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Rheumatoid arthritis (RA) is a relatively common disease in which the lining or membranes of joints become inflamed. Over time, the inflammation may destroy the tissues, leading to disability. Rheumatoid arthritis affects women twice as often as men, and frequently begins between the ages of 40 and 60.
The cause of rheumatoid arthritis is not fully understood. In some people, a genetic predisposition probably increases the risk of developing rheumatoid arthritis. An environmental trigger such as a viral infection then causes the development of rheumatoid arthritis in susceptible individuals.
An abnormal immune response causes ongoing inflammation of the tissues lining the joint, a breakdown of cartilage, and loosening of the ligaments and tendons supporting the joint. Ongoing inflammation also causes the lining to grow into a thick, abnormal tissue called pannus. These processes result in destruction of the cartilage, the underlying bone surrounding the joint, ligaments, and tendons, and eventually lead to deformed joints.
Symptoms of rheumatoid arthritis include painful, swollen, tender and stiff joints. The same joints on both sides of the body (symmetrical) are usually affected, especially the hands, wrists, elbows, feet, knees, or neck.
Rheumatoid nodules ranging in size from a pea to a mothball develop in nearly one-third of people who have rheumatoid arthritis. These bumps usually form over pressure points in the body such as the elbows, knuckles, spine, and lower leg bones. Rheumatoid arthritis can also cause symptoms throughout the body such as fatigue, loss of appetite, weight loss, mild fever, numbness and tingling in the hands.
The course of rheumatoid arthritis is difficult to predict, but it usually progresses gradually with a small percentage of cases involving symptoms that come on within days. Although only a minority of patients with rheumatoid arthritis will achieve a complete remission with treatment, most will have improvement in their symptoms with treatment.
Because irreversible joint damage, chronic pain, and long-term disability can occur if rheumatoid arthritis is not diagnosed and treated early, it is recommended that a person see a specialist in joint disease within the first three months after symptoms appear.
Rheumatoid arthritis is most often treated with disease modifying anti-rheumatic medications, exercise, and lifestyle changes. While treatment may help relieve symptoms and control the disease, there is no cure. Treatment for rheumatoid arthritis usually continues throughout life, but will vary depending on the severity of the disease.
Treatment of rheumatoid arthritis should start with education about this disease, the possibility of joint damage and disability, and the risks and benefits of potential treatments. A long-term treatment plan should be developed with a health professional team.
Medications called disease-modifying antirheumatic drugs (DMARDs) that can actually slow or sometimes prevent joint destruction are now recommended early in the course of the disease. DMARDs can help prevent the significant joint damage that may occur in the early stages.
A 2004 study concluded that use of DMARDs resulted in fewer hospitalizations from rheumatoid arthritis. A second study reported that DMARD treatment, begun as soon as possible after diagnosis and continued for a prolonged period of time, may prevent damage to joints and other complications.
Development of new disease modifying therapies, especially biologic agents, is leading to improved clinical outcomes that include decreases in disease activity, prevention of damage to joints, and better quality of life. The advent of tumor necrosis antagonists, a particular type of biologic agent, offers RA patients with moderate to severe disease more effective treatment than in the past. Joint pain, tenderness, and swelling are the most important means of measuring how the disease is progressing or responding to treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs) and/or analgesics (pain relievers, such as acetaminophen) may be used to relieve these symptoms.
Treatment to manage rheumatoid arthritis can be effective at slowing the progression of the disease, and there may be periods of time in which the disease is in remission. However, if there is joint destruction from rheumatoid arthritis, pain management treatment may be needed.
Robert M. Gay, MD, is with Emerywood Medical Specialties, a Cornerstone Health Care Practice. For more on this topic, tune in to “Regional Health Talk” today at 8 a.m. on WMFR (1230 AM). To suggest a column topic, call 878-6200 or go to info@hprhs.com
