Rheumatoid Arthritis
Basic Information
Rheumatoid arthritis is a chronic inflammatory disease that afflicts the joints. It results in swelling, pain, joint deformity, stiffness and loss of mobility. It is often called "crippling arthritis". There are several characteristics that make it different from other types of arthritis. Unlike osteoarthritis, this disease causes inflammation and almost always appears during young adulthood, with onset after the age of sixty-five being extremely rare. It also affects the body systematically, in that it is common for the disease to both spread to many joints in the body, and to debilitate the body in a symmetrical manner. This means if the left elbow is inflamed, then chances are that the right elbow will be as well. It typically affects the knee, neck, hand, wrist, finger and hip joints, although it can attack the entire body. It is particularly common in the wrists and knuckles.
The biological cause of rheumatoid arthritis is unknown. It is speculated that there may be genetic factors that trigger the onset of the disease. There is a higher risk factor if there is a history of the disease in a person's family. Rheumatoid arthritis occurs when there is inflammation of the synovium. The synovium are the membranes that envelop the joints, providing protection and lubrication. Inside the synovium is a liquid called the synovial fluid. This fluid both lubricates the joints and brings essential nutrients to the cartilage. Cartilage absorbs shock, supports the bones, and protects the joints where the bones meet, and is made up of a substance called collagen protein.
Rheumatoid arthritis is an autoimmune disorder, in that the immune system mistakes the collagen in the joints as a foreign substance and thus attacks itself. As the immune system continues to assault the joints, the synovial membrane become inflamed. The inflammation occurs because the immune system has sent masses of white blood cells to the site of the joints to combat an enemy that is not actually present. As a result, the white blood cells that have inflamed the synovial membrane destroy the collagen, causing both the joint space to close and a loss of joint flexibility. This forces the bones to rub against each other in the joint, which can often result in deterioration of the bone. The inflammation can eventually afflict the ligaments and muscles, and in some cases can deform bones and damage organs. While in a normal immune system the inflammation would subside over time, there is thought to be some kind of genetic defect characteristic of rheumatoid arthritis that prevents the inflammation shut-off signal from reaching the immune system. There is also evidence that when overproduced one of the antibodies the immune system makes to attack the perceived foreign invader--cytokine--can cause shock, fever, and organ damage. These are all ailments that can affect a person with rheumatoid arthritis.
It is estimated that a little over 2 million Americans have rheumatoid arthritis to some extent. Women are slightly more likely to be affected than men. Interestingly, women who have been pregnant decrease their chances of developing the disorder.
Rheumatoid arthritis is a chronic condition, which means that it lasts a long time and gradually worsens over time. If left untreated, the disorder can severely debilitate a person. It can deform joints, decrease mobility, and make it difficult to carry out simple tasks. When a person is affected by rheumatoid arthritis, they are more likely to suffer from infections, have gastrointestinal problems, have anemia, and develop lymphoma. It is also associated with impairment of the eyes, lungs and nerves. Even though a cure does not exist, in many cases the disease goes into remission, causing the symptoms to abate. This can happen even in severe cases of rheumatoid arthritis. There is always the possibility of an eventual recurrence. While the disease almost always manifests itself as a chronic disorder, there is an atypical form that is considered acute. Acute rheumatoid arthritis lasts a short duration and subsides without causing long-lasting effects.
Symptoms
The symptoms of rheumatoid arthritis vary from person to person. As aforementioned, some people have the disorder for a few months and only experience mild pain during that time, while others are severely debilitated for life.
The typical symptoms of rheumatoid arthritis include:
- joint inflammation
- symmetrical pattern of affliction
- besides joint pain, pain simultaneously occurring in other parts of the body
- pain and stiffness that occurs after waking up in the morning; after long rest
- joints that are warm; swollen; tender
- fatigue and malaise
- fever and chills
- weight loss
During the initial stages of rheumatoid arthritis, a person may feel both a general sense of fatigue and morning stiffness. The morning tenderness generally endures for over an hour. An afflicted person may have a fever. In most cases, a diagnosis of rheumatoid arthritis will not be considered unless the person has experienced the joint inflammation for at least a month. As the disease progresses, the inflammation spreads to the cartilage, tendons and bone. With treatment, inflammation can subside and there is not necessarily any long term damage. However, if the disease gets to the point where the joints become deformed, the ligaments and muscles becomes misaligned or the bone deteriorates, the effects of the disease will be permanent.
About a fifth of all people with rheumatoid arthritis develop small lumps just beneath the skin. These are blood vessels that have become inflamed. They often appear near the elbow. They are usually painless. When young children develop rheumatoid arthritis, they often get a high fever and chills. There may also be a pinkish rash present.
Diagnosis/Treatment
It is often difficult to diagnose rheumatoid arthritis, particularly during the initial stages. Not only is there no conclusive test for the disorder, but also the symptoms are in many ways like those of other arthritic conditions and joint problems. It does not help that the symptoms of this particular joint disorder often do not develop until the later stages. As a result, it can take a while to eliminate the possibility of other conditions before a diagnosis of rheumatoid arthritis can be made.
