obtained in 2009 at the Medical Academy. I.M.Sechenova. In 2012, he completed postgraduate studies in the specialty "Traumatology and Orthopedics" at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.


Watch the video: Rheumatoid Arthritis: Katy's Journey (March 2020).