Definition
Rheumatoid arthritis (RA) is traditionally considered a
chronic, inflammatory autoimmune disorder that causes the
immune system to attack the joints. It is a disabling and
painful inflammatory condition, which can lead to
substantial loss of mobility due to pain and joint
destruction. RA is a systemic disease, often affecting
extra-articular tissues throughout the body including the
skin, blood vessels, heart, lungs, and muscles.
Causes
As with other forms of arthritis, rheumatoid arthritis
involves inflammation of the joints. A membrane called the
synovium lines each of your movable joints. When you have
rheumatoid arthritis, white blood cells — whose usual job
is to attack unwanted invaders, such as bacteria and
viruses — move from your bloodstream into your synovium.
Here, these blood cells appear to play an important role
in causing the synovial membrane to become inflamed (synovitis).
This inflammation results in the release of proteins that,
over months or years, cause thickening of the synovium.
These proteins can also damage cartilage, bone, tendons
and ligaments. Gradually, the joint loses its shape and
alignment. Eventually, it may be destroyed.
Some researchers suspect that rheumatoid arthritis is
triggered by an infection — possibly a virus or bacterium
— in people with an inherited susceptibility. Although the
disease itself is not inherited, certain genes that create
an increased susceptibility are. People who have inherited
these genes won't necessarily develop rheumatoid
arthritis. But they may have more of a tendency to do so
than others. The severity of their disease may also depend
on the genes inherited. Some researchers also believe that
hormones may be involved in the development of rheumatoid
arthritis.
Risk
factors
The exact causes of rheumatoid arthritis are unclear, but
these factors may increase your risk:
-
Getting older,
because incidence of rheumatoid arthritis increases with
age. However, incidence begins to decline in women over
the age of 80.
-
Being female.
-
Being exposed
to an infection, possibly a virus or bacterium, that may
trigger rheumatoid arthritis in those with an inherited
susceptibility.
-
Inheriting
specific genes that may make you more susceptible to
rheumatoid arthritis.
-
Smoking
cigarettes over a long period of time.
Symptoms
The
disease usually begins gradually with fatigue, morning
stiffness (lasting more than one hour), widespread muscle
aches, loss of appetite, and weakness. Eventually, joint
pain appears. When the joint is not used for a while, it
can become warm, tender, and stiff. When the lining of the
joint (synovium) becomes inflamed, it gives off more fluid
and the joint becomes swollen. Joint pain is often felt on
both sides of the body, and may effect the wrist, knees,
elbows, fingers, toes, ankle or neck. Additional symptoms
include:
-
Loss of
appetite
-
Low-grade
fever
-
Limited range
of motion
-
Deformities of
hands and feet
-
Round,
painless nodules under the skin (usually a sign of more
severe disease)
-
Inflammation
of the lung (pleurisy)
-
Skin redness
or inflammation
-
Paleness
-
Swollen glands
-
Eye burning,
itching, and discharge
-
Numbness or
tingling
-
Anemia may
occur due to failure of the bone marrow to produce
enough new red cells.
Joint destruction may occur within 1-2 years after the
appearance of the disease.
Signs and Tests
-
Joint x-rays
-
Rheumatoid
factor test is positive in about 75% of people with
symptoms
-
Erythrocyte
sedimentation rate is elevated
-
CBC may show
low hematocrit (anemia) or abnormal platelet counts
-
C-reactive
protein may be a positive indication for patients with
no detectable rheumatoid factor
-
Synovial fluid
analysis
Treatment
Treatments for arthritis have improved in recent years.
Most treatments involve medications. But in some cases,
surgical procedures may be necessary.
Medications
Medications for rheumatoid arthritis can relieve its
symptoms and slow or halt its progression. They include:
-
Nonsteroidal
anti-inflammatory drugs (NSAIDs)
-
COX-2 inhibitors
-
Corticosteroids
-
Disease-modifying
antirheumatic drugs (DMARDs)
-
Immunosuppressants
-
TNF blockers
-
Interleukin-1
receptor antagonist (IL-1Ra)
-
Abatacept (Orencia)
-
Rituximab (Rituxan)
Surgical or other
procedures
Although a combination of medication and self-care is
the first course of action for rheumatoid arthritis, other
methods are available for severe cases:
-
Prosorba column.
This blood-filtering technique removes certain
antibodies that contribute to pain and inflammation in
your joints and muscles and is usually performed once a
week for 12 weeks as an outpatient procedure. Some of
the side effects include fatigue and a brief increase in
joint pain and swelling for the first few days after the
treatment. The Prosorba column treatment isn't
recommended if you're taking angiotensin-converting
enzyme (ACE) inhibitors or if you have heart problems,
high blood pressure or blood-clotting problems.
-
Joint replacement
surgery. For many people with rheumatoid
arthritis, medicines and therapies can't prevent joint
destruction. When joints are severely damaged, joint
replacement surgery can often help restore joint
function, reduce pain or correct a deformity. You may
need to have an entire joint replaced with a metal or
plastic prosthesis. Surgery may also involve tightening
tendons that are too loose, loosening tendons that are
too tight, fusing bones to reduce pain or removing part
of a diseased bone to improve mobility. Your doctor may
also remove the inflamed joint lining (synovectomy).
