ABOUT RHEUMATOID ARTHRITIS |
arthritis is the second most common form of the more
than 120 types of arthritis known to occur in patients.
Rheumatoid arthritis, also called R.A., is the type
of arthritis which is characterized by chronic inflammation
of the involved joints, and is most often accompanied
by swelling, pain, deformity, and stiffness. The cause
of rheumatoid arthritis is not known, although it is
thought to be an autoimmune disease, one in which the
body attacks the joints as if they are a foreign matter.
Does R.A. Occur?
order to understand how R.A. occurs, a basic understanding
of a joint and its function may be helpful. A joint is
the meeting of two bones. It consists of six parts - cartilage,
synovial membrane, bursa, muscle, tendon and ligament.
In each type of arthritis, a different part of the joint
tissue is involved. In rheumatoid arthritis the synovial
membrane is the part that becomes affected, and the patient
suffers from synovitis or inflammation of this membrane.
This synovitis of the joint membrane causes enzymes to
be released. These enzymes act as an erosive type of chemical
substance and cause a chronic inflammatory process within
the joint lining. Over time, the joint lining swells and
thickens, causing damage to the joint surface.
is Affected by R.A.?
to the Arthritis Foundation, a non-profit organization
that works for all people affected by arthritis, approximately
two million people in the United States alone have R.A.
Most people with R.A. are women. Rheumatoid arthritis
usually occurs in mid life between the forties or fifties,
but can start at any age. It also can occur in children
and in these cases is quite different from the adult onset.
and Features of R.A.
is important to remember that R.A., although a chronic
disease, is also one in which there are ups and downs.
Periods of "flares," when the symptoms are increased,
may alternate with periods of remission in which the symptoms
may decrease or go away entirely. These periods of remission
may last months or years, and it is common for even the
worst types of R.A. to lessen with time. However, it is
very important for the patient with rheumatoid arthritis
to understand that while overall symptoms may decrease
over time, any prior destruction to joints that are involved
will not improve. This fact becomes very important in
the later discussion of treatment for the diseases
in the table below are the symptoms, joints involved,
and other features usually seen in rheumatoid arthritis.
symmetrical (occurring both sides)
(inflamed blood vessels)
aches and stiffness, especially in A.M. or after
sitting ("gel phenomenon")
affect heart, lungs, eye
or sudden onset
or deformed joints over time
the symptoms of rheumatoid arthritis may develop slowly
over a period of time, the diagnosis of this disease
may not be apparent at first. The diagnosis of R.A.
is based on the overall symptoms, medical history, and
specific tests the physician orders.
initial physical exam - During this
exam, the physician may well try to identify signs
of joint swelling, tenderness, and warmth. A complete
medical history performed by the physician may also
aid in the diagnosis.
- Both blood and joint samples may be used to assist
the physician in diagnosing the disease. Common tests
performed are listed below.
- This blood test is helpful in identifying an
abnormal substance found in the blood of approximately
80% of adult patients with R.A. However, this
factor can be seen in diseases other than R.A.
and may not be seen in some patients who have
rate or Erythrocyte sedimentation rate
- This blood test measures
how quickly red blood cells settle to the bottom
of a test tube. These blood cells tend to fall or
settle more quickly in patients with R.A. or other
inflammatory diseases. The sed rate, while not conclusive
as a diagnostic test, can be helpful in assessing
the severity of the disease.
or red blood cell count -
This blood test is performed to identify the presence
of anemia which often occurs in R.A. and may contribute
to the fatigue many R.A. patients experience.
Aspirations and Biopsies
- The withdrawal of fluid from a swollen
joint or the biopsy of inflamed joint tissue may
assist the physician in determining the presence
of R.A. One or both of these tests may be performed
in patients who present with symptoms of the disease
- Because it may take time to see changes in bone
from R.A., X-rays may not be very helpful in the initial
diagnosis. However, most physicians include x-rays
in the diagnostic work-up because they can provide
a baseline in later measuring the amount of joint
damage and disease progression a patient with R.A.
The treatment of rheumatoid arthritis
can sometimes appear complicated and confusing to the
patient and his family. No current treatment can stop
or reverse the R.A. process but many of the current
therapies available can help the patient lead a life
that is as normal as possible.
Perhaps the most important guideline for treatment of
rheumatoid arthritis is the importance of realizing
that with R.A. it is strongly felt that you should be
seen early in the disease process, and that you should
be evaluated and followed by a rheumatologist, a physician
who specializes in the treatment of arthritis. By following
this recommendation, you will be treated by a specialist
who is familiar with the most current as well as the
most effective treatments available for R.A.
goals of treatment for the patient with R.A. are:
order to achieve these goals, treatment of the patient
with R. A. is multi focused. It combines medication,
exercise, joint protection, rest, heat and cold therapy,
and surgery when needed. In addition, educating patients
and helping them to manage the stress and depression
that can accompany a chronic illness such as R.A. is
also a vital part of the treatment program.
