California Becomes Latest State To Try Capping Health Care Spending
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California’s Office of Health Care Affordability faces a herculean task in its plan to slow runaway health care spending.
The goal of the agency, established in 2022, is to make care more affordable and accessible while improving health outcomes, especially for the most disadvantaged state residents. That will require a sustained wrestling match with a sprawling, often dysfunctional health system and powerful industry players who have lots of experience fighting one another and the state.
Can the new agency get insurers, hospitals, and medical groups to collaborate on containing costs even as they jockey for position in the state’s $405 billion health care economy? Can the system be transformed so that financial rewards are tied more to providing quality care than to charging, often exorbitantly, for a seemingly limitless number of services and procedures?
The jury is out, and it could be for many years.
California is the ninth state — after Connecticut, Delaware, Massachusetts, Nevada, New Jersey, Oregon, Rhode Island, and Washington — to set annual health spending targets.
Massachusetts, which started annual spending targets in 2013, was the first state to do so. It’s the only one old enough to have a substantial pre-pandemic track record, and its results are mixed: The annual health spending increases were below the target in three of the first five years and dropped beneath the national average. But more recently, health spending has greatly increased.
In 2022, growth in health care expenditures exceeded Massachusetts’ target by a wide margin. The Health Policy Commission, the state agency established to oversee the spending control efforts, warned that “there are many alarming trends which, if unaddressed, will result in a health care system that is unaffordable.”
Neighboring Rhode Island, despite a preexisting policy of limiting hospital price increases, exceeded its overall health care spending growth target in 2019, the year it took effect. In 2020 and 2021, spending was largely skewed by the pandemic. In 2022, the spending increase came in at half the state’s target rate. Connecticut and Delaware, by contrast, both overshot their 2022 targets.
It’s all a work in progress, and California’s agency will, to some extent, be playing it by ear in the face of state policies and demographic realities that require more spending on health care.
And it will inevitably face pushback from the industry as it confronts unreasonably high prices, unnecessary medical treatments, overuse of high-cost care, administrative waste, and the inflationary concentration of a growing number of hospitals in a small number of hands.
“If you’re telling an industry we need to slow down spending growth, you’re telling them we need to slow down your revenue growth,” says Michael Bailit, president of Bailit Health, a Massachusetts-based consulting group, who has consulted for various states, including California. “And maybe that’s going to be heard as ‘we have to restrain your margins.’ These are very difficult conversations.”
Some of California’s most significant health care sectors have voiced disagreement with the fledgling affordability agency, even as they avoid overtly opposing its goals.
In April, when the affordability office was considering an annual per capita spending growth target of 3%, the California Hospital Association sent it a letter saying hospitals “stand ready to work with” the agency. But the proposed number was far too low, the association argued, because it failed to account for California’s aging population, new investments in Medi-Cal, and other cost pressures.
The hospital group suggested a spending increase target averaging 5.3% over five years, 2025-29. That’s slightly higher than the 5.2% average annual increase in per capita health spending over the five years from 2015 to 2020.
Five days after the hospital association sent its letter, the affordability board approved a slightly less aggressive target that starts at 3.5% in 2025 and drops to 3% by 2029. Carmela Coyle, the association’s chief executive, said in a statement that the board’s decision still failed to account for an aging population, the growing need for mental health and addiction treatment, and a labor shortage.
The California Medical Association, which represents the state’s doctors, expressed similar concerns. The new phased-in target, it said, was “less unreasonable” than the original plan, but the group would “continue to advocate against an artificially low spending target that will have real-life negative impacts on patient access and quality of care.”
But let’s give the state some credit here. The mission on which it is embarking is very ambitious, and it’s hard to argue with the motivation behind it: to interject some financial reason and provide relief for millions of Californians who forgo needed medical care or nix other important household expenses to afford it.
Sushmita Morris, a 38-year-old Pasadena resident, was shocked by a bill she received for an outpatient procedure last July at the University of Southern California’s Keck Hospital, following a miscarriage. The procedure lasted all of 30 minutes, Morris says, and when she received a bill from the doctor for slightly over $700, she paid it. But then a bill from the hospital arrived, totaling nearly $9,000, and her share was over $4,600.
