Evidence Based Tips to Reduce Inflammation in Rheumatoid Arthritis

In this episode, Melissa Schenkman, MPH, MSJ, Founder of YMyHealth,  and Dr. Diana Girnita  discuss a real-life roadmap for people with chronic illnesses like Rheumatoid arthritis (RA). They are also discussing Dr. Girnita's new book “Thriving with Rheumatoid Arthritis” and the science behind lifestyle medicine: how the gut microbiome communicates with your immune system, why fiber and short-chain fatty acids matter, and how sugar, salt, and even certain vegetables can influence inflammation in sensitive people. We also cover conditions that can mimic Rheumatoid arthritis (RA), like celiac disease, and why “Dr. Google” can increase fear instead of clarity.

If you want practical, evidence-based steps—without the overwhelm—this conversation will leave you feeling informed, empowered, and hopeful.

Key points discussed in the episode

• Why Dr. Girnita wrote “Thriving with Rheumatoid Arthritis” after ~20 years in practice: moving from purely textbook science to patient-centered insights, patterns, and real-world outcomes
• The core message: thriving vs. surviving: RA is a chronic condition, but it doesn’t have to define your life or identity
• Patients are different: response to treatment and lifestyle changes varies widely—personalization matters
• Gut microbiome + immune system connection: the gut contains trillions of bacteria; a large portion of the immune system sits near the gut lining, so gut signals can drive systemic inflammation
• Fiber as an anti-inflammatory tool: fiber supports beneficial gut bacteria and leads to the production of short-chain fatty acids (SCFAs) that help “calm” immune overreactivity
• What SCFAs do (in plain language): they act like immune messengers that reduce overactivation and may lower systemic inflammation
• Sugar and inflammation: excess added sugar can increase pro-inflammatory pathways and may shift gut bacteria toward patterns associated with more inflammation
• Salt and immune activation: high salt intake may push immune cells toward a more pro-inflammatory state; practical advice includes removing the salt shaker and using spices (garlic, turmeric, rosemary, thyme) instead
• Nightshade vegetables: in some people (not everyone), foods like tomatoes/eggplant/peppers may worsen symptoms
• Celiac disease can mimic RA: joint pain and small-joint symptoms can resemble RA
• Viruses as potential triggers: EBV (mono) and COVID were discussed as possible immune triggers in genetically predisposed people 
• The “Dr. Google” warning: online information can mislead, catastrophize, and amplify fear—use curated, reputable medical sources and avoid absorbing others’ worst-case experiences as your future.
• Bigger takeaway: genetics load the gun, but lifestyle pulls (or doesn’

Transcript

Diana Girnita (00:00)
Well, one of the things I know is really important to our YMAA health community and to millennials across the board is looking at ways to use, whether it's diet or exercise or sleep, different avenues to take and improve their health. And for so many chronic health conditions, there's no roadmap. And we're all looking for that roadmap on how to live our healthiest life. so

For today's episode, we're going to really be focusing on that in such a unique way. We have with us Dr. Granita, who's here from rheumatologist on call. And she has written this incredible book. I'm going hold up here. Thriving with Rheumatoid Arthritis that I highly recommend. And we're going to put in the show notes ⁓ to get, but it's just a phenomenal book. And we're going to talk about that today. So welcome to the podcast.

Thank you so much for having me. It's an honor and a pleasure to be here. Well, thank you. Thank you so much. It's an honor to have you and so thrilled about this book, given your many, many years of experience in rheumatology and immunology. think for me, I just, as we get started, I just found the style of writing.

A couple of things that really stood out, the style writing, so conversational, so relatable and easy to understand. ⁓ So many actionable pieces. I know so many people in our community are always looking for like, what steps can I take? Now I have this knowledge, but how can I put it in my daily life? And you provide so much of that. And also just this incredible view behind the science, which is always for me personally, a thrill. I think for so many other people where you're kind of connecting the dots between things. think a lot of us,

maybe would not know about in relation to RA, but also just in general because it goes even beyond that. And for those who are going to be listening who have relatives, I do, with RA, friends with RA, this is going to be so, so helpful and definitely want you to share this with them and we'll have lots of information on all this in the show notes and obviously on our social media. But I'm really curious. This is such a thoughtful book.

