Arthritis and Your Eyes

 

Arthritis and Your Eyes Transcript

For Release Nov. 19, 2024

PODCAST OPEN:      

You’re listening to the Live Yes! With Arthritis podcast, created by the Arthritis Foundation to help people with arthritis — and the people who love them — live their best lives. This podcast and other life-changing resources are made possible by gifts from donors like you. If you’re dealing with chronic pain, this podcast is for you. You may have arthritis, but it doesn’t have you. Here, learn how you can take control of arthritis with tips and ideas from our hosts and guest experts.

 

MUSIC BRIDGE

 

Trina Wilcox:

Welcome to the Live Yes! With Arthritis podcast. I'm Trina Wilcox, your host for this episode. I was diagnosed at age 6. And with that comes a lot of changes, medications, doctor's appointments, and on that list was going to the eye doctor regularly. And eye appointments are something you don't usually have on your to-do list annually or even more frequently than that. But when you are diagnosed with a chronic condition, it becomes very important. And today we're going to talk about why.

 

So, when we talk about arthritis, pain, stiffness and inflammation of the joints are usually the first things that we think about. But the reality is that that inflammation can cause damage in other parts of the body, too, including the heart, lungs and even the eyes.

So many arthritis-related conditions can affect the eyes. But what types are the ones that are most impactful? What are arthritis eye-related conditions? How common are they? How do they affect everyday life? The list goes on and on.

 

In this episode of the Live Yes! With Arthritis podcast, we are going to do our best to answer these questions and discuss how arthritis affects the eyes and what you can do about it. Today, I'm joined by Claire Eby, an Arthritis Foundation staffer, who has also lived with arthritis since childhood. And Eric L. Crowell, MD, MPH, clinical director and ophthalmologist at the Mitchell and Shannon Wong Eye Institute. Welcome to the podcast.

 

Claire Eby:

Hi. Thanks for having us.

 

Dr. Eric Crowell:

Yes, we're excited to be here.

 

Trina Wilcox:

So, Claire, please tell us a little bit about your experiences with arthritis.

 

Claire Eby:

A lot of my experience with arthritis is actually centered around the eyes. And uveitis. I was diagnosed with arthritis around like age 3. And then about a year later, I was diagnosed with uveitis at age 4. My eye had turned red all of a sudden, and my mom called my dad, who was golfing. And he happened to be golfing with an eye doctor, and the eye doctor was like, "You need to get her to the doctor right away." So, they took me to the doctor, and they were like, "Wow, you have really bad inflammation. It seems like this is uveitis, maybe iritis. So, we're going to get that taken care of."

 

I saw Dr. Marylin White. She was a military doctor for a very long time. She usually didn't take pediatric patients, but she took me. She was my doctor up until she retired, I think about two years ago. Amazing doctor. She even ended up presenting my case to the NIH (National Institutes of Health). So, I got to be part of a uveitis study with the NIH. I would fly up to D.C. once or twice a year, and they would do checkups. I think I did a couple of surgeries in D.C., and I consider myself to be very lucky despite having the misfortune of having uveitis.

 

Trina Wilcox:

Right, right. And we're very thankful. It's not uncommon that there isn't always a pediatric rheumatologist around. So, we're very thankful for when others will step in and

help us get to where we need to be. Dr. Crowell, can you tell us about your experiences with arthritis?

 

Dr. Eric Crowell:

I am an ophthalmologist by training, and then after I finished my residency, I did an additional year in fellowship of uveitis and ocular immunology. And that was at Wilmer Eye Institute at Johns Hopkins in Baltimore. That fellowship is really learning how to diagnose uveitis, how to manage it, and a lot of the medication management that goes into that that's very similar to what rheumatologists use.

 

The majority of my patients are actually uveitis or ocular inflammatory disease patients. About 20% of my practice actually consists of kids with uveitis or people who need to be screened, who have JIA (juvenile idiopathic arthritis) but maybe don't have any eye symptoms yet. This is my seventh year in practice, and I see a lot of uveitis every day.