Morris called the Keck billing office multiple times asking for an itemization of the charges but got nowhere. “I got a robotic answer, ‘You have a high-deductible plan,’” she says. “But I should still receive a bill within reason for what was done.” She has refused to pay that bill and expects to hear soon from a collection agency.
The road to more affordable health care will be long and chock-full of big challenges and unforeseen events that could alter the landscape and require considerable flexibility.
Some flexibility is built in. For one thing, the state cap on spending increases may not apply to health care institutions, industry segments, or geographic regions that can show their circumstances justify higher spending — for example, older, sicker patients or sharp increases in the cost of labor.
For those that exceed the limit without such justification, the first step will be a performance improvement plan. If that doesn’t work, at some point — yet to be determined — the affordability office can levy financial penalties up to the full amount by which an organization exceeds the target. But that is unlikely to happen until at least 2030, given the time lag of data collection, followed by conversations with those who exceed the target, and potential improvement plans.
In California, officials, consumer advocates, and health care experts say engagement among all the players, informed by robust and institution-specific data on cost trends, will yield greater transparency and, ultimately, accountability.
Richard Kronick, a public health professor at the University of California-San Diego and a member of the affordability board, notes there is scant public data about cost trends at specific health care institutions. However, “we will know that in the future,” he says, “and I think that knowing it and having that information in the public will put some pressure on those organizations.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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The Complete Anti-Inflammatory Diet for Beginners – by Dorothy Calimeris and Lulu Cook
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First, about the authors: notwithstanding the names, Calimeris is the cook, and Cook is the nutritionist (and an RDN at that).
As for the book: we get a good primer on the science of inflammation, what it is, why it happens, what things are known to cause/trigger it, and what things are known to fight it. They do also go outside of nutrition a bit for this, speaking briefly on other lifestyle factors too, but the main focus is of course nutrition.
As for the recipes: while distinctly plants-forward (as one might expect of an anti-inflammatory eating book), it’s not outright vegan or even vegetarian, indeed, in the category of main dishes, there are sections for:
- Vegetarian and vegan
- Fish and shellfish
- Poultry and meat
…as well as, before and after those, sections for breakfast and brunch and snacks and sweets. As well as a not-to-be-underestimated section, for sauces, condiments, and dressings. This is important, because those are quite often the most inflammatory parts of an otherwise healthy meal! So being able to make anti-inflammatory versions is a real boon.
The recipes are mostly not illustrated, but the steps are very clearly described and easy to follow.
Bottom line: if inflammation is currently on your to-tackle list, this book will be an excellent companion in the kitchen.
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4 Ways Vaccine Skeptics Mislead You on Measles and More
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Measles is on the rise in the United States. In the first quarter of this year, the number of cases was about 17 times what it was, on average, during the same period in each of the four years before, according to the Centers for Disease Control and Prevention. Half of the people infected — mainly children — have been hospitalized.
It’s going to get worse, largely because a growing number of parents are deciding not to get their children vaccinated against measles as well as diseases like polio and pertussis. Unvaccinated people, or those whose immunization status is unknown, account for 80% of the measles cases this year. Many parents have been influenced by a flood of misinformation spouted by politicians, podcast hosts, and influential figures on television and social media. These personalities repeat decades-old notions that erode confidence in the established science backing routine childhood vaccines. KFF Health News examined the rhetoric and explains why it’s misguided:
The No-Big-Deal Trope
A common distortion is that vaccines aren’t necessary because the diseases they prevent are not very dangerous, or too rare to be of concern. Cynics accuse public health officials and the media of fear-mongering about measles even as 19 states report cases.
For example, an article posted on the website of the National Vaccine Information Center — a regular source of vaccine misinformation — argued that a resurgence in concern about the disease “is ‘sky is falling’ hype.” It went on to call measles, mumps, chicken pox, and influenza “politically incorrect to get.”
