Approaching Rheumatoid Arthritis With a Positive Mindset

The New York Times and USA Today bestselling author Diane Chamberlain talks about pursuing her writing passion while living with rheumatoid arthritis, a chronic inflammatory condition. Joining her is Ara Dikranian, MD, Rheumatologist at the Cabrillo Center for Rheumatic Disease in San Diego, CA.

Rheumatoid Arthritis is an autoimmune chronic inflammatory arthritis that causes swelling in the joints which could lead to pain and stiffness that could lead to loss of mobility. The most commonly involved joints are the hands, wrists, feet and the knees. There are about 1.6 million adults in the US living with rheumatoid arthritis and diagnosed between the ages of 40 and 70.

Diane Chamberlain is The New York Times and USA Today best-selling author of 25 novels. Diane was diagnosed with rheumatoid arthritis more than two decades ago. She wrote two novels using voice recognition software before finding a medication to control her RA symptoms and being able to get back to typing. She feels fortunate is be able to enjoy everyday activities as well as keep up with a busy travel schedule as she managed her RA.

Dr. Ara Dikranian recently joined the Cabrillo Center for Rheumatic Disease. Prior, he worked as a Senior Rheumatologist at the San Diego Arthritis Medical Clinic (SDAMC) in 2004.


Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, glad that you could join us today. Today we have New York Times and USA Today best-selling author Diane Chamberlain, she’s joining us today to talk about pursuing her writing passion while living with a chronic inflammatory condition. She’s joined today by Dr. Ara Dikranian, a Rheumatologist at the Cabrillo Center for Rheumatic Disease. Welcome to Health Professional Radio Diane and Dr. Dikranian. How are you?

Diane Chamberlain: Good, thank you for having me.

Dr. Ara Dikranian: Pleasure to be here, thank you.
N: Glad that you could both take the time with us today. Dr. Dikranian, give us just a little bit of background about yourself and talk about the Cabrillo Center for Rheumatic Disease.

A: Certainly. So I’m a Rheumatologist and the Cabrillo Center for Rheumatic Disease is a private practice in San Diego, California where we see patients on a clinical basis as well as do clinical trials for new therapies dealing with a variety of rheumatic conditions.

N: What is rheumatoid arthritis and how does it differ from other forms?

A: It’s a good question. There’s a lot of confusion about rheumatoid arthritis and arthritis in general. So it’s important for people to recognize there’s about a hundred different types of arthritis and the most common of those is “osteoarthritis” which is a degenerative process. And as contrasted with that, rheumatoid arthritis is an autoimmune chronic inflammatory arthritis that causes swelling in the joints and that swelling can lead to pain, and stiffness, and difficulty with mobility. Usually the most commonly involved joints are the hands, the wrists, the feet and the knees and we estimate that there’s about 1.6 million adults in the U.S. living with rheumatoid arthritis, most being diagnosed between the ages of 40 and 70.

N: Some of these joints are affected are the joints that we use the most. What are some of the symptoms that we should be on the look out for?

A: Absolutely. So unfortunately, we all have to use our hands, we all have to stand and walk and that becomes very problematic when those particular joints are affected. And so besides the symptoms that it causes, there’s obviously ramifications on the function of those joints such that simple tasks like writing, holding objects, opening jars and cans and opening drawers, driving, walking, these can all become problematic. And I think it’s important to keep in mind that these aren’t just sort of normal signs of aging, or stress or being overworked – these can be a part of a serious medical condition like rheumatoid arthritis and therefore should not be ignored.

N: Now Diane, you’re a best-selling author so you’re using your hands quite a bit. How has RA affected your life and how have you been able to write so well and for so long with this chronic inflammatory condition?