 

Trina Wilcox:

You guys are the experts on this. Honestly, I knew that I was going to the eye doctor to make sure arthritis or medicines weren't getting in the way, but I didn't know really the impact that can happen. So, what types of arthritis can impact the eyes?

 

Claire Eby:

I'll let Dr. Crowell go first on this one. (laughs)

 

Dr. Eric Crowell:

Well, we've mentioned JIA a couple times, which sounds like you both have been diagnosed with. And so that is one of the more common ones. And especially in kids, that is the one that we worry about the most. And that tends to have a lot of uveitis associated with it. A lot of times uveitis can be painful, but a lot of times when kids have uveitis, there's no pain. Kind of like what Claire was describing earlier. You just sort of get this red eye, and you might lose vision, but you don't necessarily realize it. And that's actually the importance of going to the eye doctor as frequently as you did, Trina, to get checked to make sure that we're not missing a smoldering disease that can have really, really bad vision impacts.

 

The other diseases that are very commonly associated with arthritis and an inflammatory disease are psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis and then Sjögren's disease. Those are a lot of the common systemic manifestations of arthritis that also have eye manifestations.

 

Trina Wilcox:

Claire, was that kind of your experience? You didn't really have any pain? You just had this crazy red eye to start out with?

 

Claire Eby:

I think so. It's hard to remember since I was so young.

 

Trina Wilcox:

Sure.

 

Claire Eby:

I remember I had pain later on in life. Just like you have arthritis flare-ups, I would have uveitis flare-ups that happened pretty much seasonally. It often coincided with like allergy season. And so, I would feel the pain then whenever I would have inflammation as I got older. But I don't remember too much when I was younger.

 

Trina Wilcox:

Since we've got this list now of arthritis-related eye conditions, can you kind of break down, Dr. Crowell, what those exactly are and how they impact what's happening?

 

Dr. Eric Crowell:

I will start with juvenile idiopathic arthritis (JIA), which can affect the joints, it can affect the eyes. There are a few tests that we're going to look for to help us diagnose that. Typically, you're going to work in conjunction with a rheumatologist and a uveitis specialist or an eye specialist to make sure that there's not any uveitis in the eye. And it can affect any joint, it can affect one joint, it can affect many joints. There are so many different classifications of juvenile arthritis.

 

For rheumatoid arthritis, it doesn't actually typically cause uveitis or inflammation inside the eye. It actually typically will cause an inflammation of the wall of the eye. And that can be as common as 40% of people with rheumatoid arthritis all the way down to 25%. So, a quarter to almost two-fifths of people that have rheumatoid arthritis can also have an eye-related disorder. That typically will lead to pain, redness; it can lead to vision loss as well.

 

For psoriatic arthritis, thankfully that is actually one of the lower associations. About 7% of people with psoriatic arthritis tend to have uveitis or inflammation inside the eye. And then for ankylosing spondylitis, that can affect any joints. But typically there's kind of two flavors of that. You can have central, where it affects your spine and kind of lower hips. And then you can also have more peripheral where it's, you know, hands and knees and all of those joints. And there's different treatments associated for where that arthritis is. And about one-third of patients who have that can also have uveitis.

 

Trina Wilcox:

How common are these arthritis-related eye conditions overall?

 

Dr. Eric Crowell:

All together, those tend to affect less than 2% of all adults. Very, very low frequency of this actually occurring in the population, but not unsubstantial.

 

Trina Wilcox:

Should anyone that is newly diagnosed, whether they're an adult or a child, should it be on their list to have their eyes checked right away?

 

Dr. Eric Crowell:

I mean, I'm going to say yes. A lot of times for adults, you're going to have something else that's telling you something is wrong. For a kid, they may not tell their parents that there's something wrong with their eyes. And so that's why we do those screening checks in kids versus adults. You know, adults know when something is wrong, so they're more likely to go to the doctor when they need to versus the kid. It may be a little bit later before we actually find some of those manifestations of disease.

