Rheumatoid Arthritis

Rheumatoid arthritis affects over 2 million Americans. Rheumatoid arthritis is considered a rheumatic disease. (Read about "Arthritis and Rheumatic Diseases") It's also an autoimmune disease in which the body's immune system (Read about "The Immune System") causes joint linings to become inflamed, leading to pain and loss of movement. A joint (the place where two bones meet) is surrounded by a capsule that protects and supports it. The joint capsule is lined with a specialized type of tissue called synovium, which produces synovial fluid that lubricates and nourishes joint tissues. In rheumatoid arthritis, the synovium becomes inflamed, causing warmth, redness, swelling and pain. (Read about "Synovitis") As the disease progresses, the inflamed synovium invades and damages the cartilage and bone of the joint. Surrounding muscles, ligaments and tendons become weakened. Rheumatoid arthritis also can cause more generalized bone loss that may lead to osteoporosis. (Read about "Osteoporosis") Researchers believe that much bone damage occurs during the first year or two that a person has the disease, one reason why early diagnosis and treatment are so important.

Rheumatoid arthritis tends to affect women more than men. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), it also has several features that make it different from other kinds of arthritis. For example, rheumatoid arthritis generally occurs in a symmetrical pattern. This means that if one knee or hand is involved, the other one is also. The disease often affects the wrist joints and the finger joints closest to the hand. It can also affect other parts of the body besides the joints. It can affect the spine but it happens less often than with osteoarthritis. (Read about "The Spine")

Some of the signs of rheumatoid arthritis can include:

• tender, warm, swollen joints
• symmetrical pattern of affected joints
• joint inflammation often affecting the wrist and finger joints closest to the hand
• joint inflammation sometimes affecting other joints, including the neck, shoulders, elbows, hips, knees, ankles and feet
• pain and stiffness lasting for more than 30 minutes in the morning or after a long rest
• fatigue
• occasional fever
• a general sense of not feeling well (malaise)

Rheumatoid arthritis affects people differently. According to NIAMS, for some people, it lasts only a few months or a year or two and goes away without causing any noticeable damage. Other people have mild or moderate forms of the disease, with periods of worsening symptoms, called flares, and periods in which they feel better, called remissions. Still others have a severe form of the disease that is active most of the time, lasts for many years or a lifetime, and leads to serious joint damage and disability. Rheumatoid arthritis is also considered a risk factor for a condition called osteonecrosis in which a portion of bone loses its blood supply and begins to die. (Read about "Osteonecrosis")

The inflammation caused by rheumatoid arthritis can often be unpredictable and hard to control. The Arthritis Foundation says this is the most crippling form of arthritis, and that it can flare up, and then go into remission. The scarring and inflammation of rheumatoid arthritis can lead to other serious health issues, including lung and heart problems, so you should talk to your doctor if you notice any new symptom. Rheumatoid arthritis can also lead to deformities in the joints.

Treatment options

Among treatment options, weight control is very important for anyone with rheumatoid arthritis. Excess weight puts added pressure on your weight-bearing joints. (Read about "Losing Weight") The Arthritis Foundation also recommends proper exercise for arthritis treatment. Exercises can increase the range of motion, using gentle stretching, for example, to improve joint mobility. Strengthening exercises for muscles can also help stabilize joints. In addition, there are a number of specific classes, such as water exercise or chair exercises, designed for people with arthritis. Always consult your doctor or physical therapist for information on the right type of exercise for your specific problem. (Read about "Rehabilitation")

In addition, NIAMS says there are other therapies that may work for flare-ups of swelling and pain. These include:

• Heat and cold - The decision to use either heat or cold for arthritis pain depends on the type of arthritis and should be discussed with your doctor or physical therapist. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed on the painful area of the joint for about 15 minutes may relieve the pain. Make sure you take all necessary precautions to avoid burning or otherwise hurting your skin, especially if you have diabetes (Read about "Skin" "Diabetes"), and if you have poor circulation, do not use cold packs.
• Joint protection - Using a splint or a brace to allow joints to rest and protect them from injury can be helpful. Your physician or physical therapist can make recommendations.
• Transcutaneous electrical nerve stimulation (TENS) - A small TENS device that directs mild electric pulses to nerve endings that lie beneath the skin in the painful area may relieve some arthritis pain. NIAMS says TENS seems to work by blocking pain messages to the brain and by modifying pain perception. (Read about "The Brain" "Nervous System")