after two decades, I think I'm ballparking this right, two decades of practicing medicine, what made you decide to, now is the time to kind of put pen to paper on so many of the incredible things you've learned. You made me feel old. I'm sorry. So many of us millennials as we get up.

we're getting up there in the early 40s, we're feeling that way, we're looking back. But really, many of us have had a lot of experience and you've had a lot of experience with patients, with research, and to be able to pour that value into something like this is really amazing, but also time consuming. So just curious, why now? I think you need time in life to realize that it is the moment.

to connect the dots. ⁓ When we grow up, we learn, not only that we learn, but we don't know, even if we know certain things, we don't know how to share them. And then along the way of practicing medicine, not only being in research, but also working with patients, you learn so much from your patients. The value of that knowledge, I think we...

most of the time we underestimate until we get later in life and we understand why certain patients said certain things and why certain patients did better than others. Because when we begin our medical career, it's all about science. It's all about what you learn from the books. But, and we are eager to apply what we learn in the books to our patients. And not all the time what we learn

in terms of diagnosing a person and treating a person, because I talk and I underline that person, not patient, will apply to them. ⁓ later on in life, in the life of a clinician, I would say, we learned that patients are so different, their experiences are so different, and the way that they respond to treatments are different. So that's why it took me

almost 20 years to publish the book. That makes a lot of sense. And that's true. that also everybody presents so differently is what I always hear to see your point in terms of responding to treatments differently. And it takes seeing, I'm certain, so many people, especially in a complex condition like RA and there are other complex conditions as well out there that takes that time. And we're so fortunate that you took the time.

to put pen to paper for this. And I was really curious, I always love the titles of different books and certain titles, sometimes you look and you say, oh, it's okay, or they did an okay job, it gets to the point, but your title really stands out as like, wow, you stop and think and it's sending a message within this title for sure, which is, again, thriving with rheumatoid arthritis. Why?

that title and kind of what was the message you were trying to put out there? It's hard to select a title, especially when you talk about an autoimmune disease like rheumatoid arthritis. You want to send a message to patients and my message was, know, initial title was thriving, not surviving. ⁓ okay. I like that one too. Yes. But ⁓ then I said,

to myself that might be a contradiction between those two terms. Let's send a message of hope and let's make patients believe that by doing certain things in their life, we'll get there and they don't only have to survive, they will be able to thrive with rheumatoid arthritis. It is so hard for patients to see that coming, especially when they get diagnosed.

because when you are in pain, of course you're going to be upset and depressed and you don't see the light at the end of the tunnel. And then when you deal with an autoimmune disease like rheumatoid arthritis, it's a lot of unknown, okay? You have to learn a lot of things. And of course you're going to encounter a lot of anxiety along the way. And I had many patients that they tried to research information about rheumatoid arthritis.

and they don't always find the right information. And if we rely just on Dr. Google, you might be surprised to see that you're gonna get even more depressed. So I want to send that message that yes, it is possible that one day you will be able to thrive with rheumatoid arthritis. I love that.

I really, really love that. it did throughout the book. I have to say the title, the message of the title is carried throughout the book. There's so much hope you walk away from chapter to chapter feeling like, yes. Especially like I was trying to put myself in the shoes of my relatives who have been living one of them for almost three decades now, or a little, I think about three decades with R.A. like if I

had been at that point or even if I was a year in, how would this resonate with me? And as I was going chapter by chapter, there was so much hope there of like, okay, yes, I have this. Yes, let's acknowledge that there are certain challenges that are part of this, but here are lots of different ways you can overcome those challenges. And that was definitely, I could feel that throughout the book.

⁓ And I also loved reading the Ford, the author note was a real, I feel like such a bonus and such a surprise because so many times people put just a tiny bit of themselves in or really very little of themselves in there, but you know, other than obviously their experience and expertise, but not that personal aspect. And so I was just really curious kind of like what made you decide to share those details and make that, you know.

kind of a part of the book and set that tone. I felt like it almost set a tone of personalization in the book. I wanted to keep that part short, the author known, and I wanted to give more to the patients than what I share about me. In that process, I realized that I am as vulnerable as they are. And I wanted my patients and the people who read the book to understand that I was vulnerable one day.