 

Trina Wilcox:

And what are some of those key symptoms that we should be watching for?

 

Dr. Eric Crowell:

Redness of the eye, blurring of your vision or just decreased vision. Pain and sensitivity to lights, pain with eye movements as well. Those are the main ones to be looking out for.

 

Trina Wilcox:

Claire, I know it's kind of evolved and changed for you, but what were some of the ones that stood out the most to you?

 

Claire Eby:

I would say vision blurriness. And I'll say, when I was younger, I only had uveitis in my left eye. And then as I got older, I was trying to go off a medication and it like sparked a lot of inflammation in my right eye. So, I ended up getting uveitis in my right eye as well. I've had cataracts in both eyes. I had a lens removal when I was around age 6. And then my parents decided not to replace the lens at that age because my body was still growing and developing. And they were like, "Well, the longer we wait, the better the science will be."

 

I ended up getting a lens replacement in both of my eyes following the cataract surgery in the right eye around age 20, 21. My body had basically fully developed at that point. And I also ended up developing glaucoma around age 12 in the left eye. And then I developed glaucoma in the right eye around age probably 23, 24. And so, yeah, I've just experienced a whole spectrum of issues.

 

Trina Wilcox:

You have.

 

Claire Eby:

But now that I've pretty much grown into the body that I'm going to have most of my life, my eyes have really calmed down with the inflammation. And since moving to a place with a little bit better eye management, I am doing a lot better.

 

Trina Wilcox:

Thank goodness. Dr. Crowell, how common is it that these eye conditions kind of snowball like they did for Claire?

 

Dr. Eric Crowell:

Unfortunately, common. A lot of our treatments start with steroids, topical steroid eyedrops. And a lot of the side effects from both the inflammation and the steroid eyedrops is: It causes cataract formation. It can cause the pressure inside your eye, which can lead to damage of the optic nerve. And that's the glaucoma that Claire was talking about. And so, you know, those are the mainstay and really the beginnings of our treatments that we use to help calm down the inflammation that we see. We also use a lot of other medications that are either an infusion or you can inject them, or they're pills that you take.

 

We don't really know how long they need to take it. The thought is potentially for life, potentially, kind of like what Claire talked about. We took her off of some of these medicines, because it had been a while, to see could she stay off of them, and she couldn't. So, we had to put her back on them, unfortunately.

 

And so, these are chronic diseases that need long-term management. And these other medicines that I was talking about, they really help to reduce the incidence of glaucoma, the incidence of cataracts. We have much better outcomes than we used to have. The problem being, you know, 20 years ago, we didn't have the majority of the medications that we have now to use as treatment, which is just really awesome, because we have so many better treatments now than we used to have.

 

PROMO:

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Trina Wilcox:

What are some of the greatest challenges that patients go through, experience, with these arthritis-related eye conditions? We'll start with Dr. Crowell, and then Claire.

 

Dr. Eric Crowell:

We rely on our vision for so many things in this world. It is probably the strongest of our senses that we use. Everything in our world is really geared towards people being able to see. And so, these diseases can be blinding, permanently blinding. And that can really affect someone's, you know, potential job security, so many different things in life and how you interact with the world. Not to mention the pain and the other things that they're going through, but just those other things, too. I don't personally have uveitis or arthritis. From a patient experience, I want to hear what Claire has to say.

 

Claire Eby:

Vision loss from a young age is very odd because you're just like, "Well, this is kind of how I've always been." But I do know they have occupational therapy for vision loss. So, I would highly encourage people to seek that out. That's not something I've had, but it's something I'm starting to look into. When I was learning how to drive, I was really lucky, and my driving instructor taught me a few tricks because I have much lower peripheral vision. And he was teaching me a few tricks about like, "Hey, when you look in your mirror this way, lean forward a little bit, angle your mirrors this way and you'll get a little bit of a better view." I also have the lane-changing cameras in my car, and that really helps me a lot with my vision.