The drugs used for treating rheumatoid arthritis fall into several different categories. Among the non-steroidal anti-inflammatory drugs (NSAIDs) are aspirin, ibuprofen, naproxen sodium and ketoprofen. Many arthritis drugs are available over-the-counter; however long-term use of these products should never be undertaken without a doctor's advice. NIAMS says common side effects of NSAIDs, including those available over-the-counter, can include stomach upset, heartburn, diarrhea, and fluid retention. (Read about "Heartburn" "Diarrhea" "Gastritis") Some patients also develop liver and kidney inflammation (Read about "The Liver" "Kidney Disease") while taking NSAIDs, making it especially important to stay in close contact with the doctor while taking these medications. (Read about "Medication and Digestion") A class of drugs - COX-2 inhibitors - has less risk of gastrointestinal ulceration and bleeding. (Read about "Gastrointestinal Bleeding") However, serious concerns about heart disease risk have made them a less common option. (Read about "Coronary Heart Disease")

Disease-modifying anti-rheumatic drugs (DMARDS) are another type of drug used to treat people with rheumatoid arthritis who have not responded to NSAIDs. NIAMS says some of these include methotrexate, hydroxychloroquine, penicillamine and gold injections; all require careful monitoring by the physician to avoid side effects.

A class of drugs called biologic response modifiers, such as TNF-blockers and other biologic DMARDs, can also be used to treat rheumatoid arthritis. NIAMS says this class of drugs work by blocking the action of a substance called tumor necrosis factor (TNF). TNF is a protein of the body's immune system (Read about "The Immune System") that can trigger inflammation. By binding TNF, these drugs can result in less inflammation. You will need to discuss the risks of TNF alpha blockers, including fungal infections (Read about "Microorganisms"), with your doctor.

Corticosteroids may also be used. These are hormones that can be taken by mouth or given by injection. Prednisone is a corticosteroid that can be taken by mouth to reduce the inflammation of rheumatoid arthritis. The doctor also may inject a corticosteroid into an affected joint to stop pain. According to NIAMS, because frequent injections may cause damage to the cartilage, they should only be done once or twice a year. Because of the potential for some serious side effects, including osteoporosis and coronary artery disease, the use of corticosteroids must be carefully monitored. In general, corticosteroids should not be taken together with NSAIDS and aspirin. NIAMS says anyone using corticosteroids should talk to their doctors about taking supplemental calcium (Read about "Calcium") and vitamin D to reduce the risk of osteoporosis. (Read about "Vitamins & Minerals" "Osteoporosis") Long-term corticosteroid use has also been linked to a condition called osteonecrosis in which a portion of bone loses its blood supply and begins to die. (Read about "Osteonecrosis")

Another class of drugs for rheumatoid arthritis is called costimulation modulators, which work by interfering with your T cells. T cells are part of the immune system. These drugs can cause serious side effects and should not be used by anyone with other conditions such as chronic obstructive pulmonary disease. (Read about "Chronic Obstructive Pulmonary Disease") There are also additional classes of drugs that work by impacting other parts of the immune system, such as B cells. You should discuss all options with your doctor.

When taking medication, it's important that you never mix different types of drugs on your own. Even medications such as cold remedies may contain ingredients that can cause problems if taken in combination with other medications, so always read labels and talk with your doctor or pharmacist first. (Read about "Drug Interaction Precautions")

In addition, topical creams can be helpful. Many contain salicylates to reduce inflammation and pain. Other topical treatments may produce feelings of warmth or coolness on the skin to help provide relief. In addition, capsaicin (the substance found in hot peppers) is being used in some topical creams to provide pain relief. As with any medicine, always talk with your doctor before using, make sure you read and follow all package directions carefully, and keep all such medications out of children's reach.

Surgery for rheumatoid arthritis

For some cases, surgery is the best option. Surgery can dramatically improve independence and quality of life by reducing pain and improving mobility, according to the Food and Drug Administration.

Joint replacement or arthroplasty replaces the damaged joint with an artificial one. Sometimes, the surgeon will not remove the whole joint, but will only replace or fix the damaged parts. (Read about "Joint Replacement" "Joint Resurfacing") The Arthritis Foundation says joint replacement has provided not only dramatic relief from pain, but also improvement in motion for many people with rheumatoid arthritis. It is most often done on the hip, the knee and the elbow. As with any surgical procedure, there are benefits and risks to all of the above. You need to discuss them with your doctor.

Joint fusion or arthrodesis is a procedure that fuses two bones together so they form one unit. This procedure can be used on smaller joints. The fused joint loses flexibility, but can be more stable and less painful. Again, you would need to discuss the advantages and disadvantages of any procedure with your doctor.

Related Information:

    Orthopedics

    Skeletal System