Rheumatoid Arthritis


 

Introduction

Arthritis is a general term for inflammation (redness, warmth, swelling, and pain) in joints. Rheumatoid arthritis is a type of chronic (ongoing) arthritis that occurs in joints on both sides of the body (for instance, both hands, wrists, and/or knees), which helps distinguish it from other types of arthritis.

In addition to affecting the joints, rheumatoid arthritis may occasionally affect other parts of the body, including the skin, eyes, lungs, heart, blood, nerves, or kidneys.

Rheumatoid arthritis is an autoimmune disease, meaning that patient’s immune system (the body’s infection-fighting system) is overreacting against itself. The result can cause some or all of the symptoms of rheumatoid arthritis.

Anatomy

Rheumatoid arthritis (RA) is an inflammatory disease and doesn’t just affect your joints. RA symptoms develop over just a few weeks or months and often begin with cold and flu-like symptoms such as fever, weakness and fatigue.

RA most often affects the following joints:

  • spine
  • knees
  • hips
  • shoulders
  • wrists
  • ankles
  • elbows

Causes

The exact cause of rheumatoid arthritis is unknown. However, it is believed to be caused by a combination the following factors:

  • Genetics (heredity)
  • Abnormal immunity
  • The environment
  • Hormones

Normally, the immune system protects the body from disease. In people who have rheumatoid arthritis, something—possibly infections, cigarette smoking, and physical or emotional stress, among other causes—triggers the immune system to attack the joints (and sometimes other organs).

Gender, heredity, and genes largely determine a person’s risk of developing rheumatoid arthritis. For example, women are about three times more likely than men to develop rheumatoid arthritis.

Symptoms

The symptoms of rheumatoid arthritis include the following:

  • Joint pain and swelling
  • Stiffness, especially in the morning or after sitting for long periods
  • Fatigue (tiredness and excessive sleepiness)

Rheumatoid arthritis affects each person differently. In most people, joint symptoms may develop gradually over several years. In other people, rheumatoid arthritis may proceed rapidly. A few people may have rheumatoid arthritis for a limited period of time and then go into remission (a time with no symptoms).

Cartilage normally acts as a “shock absorber” between the joints. Uncontrolled inflammation causes the destruction and wearing down of the cartilage, which leads to joint deformities. Eventually, the bone itself erodes, potentially leading to fusion of the joint (an effort of the body to protect itself from constant irritation). This process is aided by specific cells and substances of the immune system, which are produced in the joints but also circulate and cause symptoms throughout the body.

Diagnosis

The diagnosis of rheumatoid arthritis is based on a combination of factors, including:

  • Morning stiffness that lasts at least one hour and has been present for at least six weeks;
  • Swelling of three or more joints for at least six weeks;
  • Swelling of the wrist, hand, or finger joints for at least six weeks;
  • Swelling of the same joints on both sides of the body;
  • Changes in hand x-rays that are hallmarks of rheumatoid arthritis;
  • Rheumatoid nodules (lumps) of the skin
  • Blood test that is positive for rheumatoid factor* and/or anti-citrullinated peptide/protein antibodies

* The rheumatoid factor may be present in people who do not have rheumatoid arthritis. Other diseases can also cause the rheumatoid factor to be produced in the blood. A test called CCP antibody can sometimes help to determine whether the rheumatoid factor antibody is due to rheumatoid arthritis or some other disease. This is why the diagnosis of rheumatoid arthritis is based on a combination of several factors and NOT just the presence of the rheumatoid factor in the blood.

It is also important to note that not all of these features are present in people with early rheumatoid arthritis, and these problems may be present in some people with other rheumatic conditions.

In some cases, it may be necessary to monitor the condition over time before a definitive diagnosis of rheumatoid arthritis can be made.

Treatment

The goals of rheumatoid arthritis treatment are to:

  • Control a patient’s signs and symptoms.
  • Prevent joint damage.
  • Maintain the patient’s quality of life and ability to function.

Joint damage generally occurs within the first two years of diagnosis, so it is important to diagnose and treat rheumatoid arthritis in the “window of opportunity” to prevent long-term consequences.

Treatments for rheumatoid arthritis include medications, rest, exercise, physical therapy/occupational therapy, and surgery to correct damage to the joint.

The type of treatment will depend on several factors, including the person’s age, overall health, medical history, and the severity of the arthritis.

Surgery

When bone damage from the arthritis has become severe or pain is not controlled with medications, surgery is an option to restore function to a damaged joint.

Prevention

To reduce your risk of getting RA or having severe symptoms, put “make healthy choices” at the top of your to-do list. That doesn’t mean adding a green smoothie to your fast-food diet, or occasionally taking a long walk. A healthy lifestyle means consistent, conscious choices to eat well, exercise (short walks count), reduce stress, and get ample, restful sleep.

Complications

Having rheumatoid arthritis can lead to several other conditions that may cause additional symptoms and can sometimes be life threatening.

Possible complications include:

  • carpal tunnel syndrome
  • inflammation of other areas of the body (such as the lungs, heart and eyes)
  • an increased risk of heart attack and stroke

Making sure that rheumatoid arthritis is well controlled can help to reduce your risk of these complications.

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