 

Losing your vision at night, that's kind of tough. So, I have to sometimes take Ubers, rely on other people for rides, things like that. And then there's other silly things that I'm learning as an adult that are not normal. You don't hit the doorway every time you walk through it. (laughs) You do have to learn to adjust your body and adjust how you look at things. I use my phone for a flashlight constantly. Your vision being impacted can impact your life in a lot of different ways that you might not even think about. But that shouldn't stop you from doing the things you love and still trying to do what you love.

 

I went to art school, and one of my cataracts developed around that time. And my professor did not understand that I could not see well for our drawing class. And so, he was like, "You just follow the shadows." And I'm like, "I can't see the shadows." I ended up becoming a designer and a video editor. And I'm still doing a lot of the things I love today. My text is much bigger on my screen than a lot of people’s screens, but I am just able to make those adjustments. And I am learning ways and hacks on how to better see things.

 

Trina Wilcox:

What about things like, you know, a lot of people, the first thing when they discover they have to wear glasses, at least for me, I was like, "No, I want contacts. I don't like having anything on my face." But sometimes contacts are not necessarily an option. What was it for you, Claire?

 

Claire Eby:

When I was younger, I had a combination of contacts and glasses because I hadn't had that lens replacement yet. And so, I needed to use the contacts as a lens. And so the glasses were always necessary for me. Finding a pair that's really cute is really important.

 

There are so many types of glasses now, too. Like, finding the nose pieces that work for you. Finding a very wide set of glasses like I have, so you can see more. I turned my glasses into a fashion statement. I've turned like… I think they're part of my identity now. I'm a designer, so my logo is my initials that look like glasses. I just think it's your attitude towards it. Yeah, having things on your face is annoying. Not being able to see is even more annoying. (laughs)

 

Trina Wilcox:

Excellent point. (laughs)

 

Claire Eby:

Yeah. It just depends on your situation.

 

Trina Wilcox:

Dr. Crowell, have you seen a lot of patients with these arthritis-related conditions have success with contacts or even like, you know… I know LASIK is popular for nearsightedness, but things like that?

 

Dr. Eric Crowell:

Yeah, I'm kind of in the same camp as Claire. I always encourage my patients to find a pair of glasses that fits their identity. And I think glasses used to be like so uncool or whatever; now they really are that fashion statement.

 

Claire Eby:

Yeah.

 

Dr. Eric Crowell:

And people will wear glasses without any lenses in them anyway, just as a fashion statement. So, I think that has actually really helped with some of that stigma that has existed. For folks who are using drops and those steroid drops that we talked about earlier, I try to steer them out of contacts just because, with contact lens use and those drops, you can increase your risk of infections in the eye.

 

If you're less than two drops a day on those medications, then a lot of times you can wear contacts. You just have to do timing around when you're putting those in and taking them out. It really depends which disease we're talking about as to which thing might work. Cataracts form quite quickly. So, a lot of people are like, “Oh, I just want a new pair of glasses.” Like, well actually it’s maybe time for surgery now to fix that, to fix that vision more permanently, which can help get you out of glasses sometimes as well.

 

If you have a history of these conditions affecting your eyes,

most refractive surgery is not going to be for you. LASIK, PRK, some of the SMILE procedures, some of these other procedures that are coming out, they're typically not recommended in patients with uveitis or ocular inflammatory diseases. Mostly because the goal of those procedures is really good vision afterwards. But when you have these inflammatory diseases, the surgery itself can actually set off the inflammation, which then can give you a very unpredictable outcome, or even cause your eyeball to melt. And that's really not good. So, in general, we don't recommend that you undergo those types of refractive procedures.

 

PROMO:

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Trina Wilcox:

You mentioned drops. I know that a lot of people will rely on some of the drops for dry eye. Can you talk about some of the treatments that patients can expect they might be using to treat these conditions?

