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Rheumatoid Arthritis

Questions

What is Rheumatoid Arthritis ?

Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just joints. In some people, the condition can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels. An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body's tissues. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. While new types of medications have improved treatment options dramatically, severe rheumatoid arthritis can still cause physical disabilities.

Rheumatoid arthritis (RA) usually affects the hands and feet first, but it can occur in any joint. It usually involves the same joints on both sides of the body. Common symptoms include stiff joints, especially upon getting up in the mornings or after sitting down for a while. Some people often experience fatigue and a general feeling of being unwell.

What are the common symptoms of Rheumatoid Arthritis?

RA is a chronic disease marked by symptoms of inflammation and pain in the joints. These symptoms and signs occur during periods known as flares or exacerbations. Other times are known as periods of remission — this is when symptoms disappear completely. While RA symptoms can affect several organs in the body, the joint symptoms of RA include:

·        Joint pain, such as in the joints of the feet, hands, and knees.

·        Swollen joints

·        Fever

·        Limping

·        Loss of range of motion

·        Tender joints

·        Loss of joint function

·        Stiff joints

·        Fatigue

·        Joint redness

·        Rheumatoid nodules

·        Anemia

·        joint warmth

·        Joint deformity, and symptoms and signs that affect both sides of the body (symmetry).

What are the causes of Rheumatoid Arthritis?

Rheumatoid arthritis occurs when your immune system attacks the synovium — the lining of the membranes that surround your joints. The resulting inflammation thickens the synovium, which can eventually destroy the cartilage and bone within the joint. The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint loses its shape and alignment.

The exact cause of RA isn’t known. However, certain factors seem to play a role in increasing the risk of developing RA or triggering its onset. Factors that may increase your risk for RA include:

  • Being a woman
  • Having a family history of RA

Factors that may trigger the onset of RA involve:

  • Exposure to certain types of bacteria, such as those associated with periodontal disease
  • Having a history of viral infections, such as the Epstein-Barr virus, which causes mononucleosis
  • Trauma or injury, such as bone breakage or fracture, dislocation of a joint, and ligament damage
  • Smoking cigarettes
  • Having obesity

Diagnosis of Rheumatoid Arthritis?

Rheumatoid arthritis can be difficult to diagnose in its early stages because the early signs and symptoms mimic those of many other diseases. There is no one blood test or physical finding to confirm the diagnosis. During the physical exam, the doctor will check your joints for swelling, redness and warmth. He or she may also check your reflexes and muscle strength.

Blood tests

People with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate (ESR, or sed rate) or C-reactive protein (CRP), which may indicate the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies.

Imaging tests

Your doctor may recommend X-rays to help track the progression of rheumatoid arthritis in your joints over time. MRI and ultrasound tests can help your doctor judge the severity of the disease in your body.

TREATMENT

There is no cure for rheumatoid arthritis. But clinical studies indicate that remission of symptoms is more likely when treatment begins early with medications known as disease-modifying antirheumatic drugs (DMARDs).

Medications

The types of medications recommended by your doctor will depend on the severity of your symptoms and how long you've had rheumatoid arthritis.

·         NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve).

·         Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage.

·         Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall, Otrexup, others), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine).

·         Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), anakinra (Kineret).These drugs can target parts of the immune system that trigger inflammation that causes joint and tissue damage.

Therapy

Your doctor may send you to a physical or occupational therapist who can teach you exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks, which will be easier on your joints. For example, you may want to pick up an object using your forearms. Assistive devices can make it easier to avoid stressing your painful joints.

Surgery

If medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and improve function. Rheumatoid arthritis surgery may involve one or more of the following procedures:

·         Synovectomy. Surgery to remove the inflamed lining of the joint (synovium) can be performed on knees, elbows, wrists, fingers and hips.

·         Tendon repair. Inflammation and joint damage may cause tendons around your joint to loosen or rupture. Your surgeon may be able to repair the tendons around your joint.

·         Joint fusion. Surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief when a joint replacement isn't an option.

·         Total joint replacement. During joint replacement surgery, your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic.