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Rheumatoid Arthritis

Rheumatoid arthritis is a disabling condition affecting nearly 1.5 million Americans, as of a 2007 data count. This form of arthritis is a chronic inflammatory disorder that affects the joint lining, as opposed to being caused by wear and tear like osteoarthritis. It is considered to be an autoimmune disorder, which means that a person's immune system is attacking their body instead of guarding it. Joint deformity and bone erosion can eventually result and this is most often seen in the hands, feet, and other small joints.

What causes rheumatoid arthritis?

It is not known what causes RA. It is believed that genes, hormonal changes, and infection may play a role in developing this condition. Middle-age women are most often affected, but this condition can occur at any age and affect both genders. Smoking and having a family history of this condition are also thought to play a role.

What are the symptoms of rheumatoid arthritis?

In the early stages, the small joints will likely be affected first. The hands, fingers, feet, and toes are usually the first joints to show symptoms. As this condition progresses, the ankles, hips, knees, elbows, and shoulders often start to show symptoms. In the majority of cases, the symptoms will be bilateral, meaning that they affect both sides of the body equally.

The joints often become warm, tender, and swollen. Nodules may form under the arm skin; morning stiffness, weight loss, fever, and fatigue are also possible.

Some people experience periods of remission and then a flareup, while for some, the symptoms are rather constant.

How is rheumatoid arthritis treated?

As of today, there is no known cure for this condition. There are medications available to slow joint damage and reduce any associated pain. Physical and occupational therapy may be helpful in teaching patients how to protect their joints. In cases of severe damage, surgery may have to be performed.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can be prescribed to help relieve inflammation and pain. This type of medication comes in both prescription and over-the-counter forms. Possible side effects range greatly and may include stomach irritation, ringing in the ears, liver and kidney damage, and heart problems.

If a stronger medication is needed to reduce inflammation and pain, and slow joint damage, a corticosteroid may be prescribed. This type of medication is generally used short-term for acute exacerbations. Possible side effects may include cataracts, diabetes, thinning of bones, and weight gain.

Since RA is considered an autoimmune condition, immunosuppressant medications may be prescribed to calm the immune system down. The one downside is that these medications may increase a person's vulnerability to infection.

Disease-modifying anti-rheumatic drugs (DMARDs) can be beneficial in saving the joints from permanent damage and slowing disease progression. Side effects may include bone-marrow suppression, liver damage and severe lung infections.

TNF-alpha inhibitors can help to inhibit the natural production of an inflammatory substance called tumor necrosis factor. This can help in reducing morning stiffness, pain, and swollen or tender joints.

If surgery becomes necessary, there are three primary types that may be performed, depending on the patient's needs. A total joint replacement is just that -- it replaces joints that are severely damaged. If a patient's joint inflammation leads to tendon rupture or loosening, a tendon-repair surgery may be done. To realign or stabilize a joint, a joint fusion may be done. This is also considered when a patient cannot have total joint replacement.

Rheumatoid arthritis prognosis

The severity of a person's symptoms will ultimately determine their prognosis. A more severe form of RA is generally seen in those with anti-CCP antibody, rheumatoid factor, or subcutaneous nodules. The nodules can be palpated and the other two factors can be found in blood work.

Proper treatment is critical, because the wrong or no treatment can result in permanent joint damage. Getting early and correct treatment can help in decreasing joint damage and joint pain.

Reviewed by Jennifer Monti, MD, MPH

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