D: Oh it affected it very dramatically in the beginning. When I was in my mid-40s, I began having trouble walking with my left foot being swollen and in extreme pain. And it was very difficult to make a diagnosis. My lab work and everything was completely normal so doctors weren’t sure what was going on. And then my hands became affected and the picture grew clearer. But with my hands affected, I couldn’t type. It was extremely painful to type and so I had to write two of my novels back then using voice recognition software which I’m very grateful for and then new medication came along and I was better able to type and to do other things except that I still have trouble walking with that left foot. I wear a brace on my foot and ankle and that helps a great deal and I’m able to do pretty much anything else that I want to do at this point.

N: Doctor, is that normal as far as all of our tests coming back negative for RA or is it hard to diagnose with so many people being affected?

A: Yes. So the diagnosis is still a clinical one which means we put together information on the basis of history, physical exam, as well as imaging modalities and lab results. But a lot of times, the results may be normal especially in the early stages. So that makes it problematic for people that have early disease in terms of diagnosing it early on and certainly managing it.

N: How difficult is it to manage this disease once you’re properly diagnosed?

A: So to an experienced rheumatologist, it may not be necessarily very difficult. But certainly there is no pattern that that patience early on may necessarily fall into especially in the Diane’s case, if there’s one area involved and it’s not symmetrical or there’s not a lot of joints involved, it certainly may be problematic and in which case we have to consider other diagnostic possibilities too.

N: Diane, you said that there was a medication that helped. Is medication always used in conjunction I guess with exercise or diet or are those things factors that help you to manage?

D: Well I think Dr. Dikranian could address that little better than I could. I know for me there were things that would work other than medication. I tried many things in the beginning because I was a bit in denial as many people are when they get a serious diagnosis and unfortunately I wasted time by doing that and I think that I have more damage than I would have had otherwise but maybe Dr. Dikranian could address that question.

A: Yes, certainly. So Diane is absolutely right in that medications are one part of the therapeutic regimen and they’re very important parts because we’ve seen in the last 20 years that advances in terms of understanding rheumatoid arthritis and targeting therapies against it specifically have made a big difference in terms of minimizing the impact that rheumatoid arthritis could have physically as well as psychologically as well in terms of preventing the disease from getting worse. But medications are just one part of it and equally important is taking care of the person as a whole in terms of psychological and emotional well-being to employ a team that it would include exercise, good nutrition, physical therapy and then adapting and coping strategies such that limitations that we have, how do we work around them as Diane mentioned.

N: So when we’re talking about work arounds Diane, you mentioned that voice recognition software, brace on your left foot, things of that nature. I’m sure you know others who are dealing with RA and trying to manage least as well as you have. What type of information or tips can you give us when we are suffering with RA but want to continue to pursue our passions such as writing or maybe even exercise?

D: I think the thing that has been most helpful to me is a mindfulness practice and I don’t necessarily mean meditation but I mean stopping what we’re doing several times a day and focusing on what’s really important – the people around us that we care about, I like to walk outside and look at nature and it just sort of brings everything into perspective for me. And I’ve recently partnered with Pfizer to contribute my story to and I think in that article, there’s really a lot of tips that will be helpful to people and hopefully, inspire people who are coming to grips with living with this disease.

N: Dr. Dikranian, are you familiar with and if so, how are you contributing as well?

A: Yes. So I’ve been on the editorial board of and have really recognized that it’s an important website not just for information on the disease itself but also empowerment strategies, management strategies not just from a physical standpoint but from a spiritual-emotional standpoint and really helps people talk about and understand aspects of the disease that either we don’t have time to discuss during a regular office visit or we just don’t have the capabilities of discussing things like intimacy issues and such that really go unanswered for unfortunately to many people.

N: Well I appreciate both of you all coming in and speaking with us today about rheumatoid arthritis and how to manage your life and continue pursuing your passions while dealing with it. Thank you both Diane Chamberlain and Dr. Ara Dikranian.

A: Thank you for having us.

D: Thank you for having us.

N: You’ve been listening to Health Professional Radio. I’m your host Neal Howard. Transcripts and audio of this program are available at and also at You can subscribe to this podcast on iTunes, listen in and download at SoundCloud and be sure and visit our Affiliate Page at

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