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Rheumatoid Arthritis
What
Is It?
Rheumatoid
arthritis (RA) is a musculoskeletal condition
characterized by synovitis, the inflammation of the
membranes that line the body's joints. Typically,
rheumatoid arthritis causes pain, stiffness, warmth,
redness, and swelling at the joints. Over time, the
affected joint can become misshapen, misaligned, and
worn down. Synovium tissue in the cartilage then
proliferates, eroding the surrounding tissue,
including the ligaments, muscles and bones, as it
spreads. In addition, inflammatory cells produce
enzymes that also eat away at bone and cartilage.
The most disabling form of
arthritis, rheumatoid arthritis generally affects
more than one joint at a time, the elbows,
shoulders, hips, knees, and neck. Ordinarily, it
affects both hands or both feet. It can result in
loose, deformed joints, loss of mobility, and
diminished strength. It can also cause painless
lumps the size of a pea or acorn, called rheumatoid
nodules, to develop under the skin, especially
around the elbow, at the base of the scalp or
beneath the toes. Despite appearances, however, the
disease does not necessarily result in extreme pain
and lack of flexibility.
Generally, the pain is a
dull ache, similar to that of a headache or
toothache. Affected joints may also feel warm to the
touch, and the skin may appear flushed. On days when
the disease is more active, you may experience
fatigue, loss of appetite, fever, sweats and
difficulty in sleeping.
Unlike other common
arthritic conditions, such as osteoarthritis, which
are confined to the bones, joints, and muscles,
rheumatoid, arthritis is a systemic disease.
Occasionally, it can cause inflammation in the
membranes surrounding internal organs, such as the
heart, lungs and eyes.
The course of the disease
varies. It tends to the episodic, and symptoms come
and go. Symptoms may flare up after you've been
particularly active, or they may recede ("burn
out" or go into remission) for long periods of
time. Some people have continuous symptoms that
generally worsen with time.
Although this disease
typically strikes in middle age, between ages 20 and
50, it can also affect very young children and older
people Out of the 2.1 million people with the
disease, most are women - 1.5 million as compared to
600,000 men.
The exact cause
of RA is not known, although it does appear to be a
disease of the autoimmune system. When the body's
immune system does not operate as it should, white
blood cells that normally seek out and attack
foreign invader (bacteria, virus, and the like) move
from the bloodstream and attack healthy tissue - in
this case, the synovium, or joint tissue. As the
synovial membrane becomes inflamed, enzymes are
released. Over time the synovium becomes thick and
invasive, and the enzymes eats away at cartilage,
bone, tendons and ligaments in the joint.
Some research suggests that
a virus triggers this faulty immune response. At the
same time, it appears that some people have a
genetic predisposition - the HLA-DR4 genetic marker
-- to the disease. Even though this marker is a
common one, most people with the marker do not get
the disease.
Signs
And Symptoms
·
Pain, swelling,
redness, warmth, and tightness around hands, feet,
wrists, elbows, shoulders, neck, knees, hips, and
ankles
· General
fatigue, soreness, stiffness, and aching
· Lumps
or rheumatoid nodules below the skin
· Misshapen
or deformed joints
· Anemia
· Weight
loss
· Periodic
fever and sweats
· Sleep
difficulties
· Weakness
and loss of mobility
Diagnosis
Because very often rheumatoid
arthritis can be controlled with certain drugs, early
diagnosis is important. Your doctor will look at your
symptoms and medical history. He will also conduct a
complete physical exam.
A blood test can screen for
the antibody, rheumatoid factor, an abnormal protein
shows up in the blood of about 80% of those with
rheumatoid arthritis. However, the presence or absence
of rheumatoid factor does not in itself indicate a
positive or negative diagnosis. A blood test will also
determine the erythrocyte sedimentation rate which can
suggest the presence of an inflammatory process.
Treatment
Sixty years ago, having
rheumatoid arthritis probably meant that you would live
your life from a wheelchair. Today, a responsible
approach to the disease can make living with rheumatoid
arthritis much more bearable.
Although there is no treatment
that can cure or reverse rheumatoid arthritis, a
comprehensive approach to the disease that combines
aggressive use of medications, rest, exercise,
life-style modifications, and sometimes surgery can help
many people with the disease lead very normal lives.
Medication
Certain medications relieve the symptoms of rheumatoid
arthritis and slow its progress. Nonsteroidal
anti-inflammatory drugs (NSAIDs) - aspirin and ibuprofen
-- helps relieve pain and inflammation.
Corticosteroids -- cortisone,
prednisone and others -- reduce inflammation and slow
joint damage. However, they have little lasting benefit
and tend to become less effective overtime. Because
their side-effects can be problematic -- easy bruising,
thinning of the bones, cataracts, weight gain, puffy
face, diabetes and high blood pressure -- they must be
used under strict compliance with your doctor's order.
Your doctor will probably prescribe a corticosteroid to
relieve acute symptoms, and then gradually taper you off
the medication.
Disease-modifying
anti-rheumatic drugs -- methotrexate, hydroxychloroquine,
azulfidine, gold salts, and cyclosporine -- appear to
slow or halt the progression of rheumatoid arthritis by
suppressing an over-active immune system. However,
because they are slow-acting and don't relieve symptoms
immediately, your doctor will likely advise you also
take NSAIDs, a corticosteroid, or both.
Finding a balance between rest
and exercise is crucial to managing this disease. In
order to strike the right balance, it is essential that
you learn to listen to your body. When your symptoms
flare --when your joints are sore, warm, and swollen --
take it easy and make time to rest. At these times,
continue to do range-of-motion exercises to keep your
joints mobile, but be careful not to tire yourself or
aggravate your joints. Avoid unnecessary walking,
housework or other activities. When your joints feel
better and when other symptoms, including fatigue and
morning stiffness, are less noticeable, increase your
activity level. Moderate weight- bearing exercises, such
as walking and lifting weights, can strengthen weakened
muscles without risking additional joint damage. If
exercise produces more pain or joint swelling, you
should cut back a bit.
Joint protection
A splint, brace, sling or ace bandage worn during times
of particular tenderness can take the pressure off
joints and protect them from injury.
Occupational therapy and
assistive devices
Having rheumatoid arthritis often necessitates that you
pay special attention to the way you move and function.
An occupational therapist can offer suggestions and
guidance as you manage ordinary tasks around your home
and work. In addition, he can provide special devices
that can help you conserve energy and protect your
joints as you go about your daily activities.
Surgery
In some cases, surgery to reconstruct or replace the
affected joint is required. In fact, when rheumatoid
arthritis causes significant destruction and pain in the
hip or knee, arthroplasty, a surgical procedure to
replace the joint, may be a very promising option.
Prognosis
Rheumatoid arthritis is a
chronic illness for which there is no cure. However,
effective, responsible treatment can help you live well
with this disease. The very nature of the illness
probably means that there will be times when you are
relatively symptom-free. Some people, however experience
symptoms continuously for a number of years. Even if the
disease "burns out" or goes into remission and
active symptoms disappear, some discomfort and impaired
joint function may remain, as may joint deformities.
Last
updated November 04, 1998(Intelihealth-John's
Hopkins Health Information)
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