Rheumatoid Arthritis - symptoms, causes and treatment
A chronic, autoimmune disorder in which nodules and INFLAMMATION develop within the synovial capsules of the joints, causing erosion of the BONE and connective tissues, eventually deforming the JOINT. Synovial membranes encapsulate the joints and secrete synovial fluid, which lubricates the structures of the joint so they move smoothly and freely against each other. The antibodies that characterize rheumatoid arthritis attack the cells of the synovial membrane, causing inflammation and an IMMUNE RESPONSE that treats the cells as though they were invaders. The repeated inflammation over time results in fibrosis (scarring) that destroys the ability of the cells to produce synovial fluid and constricts the movement of the joint.
About two million Americans have rheumatoid arthritis, two thirds of them women. Rheumatoid arthritis most commonly develops between the ages of 20 and 50, though can occur in children (juvenile rheumatoid arthritis). Although treatments and lifestyle strategies can reduce inflammation and relieve symptoms, at present there is no cure for rheumatoid arthritis.
IS IT RHEUMATOID ARTHRITIS OR OSTEOARTHRITIS?
Arthritis is any condition of INFLAMMATION that affects the joints. OSTEOARTHRITIS is the form most people identify; about 20 million Americans have osteoarthritis. Though both forms involve inflammation of the joints, the two conditions are quite different. In osteoarthritis inflammation occurs in response to damage, usually that of repeated wear and tear, within the joints. In rheumatoid arthritis, the inflammation occurs first as a malfunction of the IMMUNE RESPONSE and causes damage to the joints. Osteoarthritis is more common in people over age 65, whereas rheumatoid arthritis usually arises before age 50.
Symptoms of Rheumatoid Arthritis and Diagnostic Path
The symptoms of rheumatoid arthritis typically include
- PAIN and swelling in the joints, especially the small joints of the hands and fingers
- stiffness in the joints, especially upon awakening or after long periods of inactivity
- low-grade FEVER
- fatigue and weakness
- rheumatoid nodules, painless bumps under the SKIN that develop at pressure points
- joint deformity as the disease progresses
The diagnostic path includes BLOOD tests to detect antibodies and other indications of inflammation. Many people who have rheumatoid arthritis have a specific ANTIBODY called rheumatoid factor, though not all people who have rheumatoid arthritis have this antibody, and conversely, rheumatoid factor may be present in people who do not have rheumatoid arthritis. Blood levels of C-REACTIVE PROTEIN also can indicate whether inflammation exists in the body. X-rays can help the doctor evaluate and monitor damage to the joints and bones.
Rheumatoid Arthritis Treatment Options and Outlook
Treatment typically blends lifestyle measures to protect affected joints from undue stress and medications to relieve inflammation and pain. Daily exercise and activity that puts each affected joint through its complete range of motion help keep SCAR tissue from contracting (tightening) within the synovial capsule, maintaining relative freedom of movement. Activities such as YOGA and TAI CHI also improve FLEXIBILITY, range of motion, and balance. Omega-3 fatty acids and folic acid may block steps in the inflammatory response that reduce its intensity. Stress management methods such as MEDITATION help people to cope with the challenges of a chronic health condition.
Mild rheumatoid arthritis symptoms, especially pain, often respond to NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS). Acetaminophen may also relieve pain, though it does not reduce inflammation. Topical preparations such as capsaicin and complementary therapies such as ACUPUNCTURE and REIKI may provide relief from pain and other symptoms. Medications for moderate to severe symptoms may include CORTICOSTEROID MEDICATIONS, which suppress the inflammatory response, and DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDS), which block the immune response in various ways, depending on the medication. Combinations of medications often provide the greatest relief. Surgery to replace seriously damaged joints with prosthetic joints becomes a treatment option when other therapeutic approaches cannot contain symptoms.
| MEDICATIONS TO TREAT RHEUMATOID ARTHRITIS | |
|---|---|
| acetaminophen | adalimumab |
| anakinra | aspirin |
| azathioprine | cyclosporine |
| etanercept | gold salts |
| hydroxychloroquine | ibuprofen |
| infliximab | ketoprofen |
| leflunomide | methotrexate |
| methylprednisolone | naproxen |
| prednisolone | prednisone |
| sulfasalazine | |
Risk Factors and Preventive Measures
Researchers believe rheumatoid arthritis develops when various genetic, environmental, and hormonal factors converge. But specific risk factors remain elusive. There are no known measures to prevent rheumatoid arthritis from developing. Early diagnosis and treatment of juvenile rheumatoid arthritis are important to maintain optimal joint structure, integrity, and function. Prevention efforts focus on minimizing the consequences that the inflammation of rheumatoid arthritis causes, to preserve joint function as well as QUALITY OF LIFE.
See also AUTOIMMUNE DISORDERS; CHONDROITIN; GLUCOSAMINE; JOINT REPLACEMENT; LIVING WITH IMMUNE DISORDERS; RHEUMATIC HEART DISEASE; SAME; SCAR; STRESS AND STRESS MANAGEMENT; VASCULITIS; X-RAY.