Measles kills roughly 2 of every 1,000 children infected, according to the CDC. If that seems like a bearable risk, it’s worth pointing out that a far larger portion of children with measles will require hospitalization for pneumonia and other serious complications. For every 10 measles cases, one child with the disease develops an ear infection that can lead to permanent hearing loss. Another strange effect is that the measles virus can destroy a person’s existing immunity, meaning they’ll have a harder time recovering from influenza and other common ailments.
Measles vaccines have averted the deaths of about 94 million people, mainly children, over the past 50 years, according to an April analysis led by the World Health Organization. Together with immunizations against polio and other diseases, vaccines have saved an estimated 154 million lives globally.
Some skeptics argue that vaccine-preventable diseases are no longer a threat because they’ve become relatively rare in the U.S. (True — due to vaccination.) This reasoning led Florida’s surgeon general, Joseph Ladapo, to tell parents that they could send their unvaccinated children to school amid a measles outbreak in February. “You look at the headlines and you’d think the sky was falling,” Ladapo said on a News Nation newscast. “There’s a lot of immunity.”
As this lax attitude persuades parents to decline vaccination, the protective group immunity will drop, and outbreaks will grow larger and faster. A rapid measles outbreak hit an undervaccinated population in Samoa in 2019, killing 83 people within four months. A chronic lack of measles vaccination in the Democratic Republic of the Congo led to more than 5,600 people dying from the disease in massive outbreaks last year.
The ‘You Never Know’ Trope
Since the earliest days of vaccines, a contingent of the public has considered them bad because they’re unnatural, as compared with nature’s bounty of infections and plagues. “Bad” has been redefined over the decades. In the 1800s, vaccine skeptics claimed that smallpox vaccines caused people to sprout horns and behave like beasts. More recently, they blame vaccines for ailments ranging from attention-deficit/hyperactivity disorder to autism to immune system disruption. Studies don’t back the assertions. However, skeptics argue that their claims remain valid because vaccines haven’t been adequately tested.
In fact, vaccines are among the most studied medical interventions. Over the past century, massive studies and clinical trials have tested vaccines during their development and after their widespread use. More than 12,000 people took part in clinical trials of the most recent vaccine approved to prevent measles, mumps, and rubella. Such large numbers allow researchers to detect rare risks, which are a major concern because vaccines are given to millions of healthy people.
To assess long-term risks, researchers sift through reams of data for signals of harm. For example, a Danish group analyzed a database of more than 657,000 children and found that those who had been vaccinated against measles as babies were no more likely to later be diagnosed with autism than those who were not vaccinated. In another study, researchers analyzed records from 805,000 children born from 1990 through 2001 and found no evidence to back a concern that multiple vaccinations might impair children’s immune systems.
Nonetheless, people who push vaccine misinformation, like candidate Robert F. Kennedy Jr., dismiss massive, scientifically vetted studies. For example, Kennedy argues that clinical trials of new vaccines are unreliable because vaccinated kids aren’t compared with a placebo group that gets saline solution or another substance with no effect. Instead, many modern trials compare updated vaccines with older ones. That’s because it’s unethical to endanger children by giving them a sham vaccine when the protective effect of immunization is known. In a 1950s clinical trial of polio vaccines, 16 children in the placebo group died of polio and 34 were paralyzed, said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and author of a book on the first polio vaccine.
The Too-Much-Too-Soon Trope
Several bestselling vaccine books on Amazon promote the risky idea that parents should skip or delay their children’s vaccines. “All vaccines on the CDC’s schedule may not be right for all children at all times,” writes Paul Thomas in his bestselling book “The Vaccine-Friendly Plan.” He backs up this conviction by saying that children who have followed “my protocol are among the healthiest in the world.”
Since the book was published, Thomas’ medical license was temporarily suspended in Oregon and Washington. The Oregon Medical Board documented how Thomas persuaded parents to skip vaccines recommended by the CDC, and reported that he “reduced to tears” a mother who disagreed. Several children in his care came down with pertussis and rotavirus, diseases easily prevented by vaccines, wrote the board. Thomas recommended fish oil supplements and homeopathy to an unvaccinated child with a deep scalp laceration, rather than an emergency tetanus vaccine. The boy developed severe tetanus, landing in the hospital for nearly two months, where he required intubation, a tracheotomy, and a feeding tube to survive.
The vaccination schedule recommended by the CDC has been tailored to protect children at their most vulnerable points in life and minimize side effects. The combination measles, mumps, and rubella vaccine isn’t given for the first year of a baby’s life because antibodies temporarily passed on from their mother can interfere with the immune response. And because some babies don’t generate a strong response to that first dose, the CDC recommends a second one around the time a child enters kindergarten because measles and other viruses spread rapidly in group settings.
Delaying MMR doses much longer may be unwise because data suggests that children vaccinated at 10 or older have a higher chance of adverse reactions, such as a seizure or fatigue.
Around a dozen other vaccines have discrete timelines, with overlapping windows for the best response. Studies have shown that MMR vaccines may be given safely and effectively in combination with other vaccines.
’They Don’t Want You to Know’ Trope
Kennedy compares the Florida surgeon general to Galileo in the introduction to Ladapo’s new book on transcending fear in public health. Just as the Roman Catholic inquisition punished the renowned astronomer for promoting theories about the universe, Kennedy suggests that scientific institutions oppress dissenting voices on vaccines for nefarious reasons.
“The persecution of scientists and doctors who dare to challenge contemporary orthodoxies is not a new phenomenon,” Kennedy writes. His running mate, lawyer Nicole Shanahan, has campaigned on the idea that conversations about vaccine harms are censored and the CDC and other federal agencies hide data due to corporate influence.
Claims like “they don’t want you to know” aren’t new among the anti-vaccine set, even though the movement has long had an outsize voice. The most listened-to podcast in the U.S., “The Joe Rogan Experience,” regularly features guests who cast doubt on scientific consensus. Last year on the show, Kennedy repeated the debunked claim that vaccines cause autism.
Far from ignoring that concern, epidemiologists have taken it seriously. They have conducted more than a dozen studies searching for a link between vaccines and autism, and repeatedly found none. “We have conclusively disproven the theory that vaccines are connected to autism,” said Gideon Meyerowitz-Katz, an epidemiologist at the University of Wollongong in Australia. “So, the public health establishment tends to shut those conversations down quickly.”
Federal agencies are transparent about seizures, arm pain, and other reactions that vaccines can cause. And the government has a program to compensate individuals whose injuries are scientifically determined to result from them. Around 1 to 3.5 out of every million doses of the measles, mumps, and rubella vaccine can cause a life-threatening allergic reaction; a person’s lifetime risk of death by lightning is estimated to be as much as four times as high.
“The most convincing thing I can say is that my daughter has all her vaccines and that every pediatrician and public health person I know has vaccinated their kids,” Meyerowitz-Katz said. “No one would do that if they thought there were serious risks.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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Good to Go – by Christie Aschwanden
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Many of us may more often need to recover from a day of moving furniture than running a marathon, but the science of recovery can still teach us a lot. The author, herself an endurance athlete and much-decorated science journalist, sets out to do just that.
She explores a lot of recovery methods, and examines whether the science actually backs them up, and if so, to what degree. She also, in true science journalism style, talks to a lot of professionals ranging from fellow athletes to fellow scientists, to get their input too—she is nothing if not thorough, and this is certainly not a book of one person’s opinion with something to sell.
Indeed, on the contrary, her findings show that some of the best recovery methods are the cheapest, or even free. She also looks at the psychological aspect though, and why many people are likely to continue with things that objectively do not work better than placebo.
The style is very easy-reading jargon-free pop-science, while nevertheless being backed up with hundreds of studies cited in the bibliography—a perfect balance of readability and reliability.
Bottom line: for those who wish to be better informed about how to recover quickly and easily, this book is a treasure trove of information well-presented.
Click here to check out Good To Go, and always be good to go!
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Hearing voices is common and can be distressing. Virtual reality might help us meet and ‘treat’ them
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Have you ever heard something that others cannot – such as your name being called? Hearing voices or other noises that aren’t there is very common. About 10% of people report experiencing auditory hallucinations at some point in their life.