 

Dr. Eric Crowell:

Sure. For uveitis, a lot of it is going to be drops, steroid drops. Our mainstay for years and years and years had been prednisolone. We have some stronger ones called difluprednate. And then we also have oral steroids, like prednisone, that you'll take, too. And then after our steroids, that's when we really move on to other immunomodulatory therapies: methotrexate, mycophenolate, you can move on to adalimumab; you can use infliximab, rituximab. There's lots of different medications that you get to use. And some of those are pills; some of those injections; some of those are infusions where you would go to an infusion center.

 

And so, the good news is a lot of those medications that treat the eyes, also treat the arthritis that patients have, too. We get a kind of… do a two-for-one in treatment for a lot of those things, which is really, really nice. Often when you have the eye part of the disease, the eyes sometimes end up being a lot harder to treat. So, we sometimes need higher doses of those medications. And a lot of times I'm partnering with a rheumatologist who's also seeing the patient to make sure that we're all on the same page of, "Hey, the eyes look good, the joints look good, we don't need to do anything." Or "Hey, the eyes are still a little inflamed, we need to bump this medicine up a little bit."

 

Trina Wilcox:

Perfect.

 

Dr. Eric Crowell:

One of the things we haven't talked much about is actually Sjögren's. The main manifestation of Sjögren's in the eyes is just really, really dry eyes. And that can actually have a lot of the same symptoms of uveitis, that sensitivity to light, the pain, the redness. A lot of people sometimes have dryness and the uveitis, and it's really hard to tell, "OK, which is actually causing them the most problem right now?"

 

The mainstay of our treatment for dry eyes is artificial teardrops that you can get over the counter. But there's also a lot of medications that we can use, too. Cyclosporine has been around for a very, very long time, and there's lots of different variations of that now, and there's a lot more new dry-eye drops that have come out in just the past couple of years. So, we've got a lot more options for patients, whereas we really only used to have kind of one or two.

 

Trina Wilcox:

We've talked a little bit about the treatments. Is there one that's really the most common that everyone can expect, or is that just very individualized?

 

Dr. Eric Crowell:

I think it's really individualized. I think that most everyone will start with anti-metabolites, which are like methotrexate, mycophenolate, azathioprine. Those are kind of our mainstay of our first-line medications that we'll almost always start with. Methotrexate has been around forever it seems like. We have such good data on it, on its safety in kids, its safety in adults. So, that's often our first line for a lot of things.

 

Practice patterns have really changed as we have more of these other medications available to us. Whereas we used to kind of combine some of those first-lines, much of the time now we'll start with methotrexate, and then we'll add something like adalimumab or infliximab or something like that. The availability of new medications has really changed how we practice as well.

 

Trina Wilcox:

So, when we are taking all of these medications, are there certain ones that can actually have an adverse effect on our eyes?

 

Dr. Eric Crowell:

There are a couple medications that we use commonly to treat arthritis. The first one that comes to mind, and this doesn't necessarily cause bad side effects to the eyes, but it's etanercept, or the brand name is Enbrel. It works great for arthritis, but if you actually have an eye problem, it doesn't work at all for the eye problem. That's when I have to work with my rheumatologist, like, “Oh, we’ve got to switch this medication to something that will cover both.” And then another medication that's very commonly used is hydroxychloroquine, or Plaquenil is the brand name for that one. And that can actually cause problems to the back of the eye with long-term use. It kind of can build up in some of the cells in the back of the eye, and we do a couple tests annually to monitor for any changes of that buildup that might start affecting vision.

 

Those tests are a visual field test where we'll flash some lights in your peripheral vision, and you'll click a button every time you see the light. And the other one is a picture of your retina and all of the different layers of the retina. And we're looking for very subtle changes on there to indicate the beginnings of possible toxicity from that medication. The toxicity is very, very rare.

 

In your first 10 years of that, you have a less than 1% chance, in your next few years you have a less than 2% chance. But after 20 years of use of that medication, which, you know, sounds like a really, really long time, you actually have a 4% chance of converting every year. And so that's why it's really, really important to get that screening, so we can catch it early. Because if we don't catch it early, the changes that happen can be permanent. But if we catch it early, we can catch it before it's really causing any problems and work with your rheumatologist to change treatments.