And one time and I went through what they went through and to share my experience with them. And then we all know about what's going on in the medical system today. We know about the frustrations of our patients. We know the frustration that we encounter when we deal. Finally, we deal with the medical system. Because when you are young and when you are healthy, you don't know

⁓ how that interaction will look like. But when you need the most of the healthcare system, then you're going to encounter the barriers. So I wanted people to understand that I recognize those barriers. And not only that, but there are people like me that can change that and offer a different kind of service and a different kind of interaction with patients. And although I don't want everybody to come to me.

But they will find people like me, doctors like me that will be willing to give more, spend more time and recognize that there is a problem with the medical system. And here we are trying to change that. that's absolutely beautiful. And it definitely came across that way. when everyone, when you get the book, you'll see definitely go straight to the author note ⁓ because it really, think sometimes to your point,

people think that ⁓ your healthcare providers are on one side and the patients on the other side. And that's not the truth because ultimately at the end of the day, we're all patients. that was just so beautifully put in such a great way to set the tone for the book. The other thing that I have to highlight for everyone is a very famous person in the area of science that you met that anyone, whether or not you are in the healthcare industry professionally or not.

will remember from biology and high school, maybe even middle school. ⁓ But if you all remember from learning about, when you first learned about DNA and the double helix, you actually met, was Dr. Watson of V. Watson and Crick. Incredible. Incredible. I was going to have you tell us just a brief note about that because you just don't hear that every day. Absolutely. So I feel that I was really fortunate in my life.

I come from a small country from Romania and I came in the United States with a postdoctoral fellowship at Harvard. And that was something unthinkable about when I was in Romania to get there. And while I was there doing this postdoctoral fellowship, I was fortunate to attend these lectures, which big names in medicine came to give to us. And one of the lecture was Dr. Watson. And I couldn't believe that I was standing there, you know, with

thousands of people to listen to this legend of medicine. And it's impressive because we read about these people in the book, but we don't put them in the context of a real person. So I remember his appearance on the stage there. And I remember how everyone was so excited to see him, know, led aside to ask him a question. That was

you know, unthinkable. But it is important to understand that those people, do contribute to, you know, for generations to our knowledge. And it's good to have such an experience to remind yourself that, you know, you are in the same room with them. 100 % well, and also, I think it really goes to show the value of even though you didn't necessarily work with them, but the value of mentorship, how much what we do ⁓

Especially I think in such a ⁓ complex and challenging profession in healthcare and in public health, when you take the time to speak, like all of us are really listening. People are really listening and it propels them for it to want to help other people. And so I think that is really exciting that you got to do that. Definitely a lifetime highlight. I stopped as I was reading that page and I was like, wait a second.

She actually saved Dr. Watson, it was absolutely, absolutely amazing. Well, the book itself, I say, is really the ultimate guide to thriving with RA. I think for people of all stages, know, in all stages of their journey, ⁓ for their friends and their family to have insight, it's very hard unless you're the person who's specifically living with something to have that level of insight. And so this book is really helpful in that way. ⁓

but also just a general better understanding of the impact of inflammation, which is something I think a lot of us are trying to understand because there's so much talk about the play of inflammation in different ⁓ conditions. And so I think it really, if people who are listening are interested in that, and I know a lot are, of how to reduce inflammation, this also really gives you a much better understanding of that. And one of the things I noticed

that I think people will find interesting is you highlighted a lot of patient stories in addition to providing research and a lot of those patient stories were people who are in the millennial age group at the time. And so that really stood out to me because this is something as we've talked about before, is something that starts a lot of times in the ages that millennials are now. ⁓ And so I wanted to kind of talk about

a couple of the different areas that you highlighted that I think ⁓ we often kind of, some we hear about but don't really, I can even say on my end with all that I read in public health, don't fully understand the connection and how you're able to connect those dots. The first thing, the microbiome. We hear a lot these days about the microbiome. I don't think a lot of people really know fully what that means. ⁓ And so,

I was going to have you kind of tell us a little bit about that connection between how the microbiome works with what we eat and then inflammatory processes because that was just fascinating. Thank you so much for bringing this in front of people. the book is, ⁓ I mean, the way that I designed the book was for people at all stages in their life, especially for people that got the diagnosis and they don't know where to go.

