Rheumatoid Arthritis

Overview

Rheumatoid arthritis (RA) is an inflammatory disease that affects the joints, causing pain, swelling, stiffness, and loss of function. In RA, the immune system, whose normal function is to defend the body from foreign substances like germs, attacks the membrane that lines the joints. Diseases such as RA, in which the body’s immune systems attacks healthy tissues and cells, are known as autoimmune diseases.

Rheumatoid arthritis is most often a chronic condition, meaning that it can last for a lifetime or a very long time. Some people with RA have mild symptoms, while the disease is more severe in others. Symptoms may be constant or may fluctuate between mild periods and times when symptoms are more severe, called flares.

About two or three times more women are affected by RA than men. It’s estimated that approximately 1.3 million people in the United States are affected by RA. The disease occurs in all races and ethnic groups and can begin at any age.

As of yet, there is no known cause of RA. Researchers suspect that the following factors may be involved in its development: genetics, environmental factors, and hormonal factors (of interest due to the increased prevalence of RA in women).

Symptoms

• Pain, swelling, stiffness, and loss of function in the joints
• Joint inflammation (swelling) often occurring in wrist and finger joints closest to the hand
• Joint inflammation sometimes occurring in neck, shoulders, elbows, hips, knees, ankles, and feet
• Symmetrical pattern of affected joints (if one knee or hand is affected, the other one is also)
• Fatigue
• Occasional fevers
• Overall sense of not feeling well

How Rheumatoid Arthritis Damages the Joints

In RA, tissue that lines the joints, called synovium, is attacked by the immune system and becomes inflamed. As RA progresses, the inflamed synovium invades and destroys the cartilage and bone within the joint. As a result, the muscles, ligaments, and tendons that support the joint weaken and no longer work properly. This results in pain and joint damage.

Diagnosis

Rheumatoid arthritis can be difficult to diagnose because there is no single test for the disease. Doctors must instead use several tools to make a diagnosis. These include:

• Medical history—questions about symptoms and how symptoms have changed over time and about personal and family medical problems
• Physical examination—an evaluation of the following: reflexes; general health; muscle strength; bothersome joints; ability to walk, bend, and carry out daily activities; skin (look for rash); and lungs (listen to breathing for signs of inflammation)
• Laboratory tests—tests for certain antibodies (such as rheumatoid factor) to help confirm diagnosis of RA
• X-rays—to examine bone damage in joints

Medications

Medications used to treat RA include analgesics for pain relief, corticosteroids and nonsteroidal anti-inflammatory drugs to reduce inflammation, and disease-modifying antirheumatic drugs to slow disease progression.

Therapy

Healthy behavior changes are often an important part or therapy for RA. Your healthcare team may recommend some of the following steps to help relieve pain, reduce inflammation, slow down or stop joint damage, and improve your well-being and ability to function:

• Physical or occupational therapy: Physical therapy can help you maintain or improve movement, and occupational therapy can help you continue to perform daily tasks and activities.
• Rest and exercise: The right balance between rest and exercise is important for people with RA. Rest keeps you from getting too tired and can reduce joint inflammation and pain. Exercise helps strengthen muscles and keeps joints flexible and mobile. Physical activity can also improve mood and help you maintain or lose weight. Ask your doctor or physical therapist about types of activities that are recommended for people with RA; in general, these include exercises that are easy on the joints—such as walking, water aerobics, and bicycling.
• Joint care: Some people with RA benefit from using a splint on occasion. A splint supports a painful joint and allows it to rest. They’re often used on the wrists, hands, ankles, and feet. Your physical or occupational therapist can help you choose a splint and make sure it fits properly.
• Healthy diet—People with RA are encouraged to eat an overall nutritious diet. Talk to your doctor about any foods you may want to avoid and about specific dietary concerns such as weight loss. A dietician or nutritionist can also help you develop a healthy eating plan. Also ask your doctor if it’s safe for you to consume alcohol, as some medications for RA shouldn’t be combined with alcohol.

People with RA who have severe joint damage may be candidates for surgery. The following procedures are intended to reduce pain, improve joint function, and improve the patient’s ability to carry out daily activities:

• Joint replacement: All or part of the damaged joint is removed and replaced with synthetic components. The most commonly replaced joints are knees and hips.
• Fusion: Also call arthrodesis, fusion involves removing the damaged joint and fusing together the bones to create one immobile unit. Bone grafts are used to fuse the bones, often from one’s own pelvis. Fusion does limit movement but can increase stability and relieve pain. Ankles, wrists, and joints of the fingers and toes are the most commonly fused joints.
• Tendon reconstruction: Rheumatoid arthritis sometimes causes tendons to become damaged or even rupture. Tendon reconstruction, which is most commonly performed on the hands, reconstructs the damaged tendon by attaching an intact tendon to it.

If you’re a candidate for surgery, you and your doctor will discuss the risks and benefits of the intended procedure and your overall health before determining whether surgery is appropriate for you.

To get the most effective treatment for RA, you’ll likely have a team of healthcare professionals. Members of this team may include:

• Orthopedic surgeons (specialists in treatment and surgery of joint and bone conditions)
• Physical therapists
• Occupational therapists
• Dieticians
• Nurse educators (nurses who help patients understand their condition and implement their treatment plan)
• Psychologists

Living with Rheumatoid Arthritis

The affects of RA may not be limited to physical symptoms. You may also find that it affects you emotionally—possibly causing depression, anxiety, feelings of helplessness, and low self-esteem. Emotional support can help you cope with these issues. Friends, family members, RA support groups, or mental health professionals (such as counselors and psychologist) can be good places to turn to for help.

To control the physical symptoms of RA, follow the healthy behavior recommendations of your doctor (such as those described earlier in “Therapy”) and see your doctor regularly. Sticking to an appointment schedule will allow your doctor to monitor the course of RA, change therapies as needed, and make sure medications are effective and not causing negative side effects.

Resources

Arthritis Foundation

American College of Rheumatology

SOURCES

Rheumatoid Arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp. (Accessed October 2010).

Rheumatoid Arthritis. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/arthritis/basics/rheumatoid.htm. (Accessed 2010).