X-ray showing the deformity caused by Rheumatoid Arthritis to the hand
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By: Sara M. Aksoy
Though one of the most common forms of arthritis, rheumatoid arthritis (RA) still remains much of a mystery. Affecting nearly one percent of the population, RA involves inflammation of the synovium, or lining of the joint capsule. Unlike the more common osteoarthritis, whose effects are confined to the joint, rheumatoid arthritis is a systemic disease that involves multiple parts of the body.
Rheumatoid arthritis is an autoimmune disease where the body’s immune system loses the ability to differentiate between itself and antigens, substances that the body regards as foreign. The body, seeing “self” as “foreign,” begins to attack its own tissues, including the synovium among other organs.
Causes of rheumatoid arthritis are not fully known, but are a subject of intense research. One theory is that the body encounters an infectious agent that under normal cases causes no long-term affect but in a few triggers the body to begin attacking itself. Other ideas include a genetic link, though environmental factors would likely be involved as well. About seventy-five percent of those afflicted with RA are women, and the average age of onset is 40.
Rheumatoid arthritis brings with it unique symptoms that allow it to be differentiated from other forms of arthritis. For example, joints affected by RA tend to be the wrist, feet, neck, jaw, elbows, hips, ankles, and select joints of the hands. Unlike osteoarthritis, which is associated with “wear and tear” and therefore single joints, RA often occurs symmetrically, so pain in the left foot is likely accompanied by pain in the right foot. Because joint pain is the result of the inflammatory response, pain tends to be in the morning as opposed to arthritis with activity-related pain, such as osteoarthritis, that occurs more often at the end of the day. For most individuals with RA, pain tends fluctuate daily, with occasional flares, or periods of more intense pain.
As a systemic disease, rheumatoid arthritis is often accompanied by other symptoms. Common symptoms include a flu-like illness with fever, weight-loss, and fatigue. RA can also affect the eyes, skin and peripheral nerves to the arms and legs.
Diagnosis of rheumatoid arthritis involves case history, examination of the joints and a test for a “rheumatoid factor.” The rheumatoid factor is an antibody that is responsible for regulating normal antibodies. When the immune system is functioning properly, only small amounts of this antibody is present, however, large amounts may be present when the system is not functioning properly, such as with RA. While the rheumatoid factor can be present in non-RA cases, it can help confirm the presence of the disease if the symptoms support this.
Like with many forms of arthritis, there is still no cure for RA, so medical treatment options are aimed at reducing pain and inflammation, slowing progression of the disease, and improving well-being and quality-of-life.
Medications targeted at reducing inflammation and relieving pain include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen sodium. COX-2 inhibitors, often referred to as “COX 2s,” are a newer form of NSAIDs that do not have the ulcer-related side effects characteristic of traditional NSAIDs. Examples include medications such as Celebrex and Vioxx. Analgesics, such as acetaminophen, reduce pain but not inflammation. Glucocorticoids such as cortisone and prednisone are used to control inflammation using cortisol, a naturally occurring hormone in the body. The side effects of glucocorticoids are related to the dosage, so it is important to take the lowest effective dose. Glucocorticoids are linked with increased bruising, cataracts, and osteoporosis, among other side effects. If you are taking glucocorticoids be sure to take precautionary measures against osteoporosis. Speak with your health care professional about taking vitamin D and calcium to improve bone strength.
Other medications for RA are aimed at slowing or stopping the progression of the disease, and are termed “disease modifying medications.” While many people try a variety of conservative treatments before taking the step to prescription medication, with rheumatoid arthritis it is essential to start disease-modifying anti-rheumatic drugs (DMARDs) upon diagnosis as they work to stop the disease in its current state. Common DMARDs include methotrexate, leflunomide, d-pencillamine, and sulfasalizine.
If the progression of RA in a joint reaches the point of deformation, a total joint replacement surgery may be a viable treatment option. The procedure consists of the replacement of the damaged joint with a metal and plastic prosthesis. The surgery can often restore a great deal of function to the joint and allow independence.
Medical treatment of rheumatoid arthritis should be accompanied by lifestyle changes as well. As with other forms of arthritis, exercise is an essential component of the treatment program that aims to maintain strength and functionality of the joints. Many find alternative treatments to be effective in arthritis care. Massage may ease muscle tension and stiffness, and some find acupuncture to be helpful as well. For more information about complementary treatments, refer to The Arthritis Foundation’s Guide to Alternative Therapies book.