Rheumatoid Arthritis: The Most Common Form of ArthritisBy: Joel Hirschberg, MD
Soon after forty-eight-year-old Sally Morgan (not her real name) was diagnosed with rheumatoid arthritis (RA), she wrote to a Web site for RA sufferers in order to learn more about the illness. “How can you go to bed fine one night,” she asked, “and wake up with rheumatoid arthritis the next morning? I run my own business, have a family and grandchildren and attend college part-time,” she continued. “RA was not part of my plan. I’m worried about what’s going to happen and feel depressed. Can anyone offer any advice or help?”
Sally’s frustration and anxiety are shared by an estimated two million Americans, mostly women, who suffer from this disease. Typically, the onset of the disease in adults occurs between the ages of 40 and 60. While rheumatoid arthritis is one of the most common forms of arthritis, people, like Sally, are often perplexed about the causes and treatment of the disease. Features of Rheumatoid Arthritis
Rheumatoid arthritis is an inflammatory disease that causes pain, swelling, stiffness and loss of function in the joints. It generally occurs in a symmetrical pattern; that is, if the right wrist joint is affected, the left wrist joint is also usually affected. The disease typically affects the wrist joints and finger joints closest to the hand. But other joints can be affected as well, including joints of the neck, shoulders, elbows, hips, knees, ankles and feet.
For some people, RA may last only a few months or a year or two before it goes completely away. Other people experience intermittent bouts of the disease, called flares, followed by periods in which they feel fine, called remissions. Still others have a severe form of disease that is active most of the time. This form of RA can lead to serious joint damage and disability. What Causes Rheumatoid Arthritis?
Rheumatoid arthritis is an “autoimmune” disease, which means that a person’s immune system attacks his or her own body tissues. While scientists still do not know for sure what causes this disease, there are a few factors that may play a role. For example, certain genes are associated with RA. However, while some people with those genes get RA, others do not. Consequently, researchers believe that a second factor may be environmental. An infectious agent such as a virus or bacterium may trigger the disease, but the exact agent is not known. Finally, hormonal factors may be involved. Changes or deficiencies in certain hormones may play a role in the development of the disease. Diagnosis
Rheumatoid arthritis can be difficult to diagnose in its early stages, particularly since the symptoms can be similar to those of other types of arthritis and joint conditions. Furthermore, the full range of symptoms develops over time, and only a few symptoms may be present in the early stages. Consequently, in diagnosing the disease, your doctor will consider your description of symptoms, how they began and how they have changed over time. Your doctor will also conduct a physical examination of your joints, reflexes and muscle strength. In some instances, he or she may also order a variety of tests, including a rheumatoid factor test—a test for an antibody that is eventually present in the blood of most rheumatoid arthritis patients. Treatment
Generally speaking, there are three types of treatment for RA:
Rest and Exercise. When RA is active, it is important for a patient to get adequate rest, which helps reduce joint inflammation. Likewise, when the disease is not active, exercise can help maintain healthy and strong muscles and increase joint mobility and flexibility. It’s important, however, to discuss any exercise program with your doctor first.
Medications. Initially, your doctor may suggest aspirin or similar drugs to ease the pain of RA. Other drugs can help reduce inflammation. Another type of drug is called disease-modifying antirheumatic drugs, or DMARDs. This drug is used to try to slow the course of the disease.
Surgery. When damage to the joint is severe, your doctor may recommend one of several different types of surgery, including joint replacement or tendon reconstruction. The primary purpose of these procedures is to reduce pain, improve the affected joint’s function and improve the patient’s ability to perform daily activities. Hope for the Future
Scientists are searching for new drugs or combinations of drugs that can reduce inflammation or can slow or stop the progression of rheumatoid arthritis. In the meantime, however, studies have also shown that people who are well-informed and participate actively in their own care experience less pain and make fewer visits to the doctor than do other people with rheumatoid arthritis. The Arthritis Foundation (www.arthritis.org) offers a self-help course, which teaches about RA and its treatment. Taking such a course helps people like Sally Morgan feel in greater control over their disease and lead a full and more active life, while managing their disease.