About Rheumatoid Arthritis


Overview:

Rheumatoid arthritis (RA) is a long-term disease that leads to inflammation of the joints and surrounding tissues. It can also affect other organs.

Symptoms:

The disease usually begins gradually with:

  • Fatigue
  • Loss of appetite
  • Morning stiffness (lasting more than 1 hour)
  • Widespread muscle aches
  • 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 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 affect the fingers, wrists, elbows, shoulders, hips, knees, ankles, toes, and neck.

Additional symptoms include:

  • Anemia due to failure of the bone marrow to produce enough new red blood cells
  • Eye burning, itching, and discharge
  • Hand and feet deformities
  • Limited range of motion
  • Low-grade fever
  • Lung inflammation (pleurisy)
  • Nodules under the skin (usually a sign of more severe disease)
  • Numbness or tingling
  • Paleness
  • Skin redness or inflammation
  • Swollen glands
  • Joint destruction may occur within 1-2 years after the appearance of the disease.

Causes:

The cause of RA is unknown. It is considered an autoimmune disease. The body’s immune system normally fights off foreign substances, like viruses. But in an autoimmune disease, the immune system confuses healthy tissue for foreign substances. As a result, the body attacks itself.

RA can occur at any age. Women are affected more often than men.

RA usually affects joints on both sides of the body equally. Wrists, fingers, knees, feet, and ankles are the most commonly affected. The course and the severity of the illness can vary considerably. Infection, genes, and hormones may contribute to the disease.

Tests & diagnosis:

A specific blood test is available for diagnosing RA and distinguishing it from other types of arthritis. It is called the anti-CCP antibody test. Other tests that may be done include:

  • Complete blood count
  • C-reactive protein
  • Erythrocyte sedimentation rate
  • Joint ultrasound or MRI
  • Joint x-rays
  • Rheumatoid factor test (positive in about 75% of people with symptoms)
  • Synovial fluid analysis

Prognosis:

Regular blood or urine tests should be done to determine how well medications are working and if drugs are causing any side effects.

RA differs from person to person. People with rheumatoid factor, the anti-CCP antibody, or subcutaneous nodules seem to have a more severe form of the disease. People who develop RA at younger ages also seem to get worse more quickly.

Many people with RA work full-time. However, after many years, about 10% of those with RA are severely disabled, and unable to do simple daily living tasks such as washing, dressing, and eating.

In the past, the average life expectancy for a patient with RA could be shortened by 3-7 years. Those with severe forms of RA would often die 10-15 years earlier than expected. However, as treatment for rheumatoid arthritis has improved, severe disability and life-threatening complications have decreased considerably and many people live relatively normal lives.

Treatment:

RA usually requires lifelong treatment, including medications, physical therapy, exercise, education, and possibly surgery. Early, aggressive treatment for RA can delay joint destruction.

Medications:

Disease modifying antirheumatic drugs (DMARDs): These drugs are the current standard of care for RA, in addition to rest, strengthening exercises, and anti-inflammatory drugs. Methotrexate (Rheumatrex) is the most commonly used DMARD for rheumatoid arthritis. Leflunomide (Arava) may be substituted for methotrexate. These drugs are associated with toxic side effects, so you will need frequent blood tests when taking them.

Anti-inflammatory medications: These include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Although NSAIDs work well, long-term use can cause stomach problems, such as ulcers and bleeding, and possible heart problems. NSAID packaging now carries a warning label to alert users of an increased risk for cardiovascular events (such as heart attack or stroke) and gastrointestinal bleeding.

Antimalarial medications: This group of medicines includes hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine), and is usually used in combination with methotrexate. It may be weeks or months before you see any benefit from these medications.

Corticosteroids: These medications work very well to reduce joint swelling and inflammation. Because of potential long-term side effects, however, corticosteroids should be taken only for a short time and in low doses when possible.

Cyclooxygenase-2 (COX-2) inhibitors: These drugs block an inflammation-promoting enzyme called COX-2. This class of drugs was initially believed to work as well as traditional NSAIDs, but with fewer stomach problems. However, numerous reports of heart attacks and stroke have prompted the FDA to re-evaluate the risks and benefits of the COX-2s. Celecoxib (Celebrex) is still available, but labeled with strong warnings and a recommendation that it be prescribed at the lowest possible dose for the shortest possible duration. Talk to your doctor about whether COX-2s are right for you.

Biologic Agents:

Specific white blood cell modulators: These treatments effectively control inflammation. They include:

  • Orencia (abatacept) – Given under the skin (subcutaneously) or into a vein (intravenously) once a month. Reduces the number of T-cells (a type of white blood cell).
  • Rituxan (rituximab) – Given under the skin or into a vein twice a year. Reduces the number of B-cells (a types of white blood cell).