Medications are almost always
required by patients with R.A.. Multiple medications
are available and it may take several attempts to
find the correct medication for each individual.
or NSAIDS (non-steroidal anti-inflammatory drugs)
- These medications reduce joint pain,swelling, and
stiffness. They may be given in pill or liquid form.
There are many different types of these medications
and it may be necessary to try several of them before
finding the one that works best.
-These are strong hormone medications and are used
only when the disease is active and
not responding to other medications. When given over
long periods they are taken in the smallest possible
dosage. Sometimes corticosteroids can be injected
directly into a joint to bring short-term relief,
but again this is not done repeatedly if other options
Antirheumatic Drugs (SAARDS)
- While NSAIDS and corticosteroids can provide quick
relief from pain and swelling in patients with R.A.,
they do not slow the disease process. The slow-acting
antirheumatic drugs work more slowly, but can slow
the disease process in some cases. Examples of SAARDS
include gold salts, plaquenil, penicillamine, Azulfidine,
and immunosuppressive drugs such as Imuran and Methotrexate.
- Regular exercise helps keep
joints flexible, muscles strengthened, and
improve overall fitness. For patients with R.A., this
is extremely important. The ideal program for this
type of patient is one which includes a combination
of range of motion exercises to prevent joint stiffness,
muscle strengthening exercises to provide support
to joints, and endurance exercises to improve overall
fitness. As with any exercise program, it is important
to check with your doctor before initiating any routine.
It may also be recommended that you work with a physical
therapist to help identify the best program for you
as an individual.
- Learning how to perform daily routines while placing
the least amount of stress on your joints is the goal
of a joint protection program. This may involve the
use of assistive devices such as canes, walkers, or
splints. It may also involve the use of self-help
devices for bathing, dressing, and managing household
tasks. An occupational therapist who is specially
trained in this area may be someone your physician
recommends for assistance in this area.
An important part of R.A. treatment is knowing how
to balance rest and activity. During an acute flare
of the disease, more rest will be needed. During other
times, less rest and more exercise will be required.
In general, it is important to know that this will
occur and to try planning your activities based on
- Heat can be used to relieve
pain and soreness in joints, while cold applications
may reduce swelling and help to numb an area of pain.
Many methods, from warm showers, hot packs, cold compresses
or even creams or ointments may be used to achieve
relief. Discussing which treatment may be best is
something that certainly should be done with your
physician or therapist.
much interest has been generated in the use of glucosamine,
chondroitin sulfate, or a combination of these substances.
Laboratory and clinical studies have suggested that
these materials, which are the building blocks for
cartilage, may have a positive effect on cartilage
and arthritis. One nutritional supplement, Cosamin
DS, is a patented combination of these two materials.
We are currently involved in a study to test the use
of this combination in the treatment of OA. Preliminary
studies indicate that it may also be effective in
the treatment of rheumatoid arthritis, but more studies
electromagnetic therapy has been used to stimulate
healing in the treatment of fractures. Although it
has been approved for a number of orthopaedic applications
in more than 20 countries throughout the world, it
is not approved for use in the United States except
for those patients enrolled in FDA-approved studies.
and Managing Stress and Depression
- Living with a chronic disease
such as R.A. can be a mild inconvenience or a frustrating
and perhaps depressing experience at times. Learning
about the disease and strategies to assist in coping
with it can help you to feel better about yourself.
Many patients find it useful to learn relaxation techniques
and other methods to assist them in reducing the stress
or anxiety which may occur as a result of their R.A.
Others may find it beneficial to join a support group
of R.A. patients who can identify with their feelings
and possibly offer new ideas on coping with the disease.
By contacting your local Arthritis Foundation Chapter
you may also learn of other aids available to help
you with your disease.
surgeries may be
beneficial to patients with rheumatoid arthritis.
These surgeries may help to relieve pain and restore
function to a damaged joint. Surgeries which can be
Future of R.A.
research into the cause and treatment of rheumatoid
arthritis as well as other forms of arthritis continues
everyday across the country. It is hoped that through
continued efforts new and even more
effective treatments will become available to all patients
who are diagnosed with this disease.
K., Fries, J., The Arthritis Helpbook, 4th ed.,
Addison-Wesley Publishing Co., 1995
I., All About Bone - An Owner's Manual, Demos Medical
Publishing, Inc., 1998
J., Adderly, B., Fox, B., Maximizing the Arthritis
Cure, St. Martin's Press, 1998
Information Rheumatoid Arthritis, The Foundation,
1983, 1987, 1990