• For the cure of arthritis, we will say it's controllable in a majority of the cases rather than curable with the currently available treatment.
• A patient is the center and in fact a major decision-maker in the management of arthritis, so a patient can do a lot to keep arthritis in good control like:

• In short, a healthy lifestyle, taking medicines regularly, and regular follow-up with your physician will help you to achieve good control of arthritis and good quality of life.

• The reason for deformities in RA in simple words can be explained with lack of treatment in the initial stage of the disease. Rheumatoid arthritis affects joints as well as the supporting structures of joints like tendons, which maintain the shape and alignment of joints. Damage to this supporting structure along with damage to the joints result in deformities.
• At the very initial stage of deformities, as it just starts bending, there is a fair chance to reverse it with aggressive control of the disease as well as with supportive treatment with your physical therapist. But in a few cases it progresses and surgical corrections remain the option for a few deformities, which can be discussed by your treating rheumatologist.

• In simple words, biologics are a newer type of medicine which target the chemical responsible for causingarthritis symptoms.
• When your disease is active, immune cells produce proteins called cytokines, which cause inflammation. These biologics are designed to target these cytokines to reduce inflammation and damage to your body.
• These medications are generally prescribed when other medications are not enough to control your symptoms or when it seems necessary to reduce your need for corticosteroids.
• Like most medications, biologics causes side effects, usually mild-to–moderate in severity. The common side effect of these biologics include reactions during the infusion of injections (fever or chills, itching, chest discomfort, low or high blood pressure, shortness of breath).
• As these biologics target the immune system, the susceptibility to infection increases and chance of tuberculosis increases with a category of biologics targeting a molecule called TNF.
• Regarding the cost of biologics, they are indeed expensive medications with approximate monthly expenses ranging from as low as 15,000 INR to 1,50,000 INR depending on the therapy advised to you.
• The detailed information is generally given by your treating physician once the consideration of biologics in your disease management is planned.

• Diet and nutrition may have an influence on immunity but most of the facts are yet to be proven. However, two major changes can be made in the diet to help/boost the immune system.
• First, to enrich the diet with antioxidants and second by taking a balanced diet

• Antioxidants are vitamins and minerals, found in foods and available as supplements. Oxidants, also known as free radicals, are the toxic by-products our bodies make when we turn food into energy and also by-products of cigarette smoke, pollution, sunlight exposure, and other environmental factors.
• Free radicals are capable of damaging DNA and suppressing the body's immune system.
• Research suggests that a diet high in antioxidants might protect against autoimmune diseases and cancer[b].

• You should take a balanced diet containing all essential amino acids and micronutrients in adequate amount.
• Marginal nutrient deficiencies in the diet can also weaken the immune system.

• Recent studies indicate that high salt intake is associated with an increased risk of autoimmunity; however, this fact needs further research for confirmation. Foods for cardiovascular health
• To reduce the dyslipidemia and cardiovascular risk, which is common in chronic inflammatory diseases like RA, modify your diet by eating less saturated fat and animal protein (particularly red meat), by limiting dairy products (particularly those with fat), by modifying use of oils and fats, and by eating more fresh fruits, vegetables, and whole grains.

• Try eliminating red meat from your diet or, if necessary, eat it no more than once every 10 days.
• Also, eliminate or reduce intake of fried meats.
• Try to replace meat in the diet with servings of fish.
• Use olive/mustard oil in your cooking. These oils are rich in mono- and poly-saturated fats, which decrease the risk for cardiovascular disease and stroke.
• Eat more fruits and vegetables. Green leafy vegetables are very rich in antioxidants.
• Fiber can be found in many types of whole grains. If you are going to add rice, which is healthy, try to add brown rice.
• Brans and cereals are also helpful, but avoid those with any form of artificial sugar.
• Drink plenty of water.

