Rheumatoid Arthritis

Rheumatoid arthritis (RA) involves inflammation of the lining of joints in the body. In early RA, for reasons that are not yet fully understood, inflammatory cells that usually circulate in the blood and protect against infections become activated and migrate to the lining of the joints. This lining is called synovium. In RA, inflamed synovium grows to 10-20 times its normal size and is filled with inflammatory cells. This inflammatory process progressively causes damage to the joint structures leading to chronic pain and permanent damage and in a relatively short time.  This can ultimately lead to disability.

RA occurs in 1% of the adult population in the United States.  This is greater than 2.4 million people. Usually it affects people over the age of 20.  It commonly occurs in women in their childbearing years. However, individuals in their eighth and ninth decade of life can also develop RA.

In the past, without adequate knowledge of the natural history of RA, doctors felt that the disease was a slowly progressive condition that did not alter an individual’s life span. Now it is realized that RA can be a rapidly progressive condition that alters all aspects of an individual’s life including:

• Ability to work
• Perform normal daily activities
• Walk
• Feed, bathe and dress oneself

In addition to disabling affected individuals, RA can shorten a person’s lifespan as much as cancer or heart disease. Medical costs are presently in the tens of billions of dollars.

With recent advances and better understanding of immunology new treatments are now available to slow down the destructive process.  Unfortunately, the longer the duration of RA, the harder the disease becomes to treat.   Irreversible damage to joints may lead to disability, ultimately, requiring surgery. The goal is to prevent irreversible damage by treating patients early.

Early warning signs for the development of RA include:

• Joint tenderness, warmth or  swelling
• Joints on both sides of the body affected at the same time
• Joint inflammation commonly affecting the fingers, wrists, ankles, and toes
• Other affected joints, including the neck, shoulders, elbows, hips, knees or jaw.
• Fatigue, occasional fevers, and malaise (a general sense of not feeling well)
• Pain and stiffness lasting for more than one hour in the morning or after long periods of rest
• Ongoing symptoms that generally do not go away

The exact cause of RA is not yet known. It is known that RA is an autoimmune disease. This means the body's natural immune system does not operate as it should.  Proteins that normally protect the body from harm attack a person’s normal tissue.  This starts an inflammatory process progressing to joint damage.

Many factors can contribute to the development of RA. The majority of RA sufferers are women. They tend to get a more severe form of the disease.

Genes or hereditary factors play a role. Scientists have shown certain genes that play a role in the immune system may be involved in determining whether or not a person develops RA. Individuals who have relatives with RA will have a higher chance of developing the disease.

Researchers have studied various viruses and bacteria but to date no specific infectious causes for RA have been identified.  The body seems to expose certain molecules to the immune system to activate the inflammