Rheumatoid Arthritis
What is it?
Rheumatoid arthritis is a chronic disease in which the
joints, which hold two or more bones together, become
inflamed and cause pain, stiffness, and swelling.
Eventually, the affected joint becomes deformed.
Rheumatoid arthritis most commonly affects the joints in
the hands and feet, as well as the shoulders, jaw, hips,
and knees.
Who gets it?
Rheumatoid arthritis can occur at any age, but most
often appears first between the ages of 25 and 50.
Rheumatoid arthritis affects around one percent of
Americans, but is three times more common in women than in
men. It affects people of all races, and appears to run in
families.
What causes it?
Rheumatoid arthritis is a type of autoimmune disease.
Our bodies' immune cells attack and kill what they see as
foreign invaders, usually bacteria, viruses, and fungi.
However, with autoimmune diseases, something causes the
immune system to see the body's own tissues as foreign
invaders. With rheumatoid arthritis, the immune cells,
called antibodies, crowd into the joints and the joint
lining becomes inflamed. This causes swelling and
stiffness. Normally, the inflammation goes away after the
body has fought the infection. However, rheumatoid
arthritis is a chronic condition, which means the symptoms
occur frequently, over a long period of time. This
constant inflammation damages protective tissue that
covers the end of a bone in the joint, called the
cartilage. No one knows what causes the body's immune
response. Some researchers believe certain people are more
likely to develop an autoimmune disease because of their
genetic make-up, and all it takes is some type of
infection to trigger the immune system to go out of
control. Autoimmune disorders have also been linked to
food allergies. Some people with rheumatoid arthritis find
they have flare-ups after eating certain foods.
What are the symptoms?
Rheumatoid arthritis usually affects the joints on both
sides of the body. So, if the right hip is affected, so
will the left. Some people will have only one attack of
rheumatoid arthritis, but most will have one, then a
period where they are arthritis-free, and then another
attack. These flare-ups usually continue until the time
between flare-ups is briefer and briefer, and the symptoms
are worse each time. Some flare-ups last only a few days;
some last for weeks. The joints affected by rheumatoid
arthritis have a membrane, called the synovial membrane,
that produces synovial fluid to keep the joints lubricated
and to help the bones move smoothly around the joint. When
the synovial membrane becomes stiff and thick, it becomes
difficult to move the joint. Joint pain and stiffness is
usually worse first thing in the morning. Other symptoms
include redness and warmth around the affected joint, low
fever, appetite and weight loss, and fatigue. Eventually,
the joint becomes deformed, the cartilage is destroyed,
and the unprotected bone begins to wear away. The joints
can become 'stuck' in one position, called contractures.
Rheumatoid arthritis can cause other problems in the body,
such as vasculitis (inflammation of the blood vessels),
osteoporosis (loss of bone density), lung disease,
rheumatoid nodules (small bumps) under the skin, and blood
disorders. Rheumatoid arthritis that begins with a high
fever and other general symptoms is called Still's
disease.
How is it diagnosed?
The symptoms of rheumatoid arthritis are similar to
many other conditions, so a diagnosis is made based upon a
pattern of symptoms and the results of some specific
tests. First, your doctor will review your medical history
and symptoms, and perform a careful examination. He or she
will order blood tests and x-rays of the painful joints.
In most people with rheumatoid arthritis, a test of the
blood's erythrocyte sedimentation rate, which are the red
blood cells, will show an increase. Most patients will
also have mild anemia, which is a low red blood count, and
an antibody in the blood called rheumatoid factor. But, a
high erythrocyte sedimentation rate, anemia, and the
presence of rheumatoid factor can also indicate other
diseases. The x-rays of a person with rheumatoid
arthritis, however, will show changes in the joints. Your
doctor will also numb the joint area, then insert a long,
thin needle into an affected synovial joint and withdraw a
sample of the synovial fluid. By examining this fluid
under a microscope, your doctor will be able to look for
signs of inflammation. He or she may also remove a small
tissue sample, called a biopsy, of any rheumatoid nodules,
for examination under a microscope.
What is the treatment?
There is no cure for rheumatoid arthritis. For some
people with mild symptoms, rest and good nutrition are all
that's needed. For more severe flare-ups, rest, good
nutrition, and medication will control symptoms.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen, naproxen sodium, or indomethacin, are available
over-the-counter and are effective in relieving pain and
swelling, as is aspirin. Some people cannot take these
types of drugs, however, because they have a peptic ulcer
or kidney disease. Sometimes, corticosteroids such as
prednisone, can be taken orally or injected directly into
the joint to quickly stop the inflammation.
Corticosteroids are never used for more than a few days to
avoid side effects. When over-the-counter drugs are not
effective or the disease is progressing very rapidly,
drugs such as gold compounds, D-penicillamine,
antimalarial drugs, and sulfasalazine might be used. Gold
compounds can slow the formation of bone deformities, and
are usually injected directly into the joint. Or, a drug
that actually suppresses the immune system might be
prescribed. These include methotrexate, azathioprine, and
cyclophosphamide.
All of these drugs can have severe side effects and,
like all drugs, should only be taken under the supervision
of a physician. This is only a summary of some drugs used
to treat rheumatoid arthritis. Your doctor can recommend
the drug treatment that is best for you. Non-drug
treatments include physical therapy to keep the affected
joints and muscles moving, splints to support the inflamed
joints, moist heat or cold packs, and complete bed rest
during severe flare-ups. Joint replacement surgery may be
recommended for severely damaged knees and hips.
Alternative treatments include relaxation techniques,
meditation, hypnosis, acupressure, acupuncture, yoga, and
nutritional supplements such as fish oils, bromelain and
pancreatin, and vitamins A, C, and E, selenium, and zinc.
A diet rich in fish and berries may also be helpful. If
your flare-ups of rheumatoid arthritis have been linked to
food allergies, work with an allergy specialist to
determine which foods you need to avoid.
Self-care tips
Although there is no known way to prevent the
development of rheumatoid arthritis, you can reduce the
pain of flare-ups and prevent joint deformity by following
your doctor's treatment recommendations.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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