What is Rheumatoid arthritis (RA) ?
is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks the joints producing an inflammatory synovitis that often progresses to destruction of the articular cartilage and ankylosis of the joints. Rheumatoid arthritis can also produce diffuse inflammation in the lungs, pericardium, pleura, and sclera, and also nodular lesions, most common in subcutaneous tissue under the skin. Although the cause of rheumatoid arthritis is unknown, autoimmunity plays a pivotal role in its chronicity and progression.
About 1% of the world's population is afflicted by rheumatoid arthritis, women three times more often than men. Onset is most frequent between the ages of 40 and 50, but no age is immune. It can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility. It is diagnosed chiefly on symptoms and signs, but also with blood tests (especially a test called rheumatoid factor) and X-rays. Diagnosis and long-term management are typically performed by a rheumatologist, an expert in the diseases of joints and connective tissues.
Various treatments are available. Non-pharmacological treatment includes physical therapy and occupational therapy. Analgesia (painkillers) and anti-inflammatory drugs, as well as steroids, are used to suppress the symptoms, while disease-modifying antirheumatic drugs (DMARDs) are often required to inhibit or halt the underlying immune process and prevent long-term damage. In recent times, the newer group of biologics has increased treatment options.
The name is based on the term "rheumatic fever", an illness which includes joint pain and is derived from the Greek word rheumatos ("flowing"). The suffix -oid ("resembling") gives the translation as joint inflammation that resembles rheumatic fever. The first recognized description of rheumatoid arthritis was made in 1800 by Dr Augustin Jacob Landré-Beauvais
What is Rheumatoid arthritis ?
Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks the joints producing an inflammatory synovitis that often progresses to destruction of the articular cartilage and ankylosis of the joints. Rheumatoid arthritis can also produce diffuse inflammation in the lungs, pericardium, pleura, and sclera, and also nodular lesions, most common in subcutaneous tissue under the skin. Although the cause of rheumatoid arthritis is unknown, autoimmunity plays a pivotal role in its chronicity and progression.
About 1% of the world's population is afflicted by rheumatoid arthritis, women three times more often than men. Onset is most frequent between the ages of 40 and 50, but no age is immune. It can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility. It is diagnosed chiefly on symptoms and signs, but also with blood tests (especially a test called rheumatoid factor) and X-rays. Diagnosis and long-term management are typically performed by a rheumatologist, an expert in the diseases of joints and connective tissues.
Various treatments are available. Non-pharmacological treatment includes physical therapy and occupational therapy. Analgesia (painkillers) and anti-inflammatory drugs, as well as steroids, are used to suppress the symptoms, while disease-modifying antirheumatic drugs (DMARDs) are often required to inhibit or halt the underlying immune process and prevent long-term damage. In recent times, the newer group of biologics has increased treatment options.
The name is based on the term "rheumatic fever", an illness which includes joint pain and is derived from the Greek word rheumatos ("flowing"). The suffix -oid ("resembling") gives the translation as joint inflammation that resembles rheumatic fever. The first recognized description of rheumatoid arthritis was made in 1800 by Dr Augustin Jacob Landré-Beauvais.
Causes of Rheumatoid arthritis ?
The cause of Rheumatoid arthritis currently is unknown. In fact , there prbably isn't an exact cause for RA researches now are debating weather RA is one disease or several different diseases with common features.
Diagnosis of Rheumatoid Arthritis?
Physicians take many factors into account when diagnosing a patient with RA symptoms: physical exam, blood tests, and imaging. But, first, the doctor will take a medical history. According to the Arthritis Foundation, the medical history will include these questions:
- Do you have joint pain in many joints?
- Does the pain occur symmetrically-that is, do the same joints on both sides of your body hurt at the same time? Or is the pain one-sided?
- Do you have stiffness in the morning?
- When is the pain most severe?
- Do you have pain in your hands, wrists and/or feet?
- If you have pain in your hands, which joints hurt the most?
- Have you ha periods of feeling weak and uncomfortable all over? Do you feel fatigued?
Causes
As with other forms of arthritis, rheumatoid arthritis involves inflammation of the joints. A membrane called the synovium lines each of your joints. When you have rheumatoid arthritis, white blood cells — whose normal job is to attack unwanted invaders such as bacteria and viruses — move from your bloodstream into your synovium. There, these blood cells appear to play an important role in causing the synovial membrane to become inflamed.
This inflammation results in the release of proteins that, over months or years, cause thickening of the synovium. These proteins also can damage cartilage, bone, tendons and ligaments. Gradually, the joint loses its shape and alignment. Eventually, it may be destroyed.
