|
What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is an inflammatory disease that causes pain, swelling, stiffness and loss of function in the joints. It has several special features that make it different from other kinds of arthritis.
For example, RA is symmetrical, usually affecting joints on both sides of the body - like both knees or both hands. The wrist joints and the finger joints closest to the hand are often involved. Joint stiffness in the morning (or after a long rest) lasts longer than 30 minutes. Other organs besides the joints may be affected, and people with RA may suffer from fatigue, occasional fever and an overall sense of not feeling well.
RA also varies greatly from person to person. For some, it lasts only a few months or years, and then goes away without causing any noticeable damage. Others have mild-to-moderate disease, with periods of worsening symptoms (flares) interspersed between periods of feeling well (remissions). Still others have severe disease that is active most of the time, lasts for many years, and leads to serious joint damage and disability.
Although RA can have serious effects on a person's life, current treatments allow most people with the disease to lead active and productive lives. Research has given us a new understanding of RA, increasing the likelihood that we will ultimately find ways to cure this disease.
How RA affects the joints
Your immune system is made up of cells and blood factors that protect you against infection by attacking bacteria, viruses and other invaders. In RA, the immune system, for unknown reasons, attacks a person's own cells, inside the joints. This is why RA is often described as an autoimmune disease.
The immune system's attack on the joints causes inflammation, which a person with RA notices as warmth, redness, swelling and pain in or around the affected joints. As the disease progresses, the bone and cartilage within the joint is destroyed, and the muscles, tendons and ligaments surrounding and supporting the joint become weak and unable to function normally. All these effects lead to the pain and deformities often seen in RA.
Doctors studying RA now believe that damage to joints begins during the first year or two that a person has the disease. This is one reason why early diagnosis and treatment are so important in managing RA.
The impact
About 2.1 million Americans have RA. The disease occurs in all races and ethnic groups. Although RA often begins in people ages 25 to 50, children and teenagers can also develop it. RA occurs much more often in women than in men. Researchers aren't sure why.
The financial, social and personal impact of RA is substantial. Within the United States, costs related to the treatment of RA and lost wages due to disability add up to millions of dollars. In some cases, RA can interfere with a person's ability to carry out normal activities and can affect job opportunities and family life. However, self-management programs can help people with RA cope with the pain and other effects of the disease and to preserve their independence and productivity.
Diagnosis
RA may take time to diagnose in the beginning, for several reasons:
No single test definitively proves a patient has the disease. Symptoms differ from person to person. Symptoms may be similar to those of other types of arthritis, which must be eliminated as possible causes. The full range of RA symptoms often develops over time.
Doctors generally rely on the patient's description of symptoms and the physical exam to detect RA. They may also order a lab test for rheumatoid factor, an antibody found in the blood of RA patients. However, rheumatoid factor is not always present in RA patients, and not all patients who test positive for this factor have RA.
X-rays may help determine the degree of joint destruction in RA patients, and to monitor them for disease progression. They are not as useful early in the disease, before joint damage is obvious on X-rays.
Treatment
It is important for people with RA to participate actively in their own care. Studies show people who do so have less pain and make fewer visits to the doctor than others with RA. Good communication between patient and doctor is also key.
The goals of treatment for RA are to:
These goals may be met through lifestyle activities, medication and ongoing care. Sometimes surgery is also needed.
Lifestyle activities include a good balance between rest and exercise. Exercise improves muscle strength and can help people sleep well and reduce pain. Rest helps reduce active joint inflammation and pain, and fight fatigue. Taking care of affected joints - for example, supporting a painful joint with a splint or using devices to help with daily tasks and reduce joint stress - can also help reduce pain and swelling. Stress reduction techniques may lessen the amount of pain.
Medications for RA include pain relievers, anti-inflammatory agents and disease-modifying anti-rheumatic drugs (DMARDs). DMARDs are used to slow the progress of the disease. Traditionally, doctors first prescribed pain relievers to people with RA and administered more powerful drugs later only after the disease became worse. Recently, many doctors have changed their approach, prescribing more powerful drugs earlier to halt disease progression and reduce or prevent joint damage.
Other medications include:
- Steroids (methylprednisolone and prednisone). These steroids are available as pills or for injection into a joint. You will start to feel better up to 24 hours after getting the drug. You may have some serious side effects, especially at high doses. Steroids are used for severe flares and when NSAIDs and DMARDs don't work.
- Biologic response modifiers. These drugs selectively block parts of the immune system called cytokines, which play a role in inflammation.
- Tumor necrosis factor inhibitors (etanercept, infliximab and adalimumab). These medications work well for people who don't have much luck with DMARDs. Your doctor may give you them along with some DMARDs, particularly methotrexate. Etanercept requires injections two times per week. Infliximab is injected into a vein during a two-hour procedure. Adalimumab requires injections every two weeks.
- Interleukin-1 inhibitor (nakrina). This medication requires daily injections.
Surgery that may help people with RA who have severe joint damage include joint replacement and tendon reconstruction. Surgery is not for everyone, however, and the decision to take this route should be made only after careful consideration by the patient and the doctor working together.
Ongoing medical care is important for people with RA. The patient and doctor need to monitor the course of the disease, decide whether a medication is effective or not and change therapy as needed.
Current research
Researchers are studying genetic factors that predispose some people to develop RA. Some believe bacterial or viral infections may trigger RA in people with an inherited predisposition for the disease. Identifying how this occurs could lead to new therapies or even strategies for preventing RA. Scientists are also searching for drugs or combinations of drugs that can reduce inflammation and slow or stop the progression of RA, while causing few side effects.
In addition, investigators are examining issues related to the quality of life for RA patients, and the quality, cost, and effectiveness of health care services. They have found that even a small improvement in a person's sense of physical and mental well-being can have an impact on quality of life.
The results from RA research are having an impact today, enabling people with RA to remain actively involved in family and work life far longer than was possible 20 years ago. There is every reason to believe that research advances will continue to improve the quality of life for RA patients.
What is the difference between RA and osteoarthritis?
RA usually first appears in people between ages 25 and 50, but can occur in young children and even small babies. The disorder may develop quickly after the first symptoms appear, over a period of weeks or months. It typically causes inflammation of the joints and usually involves the joints on both sides of the body. Many joints may be affected. Patients may have a sense of overall sickness and fatigue, and may experience fever and weight loss. Morning joint stiffness may be prolonged.
Osteoarthritis is usually found in middle-aged to older people and develops slowly over many years. Inflammation of the joints is not common, although pain, stiffness and limitation of motion may be present. If one joint is affected, the corresponding joint on the other side of the body may not be. In addition, pain is usually limited to the affected joint. Weight-bearing joints like the knees and hips are most often involved. Patients may get up in the morning with joint stiffness, but it usually goes away gradually as the joint is used.
Points to remember
- RA is an autoimmune disease that causes pain, swelling, stiffness and loss of function in the joints.
- People with RA may also have an overall sense of not feeling well, fatigue and fever.
- The symptoms of RA vary quite a bit from one person to another, and its course is not always predictable. Sometimes people with RA can feel fine, sometimes they need to take time to recover from a "flare" of joint pain and overall discomfort.
- Strategies for managing RA help many patients lead active lives and minimize pain. Continuing research into RA means there is hope for still more effective medications and other treatment strategies.
|
Related Articles
|
|
External Sources
 |
National Institute of Arthritis and Musculoskeletal and Skin Diseases
|
|
The Arthritis Foundation
|
|
The American College of Rheumatology
|
|
This article was reviewed and updated June 2007.
Return to the previous page
|