 

Trina Wilcox:

Claire, have you ever had any medications that worked for one and not the other and you had to adjust?

 

Claire Eby:

Not necessarily. I did have an arthritis flare-up where I just was experiencing more pain when I was in college. And so, they added me on Humira, and that helped for the arthritis. But I don't know if it had necessarily any effect on the uveitis. It might have, but that was not an issue I was dealing with at the time. It was solely the arthritis pain. You might be on methotrexate, and then they'll add another medication for the arthritis pain, but you don't notice any changes necessarily with the uveitis.

 

And we talked about this earlier: We discussed how adding a steroid can help the uveitis inflammation, but it can cause cataracts. You’ve just kind of got to try stuff, unfortunately.

 

Trina Wilcox:

Yeah, a lot of trial and error for sure. We know that the medication is going to be something that most likely happens for patients. But with everything, lifestyle is impacted, and you can usually do a lot from that aspect, too. Claire, what are some ways that you've managed, aside of your medicine, your eye condition and your joints and all the whole ball of wax?

 

Claire Eby:

Well, I think honestly the medication does most of the work, thankfully. Doing regular stretching and exercises. I do have pretty bad dry eye right now, so I have been doing some like an eye ointment at night, and that's been helping a lot. I was talking about the occupational therapy for managing vision loss. It's nice to be in a community with other people with vision loss so that you can get tips and tricks. And it's very helpful just to be able to talk to somebody else. So, that's something I think I would do.

 

One thing that I started doing because I have seasonal inflammation in my eyes — less so now as an adult — but one thing: I'm starting on allergy shots in January to see if that might help reduce the amount of inflammation that I get seasonally. And also because I'm tired of having allergies. (laughs)

 

Trina Wilcox:

Very good. Dr. Crowell, do you have anything to contribute on that aspect?

 

Dr. Eric Crowell:

I echo really everything that Claire mentioned.

 

PROMO:

The Arthritis Foundation is always looking for new ways to inform you about the things you want to know more about. Check out our webinars — in real time or on demand. Visit arthritis.org/webinars to learn more.

 

Trina Wilcox:

Before each episode we post a question on social media, and this episode we ask: Has arthritis affected your eyes? And how do you stay on top of your eye health? We got several responses, a few we'll talk about.

 

Bike-with-RA said, “Wicked dry eye, worsening eyesight. When my RA wakes me up in the middle of the night, it feels like I'm ripping my eye open when I blink. I keep eyedrops everywhere and literally cannot go more than a few hours without using them. When my RA is flaring, my eyelids swell.” That sounds miserable. Claire, have you ever woken up in the middle of the night with your eyes like burning?

 

Claire Eby:

No, I can't say that I've experienced that necessarily, at least not outside of post-surgery. For that I think, you know, keeping eye drops around the house, maybe consulting your doctor, seeing if there's a longer-term option available. Dr. Crowell, what do you think?

 

Eric Crowell:

I agree. It really sounds like the dryness of the eyes is not as well controlled as it needs to be. There's lots of different options and possibilities. Having those eyedrops everywhere sounds like they're probably artificial tears and maybe they need to escalate to a stronger therapy.

 

Trina Wilcox:

I hope you get some relief, Bike-with-RA. Kay Schneider said, “My uveitis is getting so severe I wouldn't be able to see anything for months. Thankfully, it was usually one eye at a time, but it was so painful and hard to manage, especially pre-diagnosis.” Urgent care, ER, would just say they had pink eye. “So, being on Humira has helped so much. I have frequent visits to the eye doctor to make sure my eyes remain in good health and recently started the dry-eye drops. I still have pretty bad light sensitivity and a really hard time seeing at night and already have pretty bad vision, which doesn't help. But overall Humira has been a lifesaver to my overall health.”

