WHAT IS RHEUMATOID ARTHRITIS?

Rheumatoid arthritis (RA) is one of the most common forms of arthritis. It affects more than 2 million Americans. RA involves swelling of the lining of the joints causing pain, stiffness, warmth, redness and difficult movement. It also can affect internal organs. A person with RA may have a fever, a feeling of tiredness and a decrease in the number of red blood cells (anemia). There is probably no other disease that causes body tissues to suffer such prolonged and sustained inflammation. Sometimes rheumatoid nodules (lumps of tissue under the skin) form close to the joints. Joints commonly affected include the neck, shoulders, elbows, hips, knees and ankles.

WHAT CAUSES RHEUMATOID ARTHRITIS?

The cause of rheumatoid arthritis is unknown. It occurs when the body's natural immune system attacks healthy joint tissue causing swelling and joint damage. Genetics can play a role in the chance of developing the disease. Some scientists believe that bacteria or a virus may trigger the disease. Others believe that certain hormones may play a role. RA is not contagious.

WHO IS AT RISK?

Rheumatoid arthritis occurs in all races and ethnic groups. It occurs much more frequently in women than in men and also may be more severe in women. It occurs at any age from infancy to late adulthood, but it tend to strike during the prime of life in the 30s and 40s.

In some families, inherited factors play a role in a person’s risk for developing arthritis. If a parent or other close relative has been diagnosed with arthritis, it is important to share this history with a health care provider. Early diagnosis and treatment is the key to successful management of arthritis.

HOW IS IT DIAGNOSED?

An analysis of your medical history, a physical examination and blood tests are used to diagnose rheumatoid arthritis. Another blood test indicates the amount of inflammation in the body. Rheumatoid arthritis usually attacks joints in symmetrical fashion. A doctor will suspect this disease when the same joints on both sides of the body are involved. In the affected joints, there are usually pain and swelling and morning stiffness, perhaps the most sensitive measure of the degree of inflammation. X-rays also may be taken to check for damage to the joints.

HOW IS IT TREATED?

Although there is no cure for rheumatoid arthritis, there are many treatments offering relief of symptoms and increasing the ability to function at, or near, normal levels. Medications include non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, which are often used to reduce pain and swelling. Newer drugs called COX-2 inhibitors are used to manage pain and inflammation with fewer stomach ulcers than NSAIDs but are much more expensive. Corticosteroid medications may be used to reduce inflammation and pain. Because of side effects, they cannot be used for long periods of time. Disease-modifying anti-rheumatic agents (DMARDs) are used to limit the amount of joint damage. Biologic response modifiers delay structural damage in patients with moderately to severely active RA. They target the specific components of the immune system that contribute to disease, while leaving other components of the immune system intact. Successful management of arthritis pain and disability includes self-management. It is important for patients to learn about their disease and take part in their own care. Working with health care professionals allows a person to share in decision making and gain a sense of control.

Self-management includes arthritis education, exercise programs, rest, relaxation and stress management, eating well-balance meals and maintaining proper weight, taking care of joints and using assistive devices to rest joints and relieve pressure.

• Exercise can help increase independence, improve mood, decrease pain, increase flexibility, improve blood flow, maintain proper weight and promote general physical fitness. Exercise in a warm water pool is an excellent choice. Physical/occupational therapy can help restore joint movement and increase strength. A therapist can help design an exercise program to meet a person's specific needs.
• Rest also is important. Arthritis may cause tiredness and muscle weakness. A rest or short nap that does not interfere with nighttime sleep may help. Relaxation techniques can be useful in controlling pain. Some people find stress reduction and biofeedback helpful.
• Assistive devices can be used to reduce stress on certain joints. For example, braces or canes may help reduce stress on the knees. Jar grippers or other gadgets may help reduce stress on the small joints of the hands.

Research shows that patients who take part in their own care report less pain and make fewer doctor visits, as well as enjoy a better quality of life.

WHEN SHOULD YOU GET HELP?

Early diagnosis and appropriate treatment are very important in the management of rheumatoid arthritis. Physicians now believe that damage to bones begins within the first two years that a person has the disease. Early diagnosis can decrease symptoms and long-term complications. A person should see a health care professional if symptoms of pain or swelling in multiple joints on both sides of the body develop.

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