The experience of hearing voices can be very different from person to person, and can change over time. They might be the voice of someone familiar or unknown. There might be many voices, or just one or two. They can be loud or quiet like a whisper.
For some people these experiences are positive. They might represent a spiritual or supernatural experience they welcome or a comforting presence. But for others these experiences are distressing. Voices can be intrusive, negative, critical or threatening. Difficult voices can make a person feel worried, frightened, embarrassed or frustrated. They can also make it hard to concentrate, be around other people and get in the way of day-to-day activities.
Although not everyone who hears voices has a mental health problem, these experiences are much more common in people who do. They have been considered a hallmark symptom of schizophrenia, which affects about 24 million people worldwide.
However, such experiences are also common in other mental health problems, particularly in mood- and trauma-related disorders (such as bipolar disorder or depression and post-traumatic stress disorder) where as many as half of people may experience them.
Rawpixel/Shutterstock Why do people hear voices?
It is unclear exactly why people hear voices but exposure to prolonged stress, trauma or depression can increase the chances.
Some research suggests people who hear voices might have brains that are “wired” differently, particularly between the hearing and speaking parts of the brain. This may mean parts of our inner speech can be experienced as external voices. So, having the thought “you are useless” when something goes wrong might be experienced as an external person speaking the words.
Other research suggests it may relate to how our brains use past experiences as a template to make sense of and make predictions about the world. Sometimes those templates can be so strong they lead to errors in how we experience what is going on around us, including hearing things our brain is “expecting” rather than what is really happening.
What is clear is that when people tell us they are hearing voices, they really are! Their brain perceives voice experiences as if someone were talking in the room. We could think of this “mistake” as working a bit like being susceptible to common optical tricks or visual illusions.
There may be differences in the brains of people who hear voices. Triff/Shutterstock Coping with hearing voices
When hearing voices is getting in the way of life, treatment guidelines recommend the use of medications. But roughly a third of people will experience ongoing distress. As such, treatment guidelines also recommend the use of psychological therapies such as cognitive behavioural therapy.
The next generation of psychological therapies are beginning to use digital technologies and virtual reality offers a promising new medium.
Avatar therapy allows a person to create a virtual representation of the voice or voices, which looks and sounds like what they are experiencing. This can help people regain power in the “relationship” as they interact with the voice character, supported by a therapist.
Jason’s experience
Aged 53, Jason (not his real name) had struggled with persistent voices since his early 20s. Antipsychotic medication had helped him to some extent over the years, but he was still living with distressing voices. Jason tried out avatar therapy as part of a research trial.
He was initially unable to stand up to the voices, but he slowly gained confidence and tested out different ways of responding to the avatar and voices with his therapist’s support.
Jason became more able to set boundaries, such as not listening to them for periods throughout the day. He also felt more able to challenge what they said and make his own choices.
Over a couple of months, Jason started to experience some breaks from the voices each day and his relationship with them started to change. They were no longer like bullies, but more like critical friends pointing out things he could consider or be aware of.
A screenshot from HekaVR, the software used in the Australian AMETHYST trial. HekaVR, CC BY-ND Gaining recognition
Following promising results overseas and its recommendation by the United Kingdom’s National Institute for Health and Care Excellence, our team has begun adapting the therapy for an Australian context.
We are trialling delivering avatar therapy from our specialist voices clinic via telehealth. We are also testing whether avatar therapy is more effective than the current standard therapy for hearing voices, based on cognitive behavioural therapy.
As only a minority of people with psychosis receive specialist psychological therapy for hearing voices, we hope our trial will support scaling up these new treatments to be available more routinely across the country.
We would like to acknowledge the advice and input of Dr Nadine Keen (consultant clinical psychologist at South London and Maudsley NHS Foundation Trust, UK) on this article.
Leila Jameel, Trial Co-ordinator and Research Therapist, Swinburne University of Technology; Imogen Bell, Senior Research Fellow and Psychologist, The University of Melbourne; Neil Thomas, Professor of Clinical Psychology, Swinburne University of Technology, and Rachel Brand, Senior Lecturer in Clinical Psychology, University of the Sunshine Coast
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Morning Routines That Just FLOW
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Morning Routines That Just FLOW
“If the hardest thing you have to do in your day is eat a frog, eat that frog first!”, they say.