 

I feel so frustrated on her behalf because I know, even when I wore contacts, you get something in your eye and how distracting that is. But to have something 24/7 is just... Amlot228 said, "Uveitis and scleritis is rough. Too many steroids cause glaucoma, too. It's important to be seen immediately with eye pain. It's a top leading cause of blindness if it's not treated." Do you agree with that Dr. Crowell?

 

Dr. Eric Crowell:

Yes. Yeah. Amlot also talked about, you know, too many steroids can lead to that glaucoma, can also lead to cataracts like we hit on earlier.

 

Claire Eby:

It can snowball. But I think at the end of the snowball, there is hope I'd like to think. I'm hoping I'm at the end of my snowball, where I've reached the height of the most issues I'm going to have with my eyes. And I know what triggers inflammation now. I know what medications work well and what doesn't. Unfortunately, the more experience you have with it, the more you learn. So, hopefully they'll be able to get some steady, long-term help.

 

Trina Wilcox:

Yeah, that is encouraging.

 

Dr. Eric Crowell:

It's a journey. It can be a frustrating journey, especially as we're trying to figure out which medicines are the right combination of medicines for you because we don't have a test that just tells us, "Ah, this is the magic bullet for you." And so, unfortunately, it's still somewhat trial and error for patients to figure out what is going to control that inflammation for them. And then they mentioned Humira, which is that adalimumab that I mentioned earlier. That's just one of the brand names for it.

 

There is hope, there should be hope. It can be a  journey; it can take a little bit of time for us to get the right combination with you, and that's just working and trusting your physician that you're seeing.

 

Trina Wilcox:

Well said. Thank you so much. When we close each episode, we like to take away a few things from what we've talked about. So, Claire, I'll put you on the spot first. What are your three takeaways?

 

Claire Eby:

My main takeaway is always going to be: Get a yearly eye exam minimum, maybe every six months if you can. If you have eye insurance, that'll be able to cover at least the one-year eye exam. Learn how to balance your eye inflammation and your arthritis pain. It’s going to be trial and error to see what combination of medication helps with both or either. And unfortunately, it does just kind of take a while. But there is going to be hope at the end. And my third takeaway, I would say, is maybe look into occupational therapy for vision loss if that's something you experience.

 

Trina Wilcox:

Very good. Dr. Crowell?

 

Dr. Eric Crowell:

I'm going to echo that last point that Claire mentioned: occupational therapy. And then I'm going to actually expand that to more: just low-vision services in general I think are underutilized by a lot of our patients. Anyone who has any sort of decrease in their vision from normal can access low-vision services, and that can really be life-changing, to help them navigate their environment, do better at work. There's lots of different things that a low-vision specialist, and in conjunction with an occupational therapist, can really do to help patients go about their life better. So, I think that's really important, Claire, that you made that point. And I want to echo that because it's really important.

 

It's a journey. This takes time. The sooner we find out about these diseases that you have, and the sooner we start treating them, the better the outcomes are going to be. But that being said, it is still a journey. It is not a one-size-fits-all treatment, and that's what can be both frustrating for patients and take a little bit of time until we find that. And then the other thing is just: There is hope. We can treat these diseases. We have really great medications that are available to us now to really have great outcomes for people with these diseases.

 

Trina Wilcox:

Thank you both so much. I would say: Stay proactive with your visits, have a good relationship with your doctor and always go in with a list of questions every time. Don't be afraid to ask anything that can get you educated better about your health.

 

Thank you both very much. I appreciate the contribution to the conversation. If you are listening, please continue to connect with other resources at arthritis.org. You can also learn more about our podcast at arthritis.org/podcast. Thanks.

 

PODCAST CLOSING:

The Live Yes! With Arthritis podcast is independently produced by the Arthritis Foundation. Gifts from people like you make our podcast and other life-changing resources possible. You can donate at arthritis.org/donate. This podcast aims to help people living with arthritis and chronic pain live their best life. For a transcript and show notes, go to arthritis.org/podcast. Subscribe, rate and review us wherever you get your podcasts. If you subscribe through Spotify, leave a comment on their platform, letting us know what you think about this episode. And stay in touch