What Rheumatoid Arthritis Is

Fast Facts

1. RA is the most common type of arthritis triggered by the immune system.
2. Treatments have improved dramatically and help many of those affected.
3. Rheumatologists have the expertise necessary to diagnose this disease correctly and offer patients the most advanced treatments.

What Rheumatoid Arthritis Is
RA is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well.

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The normal joint structure is pictured on the left. On the right is the joint affected by rheumatoid arthritis which has swelling of the synovium that can lead to damage to cartilage and bone.
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The stiffness seen in active RA is typically worst in the morning and may last anywhere from one to two hours to the entire day. This long period of morning stiffness is an important diagnostic clue, as not many other arthritic diseases behave this way. For example, osteoarthritis does not generally cause prolonged morning stiffness. While RA can affect any joint, the small joints in the hands and feet tend be involved more frequently than others. This produces a pattern of joint disease that rheumatologists regard as characteristic of RA.
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Other symptoms that can occur in RA include:

1. loss of energy
2. low-grade fevers
3. loss of appetite
4. dry eyes and mouth from an associated condition known as Sjogren's syndrome
5. firm lumps called rheumatoid nodules beneath the skin in areas such as the elbow and hands

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Causes

What Causes Rheumatoid Arthritis

RA is classified as an autoimmune disease, which develops because certain cells of the immune system malfunction and attack healthy joints. While the cause of RA remains unknown, exciting and rapidly advancing research is revealing the factors that are important in producing inflammation. The primary focus of the inflammation is in the synovium, which is the lining tissue of the joint. Inflammatory chemicals released by the immune cells cause swelling and damage to cartilage and bone. This research is giving us a better understanding of the immune and genetic factors that may be involved in the disease. As a result of this work, new medications have been developed that specifically block certain signals in the body from the immune system that are important in causing RA symptoms and joint damage.

Who gets rheumatoid arthritis
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RA is the most common form of inflammatory arthritis. More than 2 million Americans suffer from RA. About 75 percent of those affected are women, and 1–3% of women may develop rheumatoid arthritis in their lifetime. The disease most often begins between the fourth and sixth decades of life; however, RA can develop at any age.

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Diagnosis

How Rheumatoid Arthritis Is Diagnosed

RA can be difficult to diagnose because it may begin gradually with subtle symptoms. Many diseases, especially early on, behave in a manner similar to RA. For this reason, patients suspected of having RA should be evaluated by a rheumatologist, a physician with the necessary skill and experience to reach a precise diagnosis and develop the most appropriate treatment plan.
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The diagnosis of RA is based on the symptoms described and physical examination findings such as:

1. warmth,
2. swelling and
3. pain in the joints.

Certain laboratory abnormalities commonly found in RA can help in establishing a diagnosis. Tell-tale abnormalities include:

1. anemia (a low red blood cell count);
2. rheumatoid factor (an antibody eventually found in approximately 80% of patients with RA, but in only 30% at the start of the arthritis); and
3. an elevated erythrocyte sedimentation rate or “sed rate” (a blood test that in most patients with RA tends to correlate with the amount of inflammation in the joints).
   

X-rays can be very helpful in diagnosing RA but may not show any abnormalities in the first 3–6 months of arthritis. X rays are useful in determining if the disease is progressing.
It is important to remember that for most patients with this disease (especially those who have had symptoms for less than six months), there is no single test that “confirms” a diagnosis of RA. Rather, diagnosis is established by skillfully evaluating the appropriate symptoms, physical examination findings, laboratory tests and X-rays.

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How Rheumatoid Arthritis Is Treated

How rheumatoid arthritis is treated
Therapy for patients with RA has improved dramatically over the past 25 years. Current treatments offer most patients good to excellent relief of symptoms and the ability to continue to function at or near normal levels. Since there is no cure for RA, the goal of treatment is to minimize patients' symptoms and disability by introducing appropriate medical therapy early on, before the joints are permanently damaged. No single therapy is effective for all patients, and many patients will need to change treatment strategies during the course of their disease.
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Successful management of RA requires early diagnosis and, at times, aggressive treatment. To quickly reduce joint inflammation and symptoms, first-line treatment usually consists of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin and others), naproxen (Naprosyn, Aleve), celecoxib (Celebrex) and many others. In addition, corticosteroids such as prednisone (Deltasone and others) may be given orally at low doses or via injection into the joints.
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However, all RA patients with persistent swelling in the joints are candidates for treatment with disease-modifying anti-rheumatic drugs (DMARDs), often used in conjunction with NSAIDs and/or low dose corticosteroids. DMARDs have greatly improved the symptoms and function as well as the quality of life for the vast majority of patients with RA. DMARDs include methotrexate (Rheumatrex and Folex), leflunomide (Arava), hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), gold given orally (Auranofin) or intramuscularly (Myochrisine), minocycline (Minocin, Dynacin and Vectrin), azathiaprine (Imuran), and cyclosporine (Sandimmune and Neoral).
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A new class of medications, referred to as biologic response modifiers or “biologic agents” can specifically target parts of the immune system that lead to inflammation as well as joint and tissue damage in RA. These medications are also DMARDs, because they slow the progression of the disease. FDA-approved treatments include adalimumab (Humira), anakinra (Kineret), etanercept (Enbrel), infliximab (Remicade), abatacept (Orencia), and rituximab (Rituxan). In some cases these medications are used alone; in many cases, they are combined with methotrexate for added efficacy.
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The optimal treatment of RA often requires more than medication alone. Proper treatment requires comprehensive, coordinated care, patient education and the expertise of a number of providers, including rheumatologists, primary care physicians, and physical and occupational therapists .
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Broader health impact of rheumatoid arthritis
Recent research indicates that people with RA, particularly those whose disease is not well controlled, may have a higher risk for heart disease and stroke. Talk with your physician about your own risk and ways that you can minimize it.