Tumor necrosis factor (TNF) inhibitors: This class of medications block a protein in the body involved in creating inflammation. They are given under the skin or directly into a vein. They include:

  • adalimumab (Humira)
  • etanercept (Enbrel)
  • infliximab (Remicade)

Surgery:

Occasionally, surgery is needed to correct severely affected joints. Surgeries can relieve joint pain, correct deformities, and modestly improve joint function.

The most successful surgeries are those performed on the knees and hips. The first surgical treatment is a synovectomy, which is the removal of the joint lining (synovium).

A later alternative is total joint replacement with a joint prosthesis. In extreme cases, total knee or hip replacement can mean the difference between being totally dependent on others and having an independent life at home.

Physical Therapy:

Range-of-motion exercises and individualized exercise programs prescribed by a physical therapist can delay the loss of joint function.

Joint protection techniques, heat and cold treatments, and splints or orthotic devices to support and align joints may be very helpful.

Sometimes therapists will use special machines to apply deep heat or electrical stimulation to reduce pain and improve joint mobility.

Occupational therapists can construct splints for the hand and wrist, and teach how to best protect and use joints when they are affected by arthritis. They also show people how to better cope with day-to-day tasks at work and at home, despite limitations caused by RA.

Frequent rest periods between activities, as well as 8 to 10 hours of sleep per night, are recommended.

Prevention:

Rheumatoid arthritis has no known prevention. However, it is often possible to prevent further damage of the joints with proper early treatment.

Stop smoking. Research shows that the risk of developing RA is nearly double for current smokers compared with non-smokers.

Because RA may cause eye complications, patients should be have regular eye exams.

Complications:

Rheumatoid arthritis is not solely a disease of joint destruction. It can involve almost all organs.

A life-threatening joint complication can occur when the cervical spine (neck bones) becomes unstable as a result of RA.

Rheumatoid vasculitis (inflammation of the blood vessels) is a serious, potentially life-threatening complication of RA. It can lead to skin ulcerations and infections, bleeding stomach ulcers, and nerve problems that cause pain, numbness, or tingling. Vasculitis may also affect the brain, nerves, and heart, which can cause stroke, heart attack, or heart failure.

RA may cause the the outer lining of the heart to swell (pericarditis) and cause heart complications. Inflammation of the heart muscle, called myocarditis, can also develop. Both of these conditions can lead to congestive heart failure.

The treatments for RA can also cause serious side effects. If you experience any side effects, immediately tell your health care provider.

When to contact a doctor:

Call your health care provider if you think you have symptoms of rheumatoid arthritis.

SOURCE: https://health.google.com/health/ref/Rheumatoid+arthritis

Comments
  1. Lee says:

    Are you on all of these drugs for the rest of your life? Does the pain come back if you go off of them?

    • katiestew says:

      Hi Lee – The answer to your questions really depends on the individual with RA. Some people are able to go into permanent remission while others like myself stay on drugs for years, trying different combinations and searching for what might work best for them. I have personally tried to go off drugs completely a few times because there isn’t any other way to tell if you’ve gone into remission unless you do… But the pain always seems to come back to me.

  2. faith says:

    hi katiestew my name is faith the dr said i have inflammatory arthritis prednisone did not work well for me so i am currently on methetrexate and folic acid it was working for me but it just doesn’t seem like it is working that well anymore the morning stiffness is back my knees fingers shoulders feet toes and elbows hurt. i was hoping maybe u might know something that could help.i have good days but lately bad.i exercise a few days a week. thank u for listening.u have a blessed day

    • katiestew says:

      Hi Faith – have you tried any of the biological drugs for RA? I would suggest discussing the possibility of biological treatment options with your rheumatologist. They have honestly changed my life and I know they’ve done the same for lots of other folks, too. I would also recommend experimenting with acupuncture, heat and physical therapy. All the best to you!!!

  3. Finally do bear in mind that acupuncture should only be given by those who are fully qualified. This is not some thing to try at residence! And nor should acupuncture be tried by anyone who has a difficulty with bleeding or a blood disorder. Always consult your medical practitioner before undertaking acupuncture.Please bear in mind that this article is for general info purposes only and isn’t medical advice about your well being. If you have a medical condition or issue you need to constantly consult your doctor as to the matter which might be a lot more serious than you realise.

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Hi and thanks for stopping by katiestew.wordpress.com! I will review and approve your comment shortly. If you have questions or want to get in touch, please feel free to email me at katiestew18@hotmail.com or follow me via twitter at @kstew_arthritis. Stay well!

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