But even for those people that they had it for many years will be useful because they will understand what are the things that they are doing right or wrong in their lifestyle. Why do I bring lifestyle in the discussion? Because our lifestyle will influence our gut, our gut microbiome, and from there will influence the chances for you to develop inflammation. For people that do not know, our gut is filled with

trillions of bacteria and we ignore that in medicine for the longest time ever. We knew about the gut microbiome, but we didn't know the connection between that and our immune system. And just for people that do not know, in our gut, there is a layer with all these bacteria. There is a mucosa, like the barrier between our gut.

and the interior of our body. And right beneath that mucosa, we have 70 % of our immune system. So everything that the gut bacteria will interact with, they will send a message to our immune system. And if that message is the wrong message, the immune system will get activated and that will induce systemic inflammation. And what systemic means, means that

know, inflammation will not be only at the gut level, but will be sent out to your whole body. And in our understanding related to autoimmune diseases, about 10, 15 years ago, we started to think about maybe there is a connection, but just now we started to scratch the surface and understand that certain people

with certain bad bacteria as they will develop diseases, autoimmune diseases, or they will have worse disease or a more severe disease than other people that do not have that. So the idea is to change our lifestyle. And we can talk about multiple levels of changing lifestyle to influence this gut, make the gut bacteria happy and.

send that poor messages to our immune system. There is a famous author that talks about fiber and the role of fiber and how fiber will actually influence our bacteria to produce certain substances that we called short chain fatty acids. These are some molecules that will actually influence our immune system not to be

so reactive. And in this way, to decrease the amount of inflammation in our body. The short-chain fatty acids, they do so much more. They will control your hunger and they will control many other processes in the body, but I'm going to stick with the inflammation. So that's why by eating certain things like veggies and raw veggies or fruits and incorporating more legumes in our body,

will make our bacteria happy and in this way we'll have more short-chain fatty acids and that will decrease the amount of inflammation. That is absolutely fascinating. think, I know, speak for a lot of people who will be listening that it gives you a whole new view of why what you eat matters and how we often hear about ⁓ this microbiome.

and it being important but don't really understand how. What is the how because we don't see it? So that's extremely fascinating and I was going to touch on, yeah, the other I think thing that should be a buzzword out there as much as microbiome is short chain fatty acids that I was not familiar with either and I'm so excited to have learned about. In the book, you we often hear about monounsaturated fats and polyunsaturated fats, right? A lot of us are familiar, you know, got to get that salmon.

and Omega-3s. But short-chain fatty acids, think, is probably something more, right now, more popular still in the research community and the medical community. after reading the book, I feel like that's going to be the next ump and humming piece to all of this. I really do. So you were talking a little bit, Faris Fiber, again, kind of what...

what that connection between the short-chain fatty acids are, which sounds like it's kind of the missing link in this process, and amfiber, which is something we talk about and you were talking about with our A, we talk about as as colorectal cancer prevention, which is big top in our community. So yeah, if you can – so was going to have you so starting to do that, connect the short-chain fatty acids and the fiber for me and for all of us.

adding more fiber to your diet will be the link between your diet and less inflammation. Because by eating more fibers, you keep these bacteria happy, the certain bacteria that we have in the gut. And they are the ones who will produce these short chain fatty acids as a thank you note to our gut or to what they got. I like that. And because of those,

these substances will modulate our immune system. They have the power to tell our immune system, you shouldn't react to this or you shouldn't react to that. So they are like some messengers for our immune system not to be super active or go against us because inflammation at the end of the day, it's a normal response to something foreign or something.

that you want to destroy. Inflammation or inflammatory cells will get activated as a response to an injury, a bacteria or a virus. Okay. But when the immune system is continuously triggered or there is a genetic predisposition that will, you you get the signal that you have to start the fight, but you don't know when to stop the fight, the immune system will go on and on and on.

and after they destroy the bacteria or the virus or they repair the tissue, they continue to attack. Those cells continue to attack and that will transform into damage and what we see in autoimmune diseases. All right. I know. Super, super, super interesting, but also makes so much sense as you're thinking about and, you know, because a lot of us, we obviously we've talked about before.

with you as well about autoimmune and what that all means and that's part of that. So fiber, again, another piece of lifestyle that can make a difference and that's how. And then the other is sugar. And boy do we hear a lot about sugar and I can say I am always very honest with our contributors and with others in our community. I really like to eat.

sugar and I know I'm not the only one. far as dessert, so I try. Exactly. So we know it's not good and we need to do a moderation. We're all about moderation. But it was really interesting to hear sugar and these short chain fatty acids. There's also a connection there. Unfortunately, sugar, I mean, sugar in small quantities is not bad. But sugar in excess and the sugar that we have everywhere in the product that we eat.

