This debilitating autoimmune disease can affect organs
Rheumatoid arthritis (RA) is a long-term disease that leads to inflammation of the joints and surrounding tissues. It can also affect other organs.
Causes
The cause of RA is unknown. It is an autoimmune disease, which means the body’s immune system mistakenly attacks healthy tissue. RA can occur at any age, but is more common in middle age. Women get RA more often than men. Infection, genes, and hormone changes may be linked to the disease.
Symptoms
RA usually affects joints on both sides of the body equally. Wrists, fingers, knees, feet, and ankles are the most commonly affected.
The disease often begins slowly, usually with only minor joint pain, stiffness, and fatigue.
Joint symptoms may include:
Morning stiffness, which lasts more than one hour, is common. Joints may feel warm, tender, and stiff when not used for an hour.
Joint pain is often felt on the same joint on both sides of the body.
Over time, joints may lose their range of motion and may become deformed.
Other symptoms include:
Chest pain when taking a breath (pleurisy)
Dry eyes and mouth (Sjogren syndrome)
Eye burning, itching, and discharge
Nodules under the skin (usually a sign of more severe disease)
Numbness, tingling, or burning in the hands and feet
Sleep difficulties
Tests
There is no test that can determine for sure whether you have RA. Most patients with RA will have some abnormal test results, although for some patients, all tests will be normal.
Two lab tests that often help in the diagnosis are:
Rheumatoid factor test
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
Synovial fluid analysis
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 first drugs usually tried in patients with RA. They are prescribed in addition to rest, strengthening exercises and anti-inflammatory drugs. Methotrexate is the most commonly used DMARD for rheumatoid arthritis. Leflunomide and chloroquine may also be used. These drugs may have serious 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 and naprosen. Although NSAIDs work well, long-term use can cause stomach problems, such as ulcers and bleeding, and possible heart problems. Celecoxib is another anti-inflammatory drug, but it is labeled with strong warnings about heart disease and stroke. Talk to your doctor about whether COX-2 inhibitors are right for you.
Antimalarial medications: This group of medicines includes hydroxychloroquine, and is usually used along 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 long-term side effects, corticosteroids should be taken only for a short time and in low doses when possible.
BIOLOGIC AGENTS:
Biologic drugs are designed to affect parts of the immune system that play a role in the disease process of rheumatoid arthritis. They may be given when other medicines for rheumatoid arthritis have not worked. At times, your doctor will start biologic drugs sooner, along with other rheumatoid arthritis drugs.
Most of them are given either under the skin (subcutaneously) or into a vein (intravenously). There are different types of biologic agents:
White blood cell modulators include: abatacept and rituximab
Tumor necrosis factor (TNF) inhibitors include: adalimumab, etanercept, infliximab, golimumab and certolizumab
Interleukin-6 (IL-6) inhibitors: tocilizumab
Biologic agents can be very helpful in treating rheumatoid arthritis. However, people taking these drugs must be watched very closely because of serious risk factors:
Infections from bacteria, viruses, and fungi
Leukemia or lymphoma
Psoriasis
SURGERY
Occasionally, surgery is needed to correct severely damaged joints. Surgery may include:
Removal of the joint lining
Total joint replacement in extreme cases; may include total knee, hip replacement, ankle replacement, shoulder replacement and others
PHYSICAL THERAPY
Range-of-motion exercises and exercise programs prescribed by a physical therapist can delay the loss of joint function and help keep muscles strong.
Sometimes therapists will use special machines to apply deep heat or electrical stimulation to reduce pain and improve joint movement.
Joint protection techniques, heat and cold treatments, and splints or orthotic devices to support and align joints may be very helpful.
Frequent rest periods between activities, as well as 8 to 10 hours of sleep per night, are recommended.
NUTRITION
Some people with RA may have intolerance or allergies to certain foods. A balanced nutritious diet is recommended. It may be helpful to eating foods rich in fish oils (omega-3 fatty acids).
