After finding the correct combination of diet, exercise and holistic medicine, Cara Zanella found a way to live with the rheumatoid arthritis that affected her life for nearly two decades.

She was able to do it without the use of medication, but the North Huntingdon woman with a passion for competitive ice skating wasn’t prepared for what came next.

“I was working out and balancing on a ball about two years ago,” she said. “Then I noticed, one day … my muscles weren’t holding me. Then I was exercising my arms one morning using 25-pound weights, and it was getting really difficult,” said Zanella, 57. “And then it went to 15 pounds. To 10 pounds. To five pounds. And I was in pain.”

Zanella continued to get weaker and experienced additional pain. Around Thanksgiving 2022, she told her husband, Bob, that, if her condition persisted, she would need to seek medical help.

By December 2022, “it reached the point where, now, I couldn’t get out of a chair. I couldn’t drive. My muscles would go into spasms, and I would just shake,” she said. “I cried for so long, for so many days, because I’d just lost the ability to use my arms and legs, and I went from 130 pounds down to 119.”

After consulting with doctors, Zanella was diagnosed in February with an additional autoimmune disease, called polymyositis.

Much to her dismay, she occupied a second pew in what the University of Pittsburgh’s Dr. Chester Oddis called “the church of autoimmunity.”

“I’ve always likened it to a church where there are lots of ‘pews’ patients can occupy,” said Oddis, director at the university’s Myositis Center. “Patients with lupus are in one pew; patients with rheumatoid arthritis are in another. And one of those is myositis.”

Autoimmune conditions are characterized by a patient’s immune system malfunctioning, creating a situation where the body begins attacking itself.

“In myositis, the attack is primarily on muscles, but it’s very systemic,” Oddis said. “It can occasionally be painless, where people feel muscle weakness and just aren’t able to do certain things.”

Once diagnosed, myositis typically is treated with steroids in combination with other immunosuppressant medication, depending on the type and severity.

“It’s a spectrum,” Oddis said. “Some people may have a skin rash and a little muscle weakness. Others can be incapacitated and have a lot of difficulty.”

Zanella began a steroid regimen, which helped with her pain. She also reached out to East Suburban Sports Medicine in North Huntingdon and began physical therapy.

“In the short time I’ve been with them, I’ve made a lot of progress,” she said. “I can come back down the stairs again. I can water my plants. On a good day, I can get some cleaning done. I drove the car around our neighborhood the other day just to see if I could do it.”

The biggest challenge is that Zanella is essentially relearning how to live her life.

Oddis said myositis can be tricky to diagnose.

“It’s very challenging in the early phases of a lot of autoimmune diseases,” he said. “Patients can feel very fatigued with joint and muscle pain. Their doctor can do a preliminary assessment and check things like antibody markers, and then begin to look at more specific things — that’s when we start looking at which ‘pew’ a patient might be sitting in.”

Sitting in multiple pews has changed nearly everything about Zanella’s life.

“The doctors told me they aren’t aware of a cure, and they don’t know if it will go into remission,” she said.

In the past, she turned to her love of ice skating to help combat the effects of her rheumatoid arthritis. These days, her goals are simple: Go up the stairs. Don a life jacket and move around in her backyard pool. Exercise, but not too much.

“That is really difficult,” she said. “As an athlete, I was always taught to push through, work through that pain, but you can’t do that with myositis. Because you can overwork those muscles, and then your progress starts going in the opposite direction.”

Zanella said she never could have made it this far without her husband.

“Bob’s always running around, helping me or doing something for me,” she said.

May is National Myositis Awareness Month in the U.S. UPMC officials estimate between 50,000 and 75,000 people in the U.S. are affected by the disease.

Zanella was taken aback by its rapid progress — especially after having a good deal of success combating her rheumatoid arthritis — and said anyone experiencing similar symptoms should see their doctor as soon as possible.

“You go from being a regular person to, in a few months, being handicapped,” she said. “It starts out as muscle pain, kind of like the soreness you get from overextending yourself in a workout. But it doesn’t go away.”

For more, see UnderstandingMyositis.org.

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