Yes. problem, like, you know, the food industry a while ago, ⁓ probably in the 1960s, 70s, they started to introduce a lot of ⁓ sugar in the food as a natural preservative. The same was salt. We're going to talk about that. Yeah. much sugar, it was proven to be pro-inflammatory. It will increase the inflammation. And too much sugar will actually

increase this population of bad bacteria. And that's why you end up with more inflammation. Everyone with an autoimmune disease will tell you, and especially people with rheumatoid arthritis will tell you that after they ate a bunch of cookies, they went for a party and they kind of binge on certain things with sugar, the next day they will feel in a lot of pain. They will feel a lot of stiffness. will feel swollen. And that is because sugar

or too much sugar will increase the amount of inflammation. And the same with salt. Too much salt apparently will influence our immune system cells to be more active, more pro-inflammatory. ⁓ And it took a while to understand the connection between food and certain foods. In the book, I also write about certain products like the beverages, beverages with sugar.

It's a real problem. That are actually increasing the chances for people with a genetic predisposition to develop autoimmune diseases, including rheumatoid arthritis. And there are very serious studies that they show that if you drink two cans of soda every single day, your chances to develop rheumatoid arthritis will increase with 60%. Wow. Which is huge.

So if you know that you have family members with rheumatoid arthritis and you choose a certain lifestyle where you drink, you know, Coca-Cola every single day, you know, your chances are 63 % higher to develop rheumatoid arthritis probably faster. That's an incredible piece of information, incredible number for us to sit and think about because I think that's something, and I was so glad

I remember as you're mentioning it when I saw that, you highlighted that because so many people, that will be news to them. that's a really important piece of prevention along the way to know ⁓ that we say certain things are bad but actually how are they bad and this is something you have control over as far as substituting other drinks and limiting the sugary drinks.

For sure and then salt you had mentioned which boy the socket lots of Press between high blood pressure and you know and other things so yeah, I know you had mentioned that as well If there's anything also you wanted to share with the audience and I'm not in particular to take away Making people aware of our salt. I know people will ask me so which sort is good the salt with sodium or the salt with potassium

Apparently the salt with more potassium is a little bit better, especially for high blood pressure, because there is a clear connection between more salt and higher blood pressure. I mean, there is no doubt at this point that if you eat more salty, you will end up with ⁓ high blood pressure. But when it comes to inflammation, salt and the excess of salt ⁓ will also modulate the immune system to be more active.

So what I do propose, not take all the salt from your food, just don't add too much salt to your food. Don't add, take that shaker of salt from your table and remove it and just use it when needed. Don't keep it there to salt all the food. I know the food will enhance the taste. The food will have an enhanced taste if you add more salt. But instead of that, I do propose to replace salt with more spices.

Okay, maybe you add a little bit more garlic, a little bit more rosemary, a little bit more thyme, a little bit more ⁓ turmeric. Those will be anti-inflammatory, especially in combination, and it will enhance the food taste without the, you know, drawback of Yeah, no, and that, and which is a wonderful, wonderful solution to that because the taste is really what it's about.

anyway so you can get that another way. And that's one of the many practical ⁓ tips that is in your book that is so, helpful ⁓ for people. And the other thing that I think is going to be new also to a lot of people, nightshade vegetables. You may have never heard of those. This was new actually to me. You're going to know what these vegetables are but you probably never heard the term nightshade vegetable. ⁓ And some of them it's interesting because vegetables, right?

are healthy. told that are healthy and one of the nightshade vegetables I know on the list is tomatoes and you think immediately tomatoes, lycopene, know, so important in cancer prevention. But it's different if you have a condition that's, you know, like RA ⁓ with, you know, dealing with inflammation. if you could tell people a little bit about that, I was really fascinated by that. Sure. So I put a story of one of my patients in the book.

that was eating a lot of tomatoes. And she came to me with stiffness, swelling in her hands, and she looked like a classic picture of rheumatoid arthritis. I was even fooled about that. And when I did the blood test, apparently she had, you know, her markers of inflammation were a little bit high, but other than that, she had no other markers for rheumatoid arthritis.