• Physically active individuals are healthier, happier and live longer than those who are inactive and unfit. This is especially true for people with arthritis.
• With rheumatoid arthritis, patients have chances of developing muscle weakness, muscular deconditioning, and contractures due to lack of exercises.
• In addition, inactivity can result in a variety of health risks, including Type II diabetes, cardiovascular disease, and osteoporosis.
• So it’s important that patients with RA exercise regularly.
• In the presence of pain, the first important step is to find the reason for the pain, whether it is due to RA disease process or due to chronic damage to the joint because of long-standing disease and address the issue correctly.
• In the presence of pain, the patient should maintain at least the flexibility/range of motion activity at the joint to prevent contracture and disuse atrophy and weakness of the surrounding muscle.
• After controlling the pain gradual exercise training can be adapted.
• A therapist can be an important part of the management team of rheumatoid arthritis patient.

Pregnancy in RA is a special situation and it is preferred the decision is to be taken after discussion with treating physician.

• The success rate of pregnancy is higher and the chance of an increase in joint pain is less if the disease was well controlled for a period of at least 6 months
• Again there are certain medications which require to be stopped 3 to 6 months prior to pregnancy because of its effects on the baby and the best call stays with your treating physician.
• In most of the scenario pertaining to your doubt, a physician plans to control disease activity for at least 6 months and then plan to switch to medications which are not harmful to the baby, if this switch is successful, a patient can definitely go for pregnancy and healthy offspring.
• As such the disease RA does not affect the fertility of a female and the outcome of pregnancy but the flare of disease after the delivery is more and a close follow up with a physician is required.

• To have an honest discussion on your question, first let me introduce you to the available evidence. The chance of RA in first-degree family members (parent, sibling, children) of rheumatoid arthritis patients is only 0.8% compared to 0.5% in the general population. Although several members of the same family can be affected by rheumatoid arthritis, the tendency to pass it on from parent to child isn’t very strong.
• The risk of a child inheriting rheumatoid arthritis from a parent is between 1 in 100 to 1 in 30 (about 1%–3%).
• If you google, obviously you are going to get a lot in RA and genetics, but the fact is it’s not just the presence of gene(s) which makes you prone to develop RA, there are multiple environmental factors like smoking, activities, and a lot of unknown factors which increase RA.
• So the topic is always open for discussion till science says further things in the same direction, and we will suggest you not to invite unnecessary worryby wondering if your children are going to develop RA or not.
• And DO NOT check RA factor or Anti-CCP in your kids and invite unnecessary worries.

• Starting therapy at an early stage of treatment
• Adopting a healthy lifestyle with regular exercise
• Most importantly taking your medication regularly at the prescribed doses by your rheumatologist
• Regular follow-up with your rheumatologist for assessment of your disease status and a medication change in case of uncontrolled disease is essential

• Yes, food is a better source for the nutrients compared to multivitamin supplements. There is no point increasing pill burden unless indicated.
• In arthritis, there is no disease process which causes deficiency of vitamins; hence,home-cooked traditional food with regular intake of salads and fruits and milk take care of the body’s nutritional need.
• In some special situations, a patient can discuss with a dietician for the meal plan and supplements.

• The current availability of treatment options with the strategy of ‘hit early and hit hard’ and a healthy lifestyle help to achieve disease control in the majority of patients, and once your disease in good control for more than six months, your physician will reduce your medication burden in a gradual manner. Though stopping the medication completely is not an option with the currently available treatment.
• Importantly, if your disease is controlled well with the medication at an early stage, the chances of developing deformities and disease-related long-term complications reduce.
• Regarding Ayurveda, we are not the best to comment on whether it can really cure RA, as such cases are not evident to the physicians. There are no trials or data or scientific proof to suggest ‘complete cure’ by ayurvedic medications. So, I strongly recommend you not to lose the early window of opportunity to achieve good control of disease and prevent deformities with the care under your rheumatologist.
• Why is it that, the same medicine for RA is given for Lupus and Sjogren's or Ankylosing Spondylitis? Aren't these different autoimmune diseases. For example - Rituximab Or HCQs.