And, broadly speaking, it is indeed good to get anything stressful out of the way early, so that we can relax afterwards. But…
- Are we truly best at frog-eating when blurry-eyed and sleepy?
- Is there a spoonful of sugar that could make the medicine go down better?
- What do we need to turn eating the frog into an enjoyable activity?
Flow
“Flow” is a concept brought to public consciousness by psychologist Mihaly Csikszentmihalyi, and it refers to a state in which we feel good about what we’re doing, and just keep doing, at a peak performance level.
Writer’s note: as a writer, for example…
Sometimes I do not want to write, I pace to and fro near my computer, going on side-quests like getting a coffee or gazing out of the window into my garden. But once I get going, suddenly, something magical happens and before I know it, I have to trim my writing down because I’ve written too much. That magical window of effortless productivity was a state of flow.
Good morning!
What is a good morning, to you? Build that into your morning! Set parameters around it so you don’t get carried away timewise and find yourself in the afternoon (unless that would work for you!), but first thing in the morning is the time to light up each part of your brain with appropriate neurotransmitters.
Getting the brain juices flowing
Cortisol
When we wake up, we (unless we have some neurochemical imbalance, such as untreated depression) get a spike of cortisol. Cortisol is much-maligned and feared, and indeed it can be very much deleterious to the health in cases of chronic stress. But a little spike now and again is actually beneficial for us.
Quick Tip: if you want to artificially stimulate (or enhance) a morning cortisol spike, a cold shower is the way to go. Or even just a face-plunge into a bowl of ice-water (put ice in it, give it a couple of minutes to chill the water, then put your face in for a count of 30 seconds, or less if you can’t hold your breath that long).
Serotonin
Serotonin is generally thought of as “the happy chemical”, and it’s stimulated by blue/white light, and also by seeing greenery.
Quick tip: to artificially stimulate (or enhance) a morning serotonin boost, your best friend is sunlight. Even sun through a partly-clouded sky will tend to outperform artificial lighting, including artificial sunlight lighting. Try to get sun between 08:30 and 09:00, if you can. Best of all, do it in your garden or nearby park, as the greenery will be an extra boost!
Dopamine
Generally thought of as “the reward chemical”, but it’s also critical for a lot of kinds of brainwork, including language processing and problem-solving.
Quick Tip: to artificially stimulate* a dopamine surge to get you going, do something that you and/or your body finds rewarding. Examples include:
- Exercise, especially in a vigorous burst
- A good breakfast, a nice coffee, whatever feels right to you
- An app that has motivational bells and whistles, a streak for you to complete, etc
Note: another very enjoyable activity might come to mind that doesn’t even require you getting out of bed. Be aware, however, gentleman-readers in particular, that if you complete that activity, you’ll get a prolactin spike that will wipe out the dopamine you just worked up. So that one’s probably better for a lazy morning of relaxation, than a day when you want to get up and go!
*there’s no “(or enhance)” for this one; you won’t get dopamine from doing nothing, that’s just not how “the reward chemical” works
Flow-building in a stack
When you’ve just woken up and are in a blurry morning haze, that’s not the time to be figuring out “what should I be doing next?”, so instead:
- Work out the things you want to incorporate into your morning routine
- Put them in the order that will be easiest to perform—some things will go a lot better after others!
- Remember to also include things that are simply necessary—morning bathroom ablutions, for example
The goal here is to have a this-and-this-and-this-and-this list of items that you can go through without any deviations, and get in the habit of “after item 1 I automatically do item 2, after which I automatically do item 3, after which…”
Implement this, and your mornings will become practically automated, but in a joyous, life-enhancing way that sets you up in good order for whatever you want/need to do!
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Tips For Avoiding/Managing Rheumatoid Arthritis
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Avoiding/Managing Rheumatoid Arthritis
Arthritis is the umbrella term for a cluster of joint diseases involving inflammation of the joints, hence “arthr-” (joint) “-itis” (suffix used to denote inflammation). These are mostly, but not all, autoimmune diseases, in which the body’s immune system mistakenly attacks our own joints.