I sat down and I asked her, what do you usually do? What do you eat? And then she told me that she loves gardening. And then immediately I thought, okay, maybe she does something. Maybe she eats something. And she told me that this summer she grew so many tomatoes and she's not gonna waste any of that. And she's gonna use them in salads, stews, everywhere. And she's eating a lot of them. And I was like, hmm, maybe there is some connection there.

So I started to research it and I found out, because that's how I found out, there are certain people, not everybody, and that's why I put it in the book as well, because not everyone is sensitive to this kind of vegetables. But there are some people that will be more sensitive to cayenne peppers, to eggplants, to tomatoes, to zucchini, because some of them, they do have some components. For example, tomatoes, have solanine.

that will increase the chances for them to develop more inflammation. So what we did in this case, this patient, said, I said to her, how about stopping eating all tomatoes? And you come back to me, I gave her something for to cope with the pain. And then said to her, come back to me in a month and then I will see if you truly have rheumatoid arthritis or not. So when she came back, she had absolutely no more symptoms. She was not using any medication.

And she said, you know, I cured myself. was like, that's interesting. Yeah. And I started to read about it. And that's how I understood that are sensitive to those types of vegetables. But what I want people to take from this is they have to try and they will see if certain things are causing symptoms or not. Because once again, we are all different and we do not respond to the same things.

And I just want to make them aware that there might be a reason for them to be feeling worse with eating certain types of vegetables. ⁓ that was, I think people are going to find that absolutely fascinating. Definitely stopped me when I was, was reading and I, I said, wow, this is, I am not familiar with this. And this is so interesting that it could be something that on its surface appears healthy or what we've been told traditionally.

but doesn't necessarily interact with your body in a healthy way when it comes to inflammation. So I really appreciate that. And to switch gears a little bit from all of our extremely fascinating, because it is, dietary parts of lifestyle to other pieces of information I thought were pretty notable and pretty interesting ⁓ that I wanted to share with our audience. One was about celiac, because I know celiac disease does affect ⁓

I know several people myself actually through the years, but those in the millennial community. ⁓ And you were mentioning that celiac can mimic or mirror RA symptoms. That I had not heard before. Yes. ⁓ There are people with celiac disease that will have joint pain and they will have joint pain in the small joints. And it looks like rheumatoid arthritis, but it's not. And I always talk to my patients about what other symptoms they have.

And I always ask about the gut because many of them, they don't even think that the gut is connected with the joints. So that's why it's important to ask questions. And if they have abdominal pain, and nausea, and they have diarrhea, or was eating certain things, I will test them for celiac disease. And it's not uncommon also to see patients with rheumatoid arthritis plus celiac disease.

And even those that do not have a celiac disease per se, because that's also hard to diagnose. Yes. I will still ⁓ try a gluten free diet, because there are many people that are gluten sensitive. So they don't have the full celiac disease, but somehow their gut is not able to digest very well the gluten.

And just by trying to be gluten free for a matter of four months to six months, will see if your symptoms will improve. And it's interesting to me probably that a lot of patients will have or will experience an improvement in their symptoms by eating less gluten or no gluten. Very interesting. Definitely very, very interesting. And the one other that was, you know,

something new for me too is we, lot of people, especially at this point, have had mono at some point in their lives. And you mentioned that there's actually can be a connection between EBV, which causes mono, the acronym, and RNRA, which was interesting. So I was going to ask you about that as well. know that on the right territory, I would say right in, mean like that, but

⁓ on certain people with the genetic predisposition, a virus will come and will activate the immune system and the immune system, as I said, will get wired and doesn't know when to stop. And it's going to transform that normal reaction of response into an autoimmune disease. And apparently, ⁓ the research that we have so far show that certain viruses, including ABV and even more recent COVID

can precipitate an autoimmune disease. Not in everyone, but in certain people that are genetically predisposed, the fact that you have a viral infection could precipitate the disease. That's why we have to wait after we have a viral infection. We have to wait to see for at least six weeks if the symptoms will persist or not. Because even viruses,

can cause a lot of arthritis and a lot of inflammation that looks like rheumatoid arthritis. ⁓ I'll give you an example. ⁓ Patients with parvovirus, they will have a story that it's very, very similar with rheumatoid arthritis. But also patients with COVID, they will have stories that will tell you that they have joint pain in the small joints, morning stiffness.