Some researchers thinks that rheumatoid arthritis is triggered by an infection — possibly a virus or bacterium — in people with an inherited susceptibility. Although the disease itself is not inherited, certain genes that create a susceptibility are. People who have inherited these genes will not necessarily develop rheumatoid arthritis. But they may have more of a tendency to do so than others. The severity of their disease may also depend on the genes inherited.
Rheumatoid arthritis symptoms, your doctor will likely conduct a physical examination and order laboratory tests to determine if you have this form of arthritis. A blood test that indicates your erythrocyte sedimentation rate ( "seed" rate) can indicate the presence of an inflammatory process in your body. People with rheumatoid arthritis tend to have abnormally high seed rates. The seed rates in those with osteoarthritis tend to be normal.
Another blood test looks for an antibody called rheumatoid factor. Four out of five persons with rheumatoid arthritis eventually have this abnormal antibody, although it may be absent early on in the disease. It's also possible to have the rheumatoid factor in your blood and not have rheumatoid arthritis.
Doctors may take X-rays of your joints to differentiate between osteoarthritis and rheumatoid arthritis. A sequence of X-rays obtained over time can show the progression of arthritis.
Treating rheumatoid arthritis typically involves using a combination of medical treatment and self-care strategies. The following self-care procedures are important elements for managing the disease.
Exercise regularly. Different types of exercise achieve different goals. Check with your doctor or physical therapist first and then begin a regular exercise program for your specific needs. If you can walk, walking is a good starter exercise. If you can't walk, try a stationary bicycle with no resistance or do hand or arm exercise. A chair exercise program may be helpful. Aquatic exercise is another option, and many health clubs with pools offer such classes. It's good to move each joint in its full range of motion every day. As you move, maintain a slow, steady rhythm. Don't jerk or bounce. Also, remember to breathe. Holding your breath can temporarily deprive your muscles of oxygen and tire them. It's also important to maintain good posture while you exercise. Avoid exercising tender, injured or severely inflamed joints. If you feel new joint pain, stop. New pain that lasts more than 2 hours after you exercise probably means you've overdone it. If pain persists for more than a few days, call your doctor.
Control your weight. Excess weight puts added stress on joints in your neck, hips, knees and feet — places where arthritis pain is commonly felt. Excess weight can also make joint surgery more difficult and risky. Eat a healthy diet. A healthy diet emphasizing fruit, vegetables and whole grains can help you control your weight and maintain your overall health, allowing you to deal better with your arthritis. However, there is no special diet that can be used to treat arthritis. It hasn't been proven that eating any particular food will make your joint pain or inflammation better or worse. Apply heat. Heat will help ease your pain, relax tense, painful muscles and increase the regional flow of blood. One of the easiest and most effective ways to apply heat is to take a hot shower or bath for 15 minutes. Other options include using a hot pack, an electric heat pad (set on its lowest setting) or a radiant heat lamp with a 250-watt reflector heat bulb to warm specific muscles and joints. If your skin has poor sensation or if you have poor circulation, don't use heat treatment.
Coping Skills The degree to which rheumatoid arthritis affects your daily activities depends in part on how well you cope with the disease. Physical and occupational therapists can help you devise strategies to cope with specific limitations you experience as the result of weakness or pain. Here are some general suggestions to help you cope:
Keep a positive attitude. With your doctor, make a plan for managing your arthritis. This will help you feel in charge of your disease. Studies show that people who take control of their treatment and actively manage their arthritis experience less pain and have less difficulty functioning. Use assertive devices. A painful knee may need a brace for support. You also might want to use a cane to take weight off the joint as you walk. The cane should be used in the hand opposite the affected joint. If your hands are affected, various helpful tools and gadgets are available to help you maintain an active lifestyle. Contact your pharmacy or health care provider for information on ordering items that may help you the most. Know your limits. Rest when you're tired. Arthritis can make you prone to fatigue and muscle weakness — a deep exhaustion that makes everything you do a great effort. A rest or short nap that doesn't interfere with nighttime sleep may help.
Avoid grasping actions that strain your finger joints. Instead of using a clutch purse, for example, select one with a shoulder strap. Use hot water to loosen a jar lid and pressure from your palm to open it, or use a jar opener. Don't twist or use your joints forcefully. Spread the weight of an object over several joints. For instance, use both hands to lift a heavy pan.
Take a break periodically to relax and stretch. Maintain good posture. Poor posture causes uneven weight distribution and may strain ligaments and muscles. The easiest way to improve your posture is by walking. Some people find that swimming also helps improve their posture. Use your strongest muscles and favor large joints. Don't push open a heavy glass door. Lean into it. To pick up an object, bend your knees and squat while keeping your back straight.
