Rheumatoid Arthritis

RA

Basic Information

What is Rheumatoid arthritis?

Rheumatoid arthritis (RA) is a systemic inflammatory disease that primarily affects synovial tissue that lines joints and tendon sheaths. The disease is one of the autoimmune disorders in which the body seems to not recognize its own self and begins a self-destructive process. The synovial tissue becomes thickened (pannus), and grows to cover the joint surface, tendons, ligaments and joint capsule. The erosive and inflammatory process continues leading to joint destruction, tendon rupture and deformity. The disease may primarily involve the small joints in the hands and feet, or primarily the large joints, or both. The inflammation is usually symmetrical (for example, involving both hands).

Other organs may be affected by the inflammation. Small lumps may develop under the skin (rheumatoid nodules), especially where there is pressure. The eyes sometimes become dry with burning and sensitivity to light (Sjogren's syndrome). Another common organ involvement is the spleen, which becomes enlarged (Felty's syndrome). The disease may involve the lung and/or heart.

Rheumatoid arthritis affects women two to three times more than men, but there does not seem to be any ethnic or racial tendency. The highest incidence is during the middle years of life, but it can strike any age group. There seems to be a genetic indicator involved, as clusters of family members who develop the disease have been noted.

Rheumatoid arthritis signs and symptoms

Slow or sudden onset of:

  • Redness, pain, warmth and tenderness in any or all active joints in the hands, wrists, elbows, shoulders, feet and ankles.
  • Morning stiffness.
  • Low-grade fever.
  • Nodules under the skin (sometimes).

Causes

Unknown, but probably an autoimmune disease.

Risk increases with

  • Family history of rheumatoid arthritis or other autoimmune disorders.
  • Genetic factors, such as autoimmune system defects.
  • Female age 20-50.
  • Native American ethnicity (prevalence is higher in this group).
  • Flare-ups may be triggered by emotional stress.

Preventive measures

No specific preventive measures.

Expected outcomes

  • The disease may be mild or severe. It is presently incurable, but pain relief, prevention of disability and an active, normal life span are usually possible with early diagnosis.
  • Conservative treatment relieves symptoms in 1 year in 75% of patients. About 5% to 10% of patients are eventually disabled, despite treatment.

Possible complications

Drug reactions, multiple system involvement, joint destruction, tendon rupture, neuritis, changes in the blood contents, poor healing response to injury, depression, fatigue, and weight loss are possible complications of RA and its treatment. Neck involvement may lead to spinal instability, usually at C1-C2 joints.

  • Impaired vision.
  • Permanent deformity and crippling.
  • Drugs used in treatment can induce complications, such as gastric problems, and those associated with long-term steroid use.
  • Moderate anemia.

Rheumatoid arthritis treatment

There is no cure for rheumatoid arthritis. Management of the effects of the disease is done by a team of specialists. A pyramid of treatment includes education, rest and exercise, salicylate and other nonsteroidal anti-inflammatory drugs (NSAIDs) and referral to social services. Splints may be used. Joint injections with corticosteroid may be helpful for acute flare ups. As the disease progresses, surgery may be necessary to relieve pain by attempting to restore joint function and to slow the disease by removing the synovial tissue. The drugs used in treatment may be changed to antimalarial and gold, then disease modifying agents such as methotrexate and lastly, experimental drugs such as cyclophosphamide. Corticosteroids are reserved for local injections or if the systemic disease is severe. All of the medications have potential serious side effects.

General measures

  • Laboratory blood studies to detect a rheumatoid factor.
  • Splints at night may be helpful to support and protect a joint with active disease.
  • Gloves at night to retain heat.
  • Relieve pain with heat, including hot soaks, heat lamps, heating pads or whirlpool treatments.
  • If you don't have a firm mattress, place 3/4-inch plywood between your bed springs and mattress to support your back.
  • Consider moving to a dry climate. Damp weather aggravates symptoms.

Medications

  • Nonsteroidal anti-inflammatory drugs, including aspirin and other salicylates; gold compounds; immunosuppressive drugs.
  • Cortisone drugs usually relieve pain dramatically for short periods, but they are less effective for long-term use. They don't prevent progressive joint destruction, and they sometimes have hazardous side effects. Cortisone injections into joints can temporarily relieve pain.

Medications

Information Brand Generic Label Rating
Minocycline Dosage Minocin Minocycline Off-Label
Prednisone Deltasone Prednisone
Carafate Sucralfate
Doryx Doxycycline
Naprosyn Naproxen
Imuran Azathioprine
Arava Leflunomide
Motrin Ibuprofen
Ultram Tramadol

Alternatives

Pseudogout, systemic lupus erythematosus, scleroderma, polyarthritis, osteoarthritis, and osteoporosis must be ruled out.

Activity

  • Stay in bed, except to use the bathroom, until fever and other signs of an active flare-up disappear.
  • Remain active, but include daily rest periods. Sleep for 10 to 12 hours each night. Don't become overtired.
  • Stand, walk and sit erectly.
  • When able, exercise actively to preserve strength and joint mobility. Build up slowly to the amount suggested. Exercising in a heated pool is good for stiff joints.
  • Exercise disabled joints passively to help prevent contractures.

Diet

Eat a normal, well-balanced diet. Avoid arthritis diet fads, which are common. Lose weight if you are obese. Obesity stresses the joint.

Notify your physician if

  • You or a family member has symptoms of rheumatoid arthritis.
  • The following occur during treatment:
  • Fever or symptoms appear in previously unaffected joints.
  • New, unexplained symptoms develop. Drugs in treatment may produce side effects.

Last updated 18 November 2011


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