So that's why we have to wait for at least six weeks to test them and also to make a diagnosis of rheumatoid arthritis if the symptoms are continuous or persistent after this six weeks period. That's extremely interesting, but also extremely helpful for us to know because I know that a lot of people under 50, I'm sure many over but I've been hearing this ⁓ quite a bit in the last two years in our community.

have ended up post-COVID getting different, yes, including POTS, which is where my first thought goes to as well. But it's interesting that that's happening in terms of RA and in terms of other things. And that six-week mark, a lot of us are not aware of. So that's a really good thing to watch for and to know about it, to go back if this is still going on at six weeks to see your doctor and get checked out. ⁓ Because these things can

can last for a little while after, ⁓ as we know personally now, having had COVID. ⁓ And then another thing that all of us ⁓ are confronted with, and you had mentioned earlier on in our conversation, is Google and Dr. Google. And so I think it's...

It's very interesting in illustrating this in terms of RIA. You're having symptoms, very complex condition, and you decide to use Google. I was curious because in the book, you give a specific warning, which is so important because there's a lot of talk about this, but I can't remember the last time I've seen somebody actually write about it in a book. And I think it's just so important.

to be able to put it out there, but what kind of made you decide to give like this detailed warning about using Google, you know, to learn about your symptoms and guidance on how to actually utilize that information? Absolutely. So over the years, I have met many patients that they would come to me and they will say, I read on Google this and this and that. And I completely understand the frustration, the curiosity too.

you know, curiosity, ⁓ it's part of what, you know, will move us forward. And I completely understand that sometimes patients do not have access to information from their doctors, medical providers, because of the lack of time. And because they might not think also to ask a question while they are rushed to go through the visit and then move on. ⁓

And because of that, a lot of people, will rely on Google and now on chat GPT and other AI tools. But the reality is that none of those resources, which can be a good, good to orient you, they're not doctors. They cannot diagnose you. cannot give you medical advice. And on top of that, on Google, you find a lot of information or you find, you know, even.

We can go over that on social media now, because people don't stop at Google. They go on social media, they go on these Facebook groups or other groups and they share all their information there. And most of the time, the information that you find is information that will scare you, will put thoughts into your head that will not be true. Or you will be inclined to take the bad experience of others. So if someone says that

You know, I was diagnosed with rheumatoid arthritis and I got this medication and I had so many side effects. You will be inclined to take that negative experience and say, that will happen to me. I don't want to take this medication who almost killed the other person. So my advice is to take that with caution and also realize from where you take that information, because in our days, there are a lot of people that can write everything, you know, chat GPT to write articles.

They don't verify that information and they just spill it there for the sake of sharing information. But not all of that will apply to you. And you cannot take that advice from Google. I'll tell you something funny. have my daughters, she had abdominal pain and she literally came to me the other day to tell me, mommy, I was looking up on Google, my symptoms.

And I think Google is very wrong. And I said, why? Remember, she's a girl. And she said to me, mommy, I asked him, why do I have abdominal pain? And he said, I might have testicular cancer.

That is so funny. Even my daughter who is for sharia at Google was wrong. So once again, you can get some information. There are some reliable sources, but those sources have to be curated. I mean, if you go, go on Medscape, on Mayo ⁓ Clinic, Cleveland Clinic. right.

I would say go on your website, go on Thank you. YMyHealth.com. absolutely. I'm rheumatologist on call. Because you the effort to get the resources and you spend so much time to verify the resources. Absolutely. it's not like you tell people just because you heard somewhere, you verify the resources and you try to relay that information in such a way that will be helpful, empowering and give hope to people. demoralize them.

