Overview of Rheumatoid Arthritis
Rheumatoid arthritis (RA) affects around one percent of the adult population. Health institutes estimate that as many as 1.3 million people in American have this condition. RA affects women three times as often as men, occurring usually between the ages of 30 and 60 years. However, young children and the elderly can develop this debilitating disorder. RA is a form of inflammatory arthritis and is considered to be an autoimmune disease. The immune system accidently attacks the body tissues, particularly the synovium (lining of the joints). As a result of this attack, the joints become inflamed and fluid builds up inside of them.
Scientists are unsure of the exact cause of RA. They do agree that a combination of environmental and genetic factors contribute to the condition. Researchers have found certain genetic markers that are associated with RA, the immune system, and chronic inflammation. However, not all people with these genes develop RA. Additionally, certain infectious agents may trigger this condition, such as bacteria and viruses. Also, female hormones are thought to play a role, as well as the body's response to physical and emotional trauma. Finally, smoking is linked to an increased risk of developing RA for those who possess the gene.
People with RA experience episodic bouts of intense disease activity, known as flares. For some individuals, the disease is continuously active and only progresses with time. Evidence shows that early diagnosis and treatment can put the disease in remission and is the best chance to prevent joint destruction and organ damage. Various symptoms include:
- Joint pain, swelling, and stiffness
- Symmetrical, affecting both sides of the body
- Systemic, causing fatigue, anemia, and low-grade fever
- Joint deformities – Alignment abnormalities of the joints
- Rheumatoid nodules – Bony prominences over the joints
To diagnose RA, the doctor will take a detailed medical and family history, perform a comprehensive physical examination, and conduct numerous diagnostic tests. These include:
- Blood tests – Including rheumatoid factor, ANA, blood counts, and sedimentation rate
- X-rays – Done to determined bone loss at joint edges and loss of cartilage (erosion)
There is no cure for RA. Treatment is aimed at preventing complications, improving mobility, enhancing quality of life, and alleviating symptoms. Common therapies include:
- Physical therapy – Done to strengthen muscles and bones, increase flexibility, improve stamina, and enhance well-being. A full exercise program includes stretching, aerobic exercise, and strength training.
- NSAIDS – These can relieve pain, reduce inflammation, and alleviate stiffness. Examples include naproxen and ibuprofen.
- Oral and injectable steroids – These medications reduce pain and inflammation, slow joint damage, and improve mobility.
- DMARDS – Disease-modifying antirheumatic drugs can slow the progression of RA, save the joints and tissues from permanent damage, and alleviate RA symptoms. Examples include Arava and Plaquenil.
- Immunosuppressants – These agents reduce the immune system function. Examples include Gengraf and Neoral.
- TNF-alpha inhibitors – Tumor necrosis factor (TNF) alpha is an inflammatory substance produced by the body. Inhibitors of this reduce stiffness, swelling, and pain. Examples are Humira and Remicade.
For severe cases of RA, and when medications fail to slow or prevent joint damage, the doctor may advise surgery to restore joint mobility. Surgery is often done to reduce pain, correct deformities, and improve joint function. Procedures include:
- Total joint replacement – This involves removal of the damaged joint parts and replacing them with a prosthetic or artificial joint, often made of plastic or metal.
- Tendon repair – When inflammation leads to loosened tendons around the joint or tendon rupture, the surgeon can repair these structures to stabilize the joint.
- Joint fusion – For severely damaged joints, the surgeon can surgically fuse a joint in order to realign or stabilize it.