Rheumatoid Arthritis

What is Rheumatoid Arthritis (RA) ?

RA is an autoimmune disorder that causes inflammation of the lining of the joints. The body tissue is mistakenly attacked by its own immune system. RA may also affect the skin, eyes, lungs, heart, blood, or nerves. Rheumatoid arthritis is a chronic disorder, meaning that although there may be occasional symptom-free periods, the disease can worsen over time and may never go away. Early, aggressive treatment is key to slowing or stopping its progression.

RA Symptoms

Similar to other types of arthritis, joint inflammation from RA comes with pain, warmth, and swelling. But unlike other types of arthritis, the inflammation is typically symmetrical, occurring on both sides of the body simultaneously (such as the wrists, knees, or hands). Other symptoms of RA include joint stiffness, particularly in the morning or after periods of inactivity; ongoing fatigue, and low-grade fever. Symptoms typically develop gradually over years, but can come on rapidly for some people.

Who Gets Rheumatoid Arthritis ?

RA usually strikes between ages 30-50, but younger and older people can also be affected. RA occurs 2-3 times more often in women than in men. Other risk factors include cigarette smoking and family history.

Rheumatoid Arthritis Causes

Immune cells, such as lymphocytes, normally protect the body from foreign invaders. What causes them to target healthy joints and tissue is unknown, but researchers believe some combination of genetics and environmental factors may play a role. There may be a genetic predisposition in some people who, if they develop an infection with a particular bacterium or virus, go on to develop the condition. But to date, no specific infection has been identified.

RA’s Toll on the Joints

Inflammation of the lining of the joints (called synovium) can destroy cartilage and bone, causing deformity of the joints. As the condition progresses, joints can develop considerable pain and loss of function.

RA’s Toll on the Body

Because RA is a systemic disease, it can affect organs and areas of the body other than the joints, including:

• Rheumatoid Nodules (shown here): firm lumps under the skin and in internal organs
• Sjogren's syndrome: inflammation and damage of the glands of the eyes and mouth; other parts of the body can also be affected
• Pleuritis: inflammation of the lung lining
• Pericarditis: inflammation of lining surrounding the heart
• Anemia: reduction of red blood cells
• Felty syndrome: reduction of white blood cells, associated with enlarged spleen
• Vasculitis: blood vessel inflammation, which can impair blood supply to tissues

Juvenile Rheumatoid Arthritis (JRA)

JRA is classified by how many joints are affected: oligo- or pauci- articular JRA (four or fewer joints affected), polyarticular JRA (five or more joints affected), or systemic JRA (other organs also affected).

RA and Pregnancy

Surprisingly, rheumatoid arthritis improves in up to 80% of women during pregnancy, though the disease may flare up after delivery. How and why this happens is still unclear. If you are trying to conceive, ask your doctor which RA mediations are safe for you to take. Medication adjustments may be necessary before you become pregnant and during pregnancy.

Diagnosing RA : Evaluating Symptoms

Because symptoms may come and go, diagnosing RA in its early stages is challenging. Observance of these signs and symptoms may prompt your doctor to order further tests:

• Morning joint stiffness
• Swelling/fluid around three or more joints simultaneously
• Swelling in the wrist, hand, or finger joints
• Symmetrical joints affected
• Firm lumps under the skin (rheumatoid nodules)

Diagnosing RA : Blood Tests

If RA is suspected, your doctor may order blood tests to check for markers of inflammation in the body. Other common tests are for rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP), which is present in most cases of RA.

Diagnosing RA : Imaging Tests

X-rays are helpful in diagnosing RA, to provide a baseline for comparison later as the disease progresses. An MRI or ultrasound may also be done to help detect joint damage and inflammation.

Treating RA

There is no known cure for RA. The goal of treatment is to reduce joint inflammation and pain, prevent joint destruction, and maximize joint function. Aggressive treatment should be started as early as possible. Treatment includes a combination of medication and exercises to strengthen supporting muscles around the joints. Treatment may also include surgery. Treatment is tailored to the individual, taking into account their age, affected joints, and the progression of the disease.

RA Medications

Medications used to treat RA include disease-modifying antirheumatic drugs (DMARDs) which include biologics, nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and analgesics (pain drugs). DMARDs slow progression of disease and are often used with NSAIDs and steroids in treatment.

Is Surgery an Option ?

After significant joint damage has occurred or when pain or disability becomes unbearable, some people choose surgery to improve function and relieve pain. Joint replacement is the most frequently performed surgery for RA patients -- with the knee and hip joints most often replaced. Other types of surgery, such as arthroscopy (inserting a tube-like instrument into the joint to see and repair abnormal tissues) and tendon reconstruction, can be performed as well.

Other Treatments for RA

Some RA patients have found relief in the following: moist heat, relaxation remedies, and acupuncture. There is no conclusive evidence that any herbal or dietary supplement can effectively treat RA. Consult your doctor before beginning any complementary or alternative therapy.

RA and Diet

The most important diet is a healthy one that is balanced in nutrients. Although there’s no “arthritis diet” per se, RA sufferers may find that eating or avoiding certain foods helps their symptoms. Foods high in saturated fats (bacon, steak, butter) have been shown to increase inflammation in the body. Some people with RA find a diet high in omega-3 fatty acids (salmon, tofu, walnuts) helpful. Some people feel that other foods -- such as tomatoes, citrus fruits, white potatoes, peppers, coffee, and dairy -- worsen RA symptoms.

The Importance of Exercise

It may seem counterintuitive, but regularly exercising those stiff, painful joints can reduce the overall pain of RA. Plus, it can keep bones and muscles strong, and help reverse joint stiffness. Choose exercises such as stretching, resistance training, and low-impact aerobics (swimming, water aerobics). Use caution with any exercise that puts pressure on the joints, like jogging and heavy weight lifting. See your doctor before starting an exercise program.