Self Care
Treating rheumatoid arthritis typically involves using a combination of medical treatment and self-care strategies. The following self-care procedures are important elements for managing the disease.
Exercise regularly. Different types of exercise achieve different goals. Check with your doctor or physical therapist first and then begin a regular exercise program for your specific needs. If you can walk, walking is a good starter exercise. If you can't walk, try a stationary bicycle with no resistance or do hand or arm exercise. A chair exercise program may be helpful. Aquatic exercise is another option, and many health clubs with pools offer such classes. It's good to move each joint in its full range of motion every day. As you move, maintain a slow, steady rhythm. Don't jerk or bounce. Also, remember to breathe. Holding your breath can temporarily deprive your muscles of oxygen and tire them. It's also important to maintain good posture while you exercise. Avoid exercising tender, injured or severely inflamed joints. If you feel new joint pain, stop. New pain that lasts more than 2 hours after you exercise probably means you've overdone it. If pain persists for more than a few days, call your doctor.
Control your weight. Excess weight puts added stress on joints in your neck, hips, knees and feet — places where arthritis pain is commonly felt. Excess weight can also make joint surgery more difficult and risky. Eat a healthy diet. A healthy diet emphasizing fruit, vegetables and whole grains can help you control your weight and maintain your overall health, allowing you to deal better with your arthritis. However, there is no special diet that can be used to treat arthritis. It hasn't been proven that eating any particular food will make your joint pain or inflammation better or worse. Apply heat. Heat will help ease your pain, relax tense, painful muscles and increase the regional flow of blood. One of the easiest and most effective ways to apply heat is to take a hot shower or bath for 15 minutes. Other options include using a hot pack, an electric heat pad (set on its lowest setting) or a radiant heat lamp with a 250-watt reflector heat bulb to warm specific muscles and joints. If your skin has poor sensation or if you have poor circulation, don't use heat treatment.
Coping Skills The degree to which rheumatoid arthritis affects your daily activities depends in part on how well you cope with the disease. Physical and occupational therapists can help you devise strategies to cope with specific limitations you experience as the result of weakness or pain. Here are some general suggestions to help you cope:
Keep a positive attitude. With your doctor, make a plan for managing your arthritis. This will help you feel in charge of your disease. Studies show that people who take control of their treatment and actively manage their arthritis experience less pain and have less difficulty functioning. Use assertive devices. A painful knee may need a brace for support. You also might want to use a cane to take weight off the joint as you walk. The cane should be used in the hand opposite the affected joint. If your hands are affected, various helpful tools and gadgets are available to help you maintain an active lifestyle. Contact your pharmacy or health care provider for information on ordering items that may help you the most. Know your limits. Rest when you're tired. Arthritis can make you prone to fatigue and muscle weakness — a deep exhaustion that makes everything you do a great effort. A rest or short nap that doesn't interfere with nighttime sleep may help.
Avoid grasping actions that strain your finger joints. Instead of using a clutch purse, for example, select one with a shoulder strap. Use hot water to loosen a jar lid and pressure from your palm to open it, or use a jar opener. Don't twist or use your joints forcefully. Spread the weight of an object over several joints. For instance, use both hands to lift a heavy pan.
Take a break periodically to relax and stretch. Maintain good posture. Poor posture causes uneven weight distribution and may strain ligaments and muscles. The easiest way to improve your posture is by walking. Some people find that swimming also helps improve their posture. Use your strongest muscles and favor large joints. Don't push open a heavy glass door. Lean into it. To pick up an object, bend your knees and squat while keeping your back straight.
Rheumatoid Arthritis Treatment
by Alan K. Matsumoto, M.D. , Joan Bathon, M.D. and Clifton O. Bingham III, M.D.
Rheumatoid arthritis is a chronic disorder for which there is no known cure. Fortunately in the last few years, a shift in strategy toward the earlier institution of disease modifying drugs and the availability of new classes of medications have greatly improved the outcomes that can be expected by most patients. The goal of treatment now aims toward achieving the lowest possible level of arthritis disease activity and remission if possible, the minimization of joint damage, and enhancing physical function and quality of life. The optimal treatment of RA requires a comprehensive program that combines medical, social, and emotional support for the patient. It is essential that the patient and the patient’s family be educated about the nature and course of the disease. Strategies are all aimed at reducing pain and discomfort, preventing deformities and loss of joint function, and maintaining a productive and active life. Inflammation must be suppressed and mechanical and structural abnormalities corrected or compensated by assistive devices. Treatment options include medications, reduction of joint stress, physical and occupational therapy.
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