Rheumatoid Arthritis
Created | Updated May 21, 2008
Rheumatoid arthritis is an autoimmune disease characterized by inflammation of the synovial lining of the joint. It's chronic, with symptoms varying over time, and affects approximately 1.3 million people in the United States. In short, the body attacks itself, with the primary symptoms visible in the joints, but it can affect other internal organs, particularly in severe cases.
Rheumatoid arthritis can have a sudden onset, or a slow progression. It also has a high rate of co-morbidity (presence of other conditions), particularly with fibromyalgia.
Symptoms:
1. Pain in both sides of the body (i.e., both wrists or hands) versus one side with osteoarthritis.
2. Inflammation, swelling, and heat in the affected joint(s).
3. "Flares", in which the pain and swelling gets worse for a time. Flares also typically include fatigue, loss of appetite, body aches, joint stiffness, and low-grade fever.
4. Rheumatoid nodules in the skin affecting up to 25% of patients(1).
5. Lung fibrosis in advanced cases.
Causes are currently unknown. It is believed that genetics may play a role, but this is inconclusive. Gender may have an effect; 75% of RA patients are women. (2)
Typical progression of the disease:
There are three stages of RA. The first stage is the swelling of the synovial lining, causing pain, warmth, stiffness, redness and swelling around the joint. Second is the rapid division and growth of cells, or pannus, which causes the synovium to thicken. In the third stage, the inflamed cells release enzymes that may digest bone and cartilage, often causing the involved joint to lose its shape and alignment, more pain, and loss of movement. (3)
Diagnosis:
A patient with suspected RA is typically sent for x-rays and blood tests. Other conditions must be ruled out, such as gout, osteothritis, lupus, and psoriatic arthritis. An elevated rheumatoid count is associated with rheumatoid arthritis.
There is no one test for RA; it is primarily diagnosed by exclusion.
Treatment:
First-line treatment for RA is typically NSAIDS (non-steriodal anti-inflammatory drugs), such as naproxen or ibuprofen, to reduce the inflammation quickly and treat the pain. Predinsone or other corticosteriods are often prescribed to further reduce inflammation and, in some cases, to confirm the diagnosis.
Long-term treatments include DMARDs, disease-modifying anti-rheumatic drugs. Methotrexate is the most commonly prescribed DMARD. A more specific class of DMARDs, called biologics, include infliximab, anakinra, and adalimumab. Currently, all biologics must be injected or infused through an IV.
When RA is diagnosed early and treated aggressively, the outcomes generally tend to be better, even to the point of remission. Many people with RA can, with a combination of treatment and lifestyle adjustments, continue to live without substantial difficulties.
1. http://en.wikipedia.org/wiki/Rheumatoid_arthritis
2. http://www.rheumatology.org/public/factsheets/ra.asp?aud=pat
3. http://www.arthritis.org/disease-center.php?disease_id=31
Rheumatoid arthritis can have a sudden onset, or a slow progression. It also has a high rate of co-morbidity (presence of other conditions), particularly with fibromyalgia.
Symptoms:
1. Pain in both sides of the body (i.e., both wrists or hands) versus one side with osteoarthritis.
2. Inflammation, swelling, and heat in the affected joint(s).
3. "Flares", in which the pain and swelling gets worse for a time. Flares also typically include fatigue, loss of appetite, body aches, joint stiffness, and low-grade fever.
4. Rheumatoid nodules in the skin affecting up to 25% of patients(1).
5. Lung fibrosis in advanced cases.
Causes are currently unknown. It is believed that genetics may play a role, but this is inconclusive. Gender may have an effect; 75% of RA patients are women. (2)
Typical progression of the disease:
There are three stages of RA. The first stage is the swelling of the synovial lining, causing pain, warmth, stiffness, redness and swelling around the joint. Second is the rapid division and growth of cells, or pannus, which causes the synovium to thicken. In the third stage, the inflamed cells release enzymes that may digest bone and cartilage, often causing the involved joint to lose its shape and alignment, more pain, and loss of movement. (3)
Diagnosis:
A patient with suspected RA is typically sent for x-rays and blood tests. Other conditions must be ruled out, such as gout, osteothritis, lupus, and psoriatic arthritis. An elevated rheumatoid count is associated with rheumatoid arthritis.
There is no one test for RA; it is primarily diagnosed by exclusion.
Treatment:
First-line treatment for RA is typically NSAIDS (non-steriodal anti-inflammatory drugs), such as naproxen or ibuprofen, to reduce the inflammation quickly and treat the pain. Predinsone or other corticosteriods are often prescribed to further reduce inflammation and, in some cases, to confirm the diagnosis.
Long-term treatments include DMARDs, disease-modifying anti-rheumatic drugs. Methotrexate is the most commonly prescribed DMARD. A more specific class of DMARDs, called biologics, include infliximab, anakinra, and adalimumab. Currently, all biologics must be injected or infused through an IV.
When RA is diagnosed early and treated aggressively, the outcomes generally tend to be better, even to the point of remission. Many people with RA can, with a combination of treatment and lifestyle adjustments, continue to live without substantial difficulties.
1. http://en.wikipedia.org/wiki/Rheumatoid_arthritis
2. http://www.rheumatology.org/public/factsheets/ra.asp?aud=pat
3. http://www.arthritis.org/disease-center.php?disease_id=31
