Rheumatoid Arthritis
Definition
Rheumatoid arthritis (RA) is an autoimmune disease. It causes pain, swelling, stiffness, and loss of function in the joints. RA usually affects the same joint on both sides of the body. It occurs mostly in the:
Fingers
Wrists
Elbows
Shoulders
Jaw
Hips
Knees
Toes
Rheumatoid arthritis (RA) is an autoimmune disease. It causes pain, swelling, stiffness, and loss of function in the joints. RA usually affects the same joint on both sides of the body. It occurs mostly in the:
Fingers
Wrists
Elbows
Shoulders
Jaw
Hips
Knees
Toes
Causes
RA is caused by a combination of genetic and environmental factors that trigger an abnormal immune response. Possible causes:
Genetic factors—Certain genes that play a role in the immune system are associated with RA development.
Defects in the immune system can cause ongoing inflammation.
Environmental factors—Certain infectious agents, such as some viruses or bacteria, may increase susceptibility to RA.
Other factors—Some evidence suggests that hormonal factors may promote RA development in combination with genetic factors and environmental exposure.
Risk Factors
These factors increase your chance of developing RA. Tell your doctor if you have any of these risk factors:
Family members with RA
Sex: female
Ethnic background: Pima Indians
Heavy or long-term smoking
RA is caused by a combination of genetic and environmental factors that trigger an abnormal immune response. Possible causes:
Genetic factors—Certain genes that play a role in the immune system are associated with RA development.
Defects in the immune system can cause ongoing inflammation.
Environmental factors—Certain infectious agents, such as some viruses or bacteria, may increase susceptibility to RA.
Other factors—Some evidence suggests that hormonal factors may promote RA development in combination with genetic factors and environmental exposure.
Risk Factors
These factors increase your chance of developing RA. Tell your doctor if you have any of these risk factors:
Family members with RA
Sex: female
Ethnic background: Pima Indians
Heavy or long-term smoking
Symptoms
When RA begins, symptoms may include:
Joint pain and stiffness that is:
Symmetrical
Most prominent in the morning
Lasts for at least half an hour
Red, warm, or swollen joints
Joint deformity
Mild fever, tiredness
Loss of appetite
Small lumps or nodules under the skin
As RA progresses, it may cause complications with the:
Heart
Lungs
Eyes
Skin
Liver
Kidneys
Blood
Nervous system
Blood vessels
It is also linked to early cardiovascular disease and death.
Diagnosis
There is no single test for RA. The doctor will ask about your symptoms and medical history. She will examine your joints, skin, reflexes, and muscle strength.
Tests:
Rheumatoid factor (RF) level in the blood
Erythrocyte sedimentation rate (ESR) of the blood—to measure inflammation in the body
C-reactive protein (CRP) —an indicator of active inflammation in the blood
White blood cell count
X-rays of affected joints (especially dual energy x-ray absorptiometry)—a test that uses radiation to take a picture of structures inside the body, especially bones
Treatment
There is no cure for RA. The goals of treatment are to:
Relieve pain
Reduce inflammation
Slow down joint damage
Improve functional ability
Medications
Disease-modifying anti-rheumatic drugs (DMARDS)—to slow the course of the disease. These medications are used early in the course of the disease to prevent long-term damage:
Methotrexate (eg, Rheumatrex)
Hydroxychloroquine (eg, Plaquenil)
Sulfasalazine (eg, Azulfidine)
Leflunomide (eg, Arava)
Cyclosporine (eg, Neoral)
Penicillamine (eg, Cuprimine)
Gold (eg, Ridaura) —can also be given as an injection
Minocycline (eg, Minocin)
Immunosuppressive drugs (only used when other DMARDS are ineffective):
Azathioprine (eg, Imuran)
Cyclophosphamide (eg, Cytoxan) —rarely used
Chlorambucil (eg, Leukeran)—rarely used
Biologic response modifiers—drugs that interfere with the autoimmune response associated with RA:
Etanercept (eg, Enbrel)
Infliximab (eg, Remicade)
Adalimumab (eg, Humira)
Abatacept (eg, Orencia)
Rituximab (eg, Rituxan)
Adjunctive medications:
Acetaminophen (eg, Tylenol)
Nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen and naproxen
Steroids
Low-dose corticosteroids (eg, prednisone) are often used first. They may be tapered when other drugs start working. Avoid long-term steroid use. Corticosteroid injections to inflamed joints may also be used.
Rest and Exercise
Rest reduces active joint inflammation and pain and fights fatigue. Exercise is important for maintaining muscle strength and flexibility. It also preserves joint mobility.