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Living With Rheumatoid Arthritis

Living with Rheumatoid Arthritis
It is important for people with RA to remain physically active, while occasionally scaling back activities when the disease flares. A consultation with a physical or occupational therapist may help to determine what level and types of activities are appropriate. In general, rest when a joint is swollen and inflamed, or when feeling fatigued. At these times, gentle range-of-motion exercises will keep the joint flexible. When feeling better, low-impact aerobic exercises such as walking and exercises to boost muscle strength will improve overall health and reduce pressure on joints. The diagnosis of a chronic illness is a life-changing event that can cause anxiety and occasionally feelings of isolation or depression. Because the treatments for rheumatoid arthritis have improved dramatically, these feelings usually decrease with time as energy improves and pain and limitation decrease. It is important to discuss the normal reactions to illness with your physician and health care providers, who can provide you with the information and resources you need for support during your treatment.





Rheumatoid arthritis affects the wrist and the small jointsof the hand including the knuckles and the middle joints of thefingers.














Taking an active role in the management of your rheumatoid arthritis
Provided by:



Last Updated: August 27, 2004

Introduction
Living with rheumatoid arthritis can mean living with chronic pain, fatigue, and joint stiffness. Thousands of people have benefited from developing and following plans to help them manage their symptoms. You and your health professional can develop a medical treatment plan that may include medication and other therapies. Early medical treatment can help you avoid disabling joint changes and chronic pain.

Besides following your medical treatment plan, there are several steps you can take to maintain your normal life and activities. This is often called self-management. The first steps include:

• Learning as much as you can about rheumatoid arthritis.
• Learning ways to reduce joint pain, fatigue, and stiffness.
• Taking an active role in managing your rheumatoid arthritis.

What does it mean to take an active role in the management of rheumatoid arthritis?
Why is it important to take an active role in developing a management plan for rheumatoid arthritis?
How do I manage my rheumatoid arthritis?
Where to go from here

Rheumatoid Arthritis.
Author:
Kerry V. Cooke

Medical Review:
Renée M. Crichlow, MD - Family Medicine
Adam Husney, MD - Family Medicine
Stanford M. Shoor, MD - Rheumatology

Last Updated:
August 27, 2004
© 1995-2006, Healthwise, Incorporated, P.O. Box 1989, Boise, ID 83701. ALL RIGHTS RESERVED.

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information. For more information, click here. Privacy Policy. How this information was developed.

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More About Rheumatoid Arthritis:

• Overview
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• Living With
• Additional Resources
  

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Points to Remember

Points to Remember

1. RA has been a primary focus of rheumatologic research and the treatments now available have dramatically improved outcomes for patients. Joint pain and swelling can usually be well controlled and joint damage can be minimized by early treatment.
2. Expertise is particularly needed to establish a diagnosis of RA early, to rule out diseases that mimic RA (thereby avoiding unnecessary testing, drug therapy and costs) and to design a treatment plan that is best suited and customized for the patient and addresses the need for and the risks and benefits of DMARD therapy. Accordingly, the rheumatologist, working with the primary care physician and other health care providers, should play the major role in outlining, implementing and supervising the management of the patient with RA.
3. Studies have shown that people who receive early treatment of RA feel better, are more likely to be able to be lead an active life, and are less likely to experience the type of joint damage that leads to joint replacement.

The rheumatologist's role in the treatment of rheumatoid arthritis
RA is a complex disease, but many advances in treatment have been made recently. Rheumatologists are specialists in musculoskeletal disorders and therefore are more likely to make a proper diagnosis. They can also advise patients about the best treatment options available.
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For More Information

For more information
The American College of Rheumatology has compiled this list to give you a starting point for your own additional research. The ACR does not endorse or maintain these Web sites, and is not responsible for any information or claims provided on them. It is always best to talk with your rheumatologist for more information and before making any decisions about your care.

The Arthritis Foundation http://www.arthritis.org

To find a rheumatologist
For more information about rheumatologists, click here.
For a listing of rheumatologists in your area, click here.

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