⁓ 100%. 100%. And I'm so glad that you put it in the book because it is something that all of us contend with. It's something that everybody is used to doing now. It's kind of like you're almost, you've made the appointment to go to your doctor and we 1,000 % always encourage everybody to do that. But it's almost like that first step, like as you're waiting for the appointment because you've come like prepared for those of us who are in, but the problem is

you might be prepared with the wrong information or super worried about something that you don't need to be worried about. to your point, no, I really appreciate that. And I'm really curious with you gave hundreds of pieces of fascinating information in thriving with rheumatoid arthritis. Are there two pieces, and it's a tough question, of scientific knowledge or immunologic and biologic connections?

or research that you learned in your career that you wanted so much to put in this book that you find the most interesting. So as you know, I was a researcher. Yeah. Besides as a clinician, did research in genetics. And I thought when I started my medical career that it's all about in our genes and we have to work at the molecular level to change the outcome of a patient. That was in my mind.

And what I learned through practice and through dealing with patients and dealing with people, normal, know, beautiful people, I learned to listen to my patients because they give you so much information and they give you most of the time the answer that you are looking for. And I learned that, yes, we do have genetics, but we cannot change them. But what we can change is our lifestyle.

And our lifestyle matters so much. And when I talk about lifestyle, I will talk about what we put in our mouths, ⁓ what we eat, how much we sleep, how much we exercise, and how much we stress. And that's why I collected all these articles to support my scientific mind and to feed my scientific mind and to give a reasoning why you should

With science, scientific evidence, use certain things or change certain things in your lifestyle, which will definitely impact your risk to develop autoimmune disease. And then if you develop one, the risk can get a bad autoimmune disease or a more manageable one and the need for medications. Because if you eat certain things, if you do certain things in your lifestyle, you will be

able to decrease the amount of medication that you take. And I feel like with less medication, you have a better lifestyle and the chances to develop side effects are much, lower. No, excellent, excellent point. And I think it's just there's so much to learn. And it's so amazing to have you as a guide and this book as a guide to have that ⁓ for all of us.

to you, I greatly appreciate that very, very much. And thank you for kind of saving, filing away all these phenomenal things all these years that you've learned between research and immunology between patients. It's just so wonderful. And I was wondering, lastly, kind of what is your hope? You know, now you have this incredible book, this incredible guide for...

patients and for their friends and family ⁓ about remote-toed arthritis, kind of what is your hope for how the knowledge that you've provided in this book will be used by readers? My biggest hope is that once they read the book, they will feel that they are educated, they are empowered with the right information. The most information that I was able to bring is

the most updated information that I was able to find. And I really hope that they will be able to live a life that they love with the people that they love and they enjoy their life, even if they have rheumatoid arthritis. I very often tell to my patients that they have a disease, but that disease does not put a label on them. They are not the disease.

they just carry a disease. And even in the book, I compare rheumatoid arthritis with high blood pressure or diabetes ⁓ to try to make these people understand that yes, it's a chronic condition, but can be as manageable as your diabetes or as high blood pressure. So I really hope that they will take that and they will, first of all, they will enjoy to read it.

I try to make it as easy as possible. And I would like them to feel that they are the ones that they have the power to change things for their life. Well, I can say that after reading this book and knowing people who have been, ⁓ you know, living with RA for years and ones of different ages and some who were diagnosed when they were the age

that many millennials are today, that you will walk away from this very empowered. I felt very empowered myself in reading it, much more knowledgeable in reading it and understanding the incredible importance of lifestyle, how we choose to live our life, the daily health choices that we make really impact our health and to your point, risk ⁓ for RA and also just

in inflammatory processes. And so I'm very grateful to you for taking the time because I know any book, but especially an incredibly well researched and well thought out book is a very time consuming project, but well worth it. And you're going to help so many people with it in addition to all the people you've already helped. So thank you so much for this and for your time to share with us. So, so, so welcome. It's a pleasure.

And thank you so much for inviting me. So thank you so much for reading the book and helping others to get to the right amount of information and the right information in time, because we are bombarded with information these days. We just have to kind of sort out where are we going to take that information and what are we going to do with that? How are we going to implement it? Absolutely. Absolutely.

Well, with with guides like yourself, we are going to be ahead of the curve for sure. You're so welcome. Thank you so much, Dr. Granita.