Joint Care
Splints applied to painful joints may reduce pain and swelling. Devices that help with daily activities can also reduce stress on joints. Devices include:
Zipper extenders
Long-handled shoehorns
Specially designed kitchen tools
Stress Reduction
Stress reduction can ease the difficulties of living with a chronic, painful disease. Exercise programs, support groups, and open communication with doctors can reduce stress.
Surgery
Joint replacement and tendon reconstruction help relieve severe joint damage.
Lifestyle Measures
These may relieve stiffness and weakness and reduce inflammation:
Maintain a balance between rest and exercise.
Attempt mild strength training.
Participate in aerobic exercise (eg, walking, swimming, dancing).
Avoid heavy impact exercise.
If you smoke, quit.
Control weight.
Participate in a physical therapy program.
Prevention
There are no guidelines for preventing RA. RESOURCES:
American College of Rheumatologyhttp://www.rheumatology.org/
The Arthritis Foundationhttp://www.arthritis.org/
When RA begins, symptoms may include:
Joint pain and stiffness that is:
Symmetrical
Most prominent in the morning
Lasts for at least half an hour
Red, warm, or swollen joints
Joint deformity
Mild fever, tiredness
Loss of appetite
Small lumps or nodules under the skin
As RA progresses, it may cause complications with the:
Heart
Lungs
Eyes
Skin
Liver
Kidneys
Blood
Nervous system
Blood vessels
It is also linked to early cardiovascular disease and death.
Diagnosis
There is no single test for RA. The doctor will ask about your symptoms and medical history. She will examine your joints, skin, reflexes, and muscle strength.
Tests:
Rheumatoid factor (RF) level in the blood
Erythrocyte sedimentation rate (ESR) of the blood—to measure inflammation in the body
C-reactive protein (CRP) —an indicator of active inflammation in the blood
White blood cell count
X-rays of affected joints (especially dual energy x-ray absorptiometry)—a test that uses radiation to take a picture of structures inside the body, especially bones
Treatment
There is no cure for RA. The goals of treatment are to:
Relieve pain
Reduce inflammation
Slow down joint damage
Improve functional ability
Medications
Disease-modifying anti-rheumatic drugs (DMARDS)—to slow the course of the disease. These medications are used early in the course of the disease to prevent long-term damage:
Methotrexate (eg, Rheumatrex)
Hydroxychloroquine (eg, Plaquenil)
Sulfasalazine (eg, Azulfidine)
Leflunomide (eg, Arava)
Cyclosporine (eg, Neoral)
Penicillamine (eg, Cuprimine)
Gold (eg, Ridaura) —can also be given as an injection
Minocycline (eg, Minocin)
Immunosuppressive drugs (only used when other DMARDS are ineffective):
Azathioprine (eg, Imuran)
Cyclophosphamide (eg, Cytoxan) —rarely used
Chlorambucil (eg, Leukeran)—rarely used
Biologic response modifiers—drugs that interfere with the autoimmune response associated with RA:
Etanercept (eg, Enbrel)
Infliximab (eg, Remicade)
Adalimumab (eg, Humira)
Abatacept (eg, Orencia)
Rituximab (eg, Rituxan)
Adjunctive medications:
Acetaminophen (eg, Tylenol)
Nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen and naproxen
Steroids
Low-dose corticosteroids (eg, prednisone) are often used first. They may be tapered when other drugs start working. Avoid long-term steroid use. Corticosteroid injections to inflamed joints may also be used.
Rest and Exercise
Rest reduces active joint inflammation and pain and fights fatigue. Exercise is important for maintaining muscle strength and flexibility. It also preserves joint mobility.
Joint Care
Splints applied to painful joints may reduce pain and swelling. Devices that help with daily activities can also reduce stress on joints. Devices include:
Zipper extenders
Long-handled shoehorns
Specially designed kitchen tools
Stress Reduction
Stress reduction can ease the difficulties of living with a chronic, painful disease. Exercise programs, support groups, and open communication with doctors can reduce stress.
Surgery
Joint replacement and tendon reconstruction help relieve severe joint damage.
Lifestyle Measures
These may relieve stiffness and weakness and reduce inflammation:
Maintain a balance between rest and exercise.
Attempt mild strength training.
Participate in aerobic exercise (eg, walking, swimming, dancing).
Avoid heavy impact exercise.
If you smoke, quit.
Control weight.
Participate in a physical therapy program.
Prevention
There are no guidelines for preventing RA. RESOURCES:
American College of Rheumatologyhttp://www.rheumatology.org/
The Arthritis Foundationhttp://www.arthritis.org/
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