Inflammatory vs Non-Inflammatory Arthritis
Arthritis is broadly divided into inflammatory arthritis and non-inflammatory arthritis.
You may be wondering: how does one get non-inflammatory inflammation of the joints?
The answer is, in “non-inflammatory” arthritis, such as osteoarthritis, the damage comes first (by general wear-and-tear) and inflammation generally follows as part of the symptoms, rather than the cause. So the name can be a little confusing. In the case of osteo- and other “non-inflammatory” forms of arthritis, you definitely still want to keep your inflammation at bay as best you can, but it’s not as absolutely critical a deal as it is for “inflammatory” forms of arthritis.
We’ll tackle the beast that is osteoarthritis another day, however.
Today we’re going to focus on…
Rheumatoid Arthritis
This is the most common of the autoimmune forms of arthritis. Some quick facts:
- It affects a little under 1% of the global population, but the older we get, the more likely it becomes
- Early onset of rheumatoid arthritis is most likely to show up around the age of 50 (but it can show up at any age)
- However, incidence (not onset) of rheumatoid arthritis peaks in the 70s age bracket
- It is 2–4 times more common in women than in men
- Approximately one third of people stop work within two years of its onset, and this increases thereafter.
Well, that sounds gloomy.
Indeed it’s not fun. There’s a lot of stiffness and aching of joints (often with swelling too), loss of joint function can be common, and then there are knock-on effects like fatigue, weakness, and loss of appetite.
Beyond that it’s an autoimmune disorder, its cause is not known, and there is no known cure.
Is there any good news?
If you don’t have rheumatoid arthritis at the present time, you can reduce your risk factors in several ways:
- Having an anti-inflammatory diet. Get plenty of fiber, greens, and berries. Fatty fish is great too, as are oily nuts. On the other side of things, high consumption of salt, sugar, alcohol, and red meat are associated with a greater risk of developing rheumatoid arthritis.
- Not smoking. Smoking is bad for pretty much everything, including your chances of developing rheumatoid arthritis.
- Not being obese. This one may be more a matter of correlation than causation, because of the dietary factors (if one eats an anti-inflammatory diet, obesity is less likely), but the association is there.
There are other risk factors that are harder to control, such as genetics, age, sex, and having a mother who smoked.
See: Genetic and environmental risk factors for rheumatoid arthritis
What if I already have rheumatoid arthritis?
If you already have rheumatoid arthritis, it becomes a matter of symptom management.
First, reduce inflammation any (reasonable) way you can. We did a main feature on this before, so we’ll just drop that again here:
Next, consider the available medications. Your doctor may or may not have discussed all of the options with you, so be aware that there are more things available than just pain relief. To talk about them all would require a whole main feature, so instead, here’s a really well-compiled list, along with explanations about each of them, up to date as of this year:
Rheumatoid Arthritis Medication List (And What They Do, And How)
Finally, consider other lifestyle adjustments to manage your symptoms. These include:
- Exercise—gently, though! You do not want to provoke a flare-up, but you do want to maintain your mobility as best you can. There’s a use-it-or-lose-it factor here. Swimming and yoga are great options, as is tai chi. You may want to avoid exercises that involve repetitive impacts to your joints, like running.
- Rest—while keeping mobility going. Get good sleep at night (this is important), but don’t make your bed your new home, or your mobility will quickly deteriorate.
- Hot & cold—both can help, and alternating them can reduce inflammation and stiffness by improving your body’s ability to respond appropriately to these stimuli rather than getting stuck in an inappropriate-response state of inflammation.
- Mobility aids—if it helps, it helps. Maybe you only need something during a flare-up, but when that’s the case, you want to be as gentle on your body as possible while keeping moving, so if crutches, handrails etc help, then by all means get them and use them.
- Go easy on the use of braces, splints, etc—these can offer short-term relief, but at a long term cost of loss of mobility. Only you can decide where to draw the line when it comes to that trade-off.
You can also check out our previous article:
Managing Chronic Pain (Realistically!)
Take good care of yourself!
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