Rheumatoid Arthritis

Rheumatoid arthritis(RA), the second most common form of arthritis, is a disease of many joints. And unlike osteoarthritis, RA is known as a systemic disease; it can affect every system in the body. It is an autoimmune disease brought about when the immune system attacks the body. RA is a much more complicated and involved form of arthritis than osteoarthritis.

In its mildest form, RA is characterized as joint pain caused by inflammation of the joint lining. In serious cases, RA can cause painful, deformed joints and can harm the lungs, blood vessels, and other parts of the body.

In its most severe form, rheumatoid arthritis results in deformity of the joints. But with early medical intervention, most people with RA can lead a normal life. It is important to treat the disease correctly in the early years so the joints will work well after the disease subsides.

Treating rheumatoid arthritis can be complicated. It requires a doctor who is up to date on all the latest treatments. It would be in your best interest to seek the help of an arthritis specialist, a rheumatologist.

In RA, the white blood cells of the immune system attack the joint lining(synovium) as if it were a foreign object. Inflammation occurs in the joint membrane and enzymes are released that slowly damage the joint and surrounding structures. White blood cells break down collagen and bone by producing high levels of free radicals.

Attack of the White Blood Cells

• The white blood cells of the immune system attack the synovial membrane(joint lining).
• The attacked membrane becomes inflamed and painful and the joint capsule swells. The synovial cells grow and divide abnormally.
• The abnormal cells then attack the surrounding tissue, mostly the bone and cartilage.
• The joint space narrows and the joint's supporting structures weaken. Simultaneously, the abnormal cells release enzymes that eat away at the bone and cartilage, causing joint breakdown and scarring.
• Eventually, the joint deteriorates and becomes deformed.

Signs and Symptoms of Rheumatoid Arthritis

The symptoms of RA vary from person to person. It typically begins with minor symptoms and slowly progresses.

The first thing you may experience is a dull ache, stiffness, and swelling in two complementary joints(both knees, both wrists, etc). Affected areas of the body include feet, ankles, knees, hips, neck, shoulders, elbows, wrists, and fingers. The fingers and wrists are the most common areas affected by RA.

Common Symptoms

• pain, warmth, redness, swelling, tightness in a joint
• swelling of 3 or more joints for 6 or more weeks
• joint pain or stiffness lasting longer than an hour upon arising or after prolonged activity
• joints affected in a symmetrical pattern
• loss of mobility
• joint erosion visible on an x-ray
• general soreness and aching
• a general feeling of malaise
• periodic low-grade fever and/or sweats
• fatigue and weakness, especially in the early afternoon
• anemia
• difficulty sleeping
• rheumatoid nodules(pea-shaped bumps) under the skin (usually around the elbows, each bump is inflammation of a small blood vessel)
• blood test showing the presence of rheumatoid factor(an abnormal substance found in the blood of about 80% of RA patients)

Treatment of Rheumatoid Arthritis

The progression of RA causes joint deformity and can result in joint contractures(the inability to completely straighten or bend a joint). As mentioned earlier, it is very important to get treatment early in the disease before it has time to progress.

Early treatment reduces inflammation and stops the damage. Pain killers reduce the pain but not the arthritis. In fact, pain helps to protect the joints by limiting their use. Pain serves the purpose of temporarily slowing down the body part to allow it to better heal itself. It is a sign for a need to rest. It's important to treat the pain by treating the inflammation that causes the pain. Heavy duty pain killers should be avoided.

Rheumatoid arthritis treatment involves both rest and exercise. If you're tired or aching, rest is recommended. Rest reduces inflammation. But joint stiffness and weakening muscles can result from too much rest. It's a balancing act. Moderation is your best guideline. If you experience too much pain, stop what you're doing. If you don't have much problem with an activity, continue on. As a rule, if you have continued pain two hours after exercising, you've over done it.

Your doctor or therapist may prescribe a splint to help rest your joint. You may only have to wear the splint at night. As the joint improves, the splint will no longer be necessary. As you begin using the joint more, start out slowly by progressing to more and more activity. If you're following an exercise program, focus on exercises or activities that build good muscle tone, not exercises that build great muscle strength. Pool therapy is a great way to build muscle tone. The water allows you to exercise without putting to much stress on your joints.

If you've worked with a physical therapist or an occupational therapist, they'll develop an exercise program for you to do at home. It's your responsibility to maintain an exercise and rest program at home. You need to make it a daily routine so that you can strengthen and protect your joints for life.

Almost all rheumatoid arthritis sufferers take some type of medication for years after being diagnosed with the disease. Disease-modifying antirheumatic drugs(DMARDs) should be prescribed early in the disease process. They work by altering the behavior of the immune system.

Drugs similar to aspirin, known as nonsteroidal anti-inflammatory medications(NSAIDs), are often used to reduce pain and inflammation. If your doctor is a rheumatologist, he will be aware of the latest medications for successfully treating your RA.

Medications aren't without their side effects. Discuss this with your doctor prior to starting any new medications so you know what to expect. If you're experiencing unpleasant side effects, your doctor may be able to switch your medication to something more tolerable.

Surgery can restore function to damaged joints. But this, too, carries risks. Discuss this option thoroughly with your doctor before deciding to go this route.

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