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Dearest Name 

After quite a bit of thought and discussions with Mum, I have decided to write to you about rheumatoid arthritis (RA).  My rheumatologist Dr. Fred thinks I should as well.  I do not want a situation to develop where you feel I did not inform you, given the propinquity of my condition.  Consider this note and if you would like to take the matter further, call.

Name, the cause of RA is unclear but it appears to run in families and starts with a trigger.  To our knowledge, our wider family down the male line has generated four autoimmune conditions.  Name 2 has RA, her sister has fibromyalgia, Name 3 has Hashimoto Disease and I have RA.  Research seems to indicate that there are four types of triggers: smoking, gum disease, stress or a biologic event.  I will digress a little before detailing these trigger events.

All autoimmune diseases produce inflammation, often rampant inflammation.  It is the inability of the body to turn the immune system off from attacking the body itself that produces these different disease types.  There are no known cures only management strategies and they all have fairly severe side effects.

Soldiers with combat experience have an incidence of RA about three times that of the general population.  Marathon runners develop RA at twice the rate.  Last week a gold meddle velodrome cyclist here in Australia retired prematurely due to RA.  He was about 32 years old.  What these observations point to is stress.  Too much stress, physical or emotional is a definite trigger; more so if you have a family history.  The second trigger refers to infections and viruses and I think this is probably what started Name 3 off.  Combine the two triggers and perhaps one is asking for trouble.  In my case, I was training for a long ride, travelling a lot and, we think, the tick bit was the biologic trigger.

I am telling you this not to scare but to warn and inform.  I know you are training very hard to row competitively and also travelling quite a bit.  I believe that you need to be careful about over doing things, about putting your body through too much stress.  You are already a higher risk potential than the general population so listen to your body and take a break regularly.  I suspect that you have a 1 in 30 probability of RA.  Dr. Fred said that if you get aches and pains in your hands or feet not associated with injury or exercise then go to a rheumatologist and get yourself checked.  Do not put this off.  Otherwise carry on! By all means have fun and enjoy life but you may consider tempering the competitive aspects a little.

There is very little information about early warning signs about disease activation.  In my own case there were odd little aches and pains, particularly in my big toe. 

I would not wish RA upon my worst enemy and I certainly do not want any more of this in our family or in your future family.  Rheumatoid arthritis is very unpleasant and changes everything. 

Please consider this letter.  I am very happy to chat over the details and to answer your questions.  I won’t nag you about reducing stress and Mum and I take great pleasure in your many exploits.

Much love, Dad.