A diagnostic examination will usually begin with the doctor asking if the person has a history of rheumatoid arthritis in the family. The doctor will also want a detailed description of the person's symptoms. After the doctor has finished with the medical history, they may perform a physical examination, where they feel the inflamed joints and perhaps even move the joints to test for flexibility.
A common test that doctors use as a diagnostic tool for this disorder is a blood test called the rheumatoid factor. Rheumatoid factor is an antibody present in the blood in the majority of rheumatoid arthritis cases. One thing to keep in mind is that not every one who has the disease tests positive for the rheumatoid factor.
The erythrocyte sedimentation rate is a blood test that tests for elevated levels of inflammation in the body. Because this rate can be high in a wide variety of health conditions, this test is not used as much as a diagnostic tool as it is a measurement of the severity of the arthritis. A blood test can also indicate whether there is a large presence of the C-reactive protein in the body. This protein occurs in greater profusion whenever there is inflammation in the body. Other blood tests that a doctor may use in making a diagnosis are a hemoglobin test that determines the amount of red blood cells, and a similar test that determines the white blood cell count. The red blood cell count is helpful because some people with rheumatoid arthritis also have anemia which lowers the number of red blood cells in the body.
Although X-rays are not extremely helpful because they do not expose the soft tissue where most of the damage occurs as a result of rheumatoid arthritis, they can reveal joint and bone destruction during the more progressed stages of the disease.
Rheumatoid arthritis does not have a cure and it cannot be prevented. However, there are a variety of treatments that can help to alleviate symptoms, increase function, improve a person's sense of well-being, and decelerate the progression of the disease. Because the disease can affect people in so many different ways, the type of therapy used will vary from person to person.
The initial approach to therapy generally involves the afflicted person's lifestyle. It is extremely important that the person finds a good balance between rest and exercise. While rest can help alleviate pain and inflammation, exercise increases muscle strength and joint mobility. Both rest and exercise can play a role in reducing fatigue. If the affected person is obese, diet and exercise are important because the loss of weight can diminish the amount of strain on the inflamed joints. This can both reduce pain and prevent further joint damage.
In some cases, a person may want to apply heat or cold to their inflamed joints. While heat can alleviate pain, cold can reduce swelling. Heat or cold should not be applied to any part of the body for longer than twenty minutes. Also, some doctors suggest that the afflicted person use either a splint or a brace to protect a painful joint. A splint or brace can reduce the amount of stress being placed on a joint, and hence, can allow time for the joint to rest and heal.
There are also some bodywork therapies that can be helpful. Acupuncture is a form of therapy in which needles are placed into the body. The placement of these needles can stimulate areas that are inflamed, thus releasing the pent-up energy, and can also trigger the body's release of naturally-occurring pain-reducing chemicals. Likewise, with massage, a therapist can do gentle bodywork on a painful muscle or joint. This can relax the body, which may help to alleviate pain and stimulate blood flow.
An extremely important part of any therapy seeking to reduce the symptoms of rheumatoid arthritis is stress management. Some doctors suggest that stress makes people more sensitive to pain. Others feel it simply makes life even more unpleasant for a person who is already dealing with a painful joint disorder. Deep breathing techniques, visualization exercises, and open communication with the patient's therapy providers are good ways to reduce stress in the patient's life.
In some cases, life style changes are not enough to cause the symptoms to abate. Most people with rheumatoid arthritis take nonsteroidal anti-inflammatory drugs such as ibuprofen to reduce pain and swelling in the joints. This class of drugs includes aspirin, which can have negative side effects.
If these drugs are not effective, a person might be prescribed "disease-modifying anti-rheumatic drugs". Although these drugs can have negative side effects, they are used to slow down the progress of the disease.
Corticosteroids may also be taken to mitigate inflammation. Although they can be very effective, corticosteroids can have powerful side effects, such as calcium depletion, fluid retention and edema. They are taken orally or are injected directly into the inflamed joint. If the injections are too frequent, it can precipitate joint damage. While corticosteroids in the past were only administered in cases where the arthritis was severe, more doctors today are prescribing stronger drugs early on in treatment. This can increase the chances that further joint damage will be prevented.
If the joint damage caused by rheumatoid arthritis is severe, surgery may be necessary. Most people do not need surgery. However, in severely debilitating cases it can help relieve pain, reduce inflammation, improve joint mobility, and allow the afflicted person to function better.
A joint replacement is a common type of surgery. During this surgery, the damaged joint will be removed, and replaced by an artificial joint. This can reduce pain and help with appearance if the joint is deformed. Sometimes the joints do not last and must also be replaced.
A tendon replacement is a type of surgery that can repair any damaged tissue with the function of attaching muscle to bone. It is particularly effective with tendons in the hands.
Another surgical procedure is the synovectomy. This type of surgery is usually performed along with a joint or tendon replacement. It removes and replaces any inflamed synovial tissue.
In most cases, treatment is effective and people with rheumatoid arthritis can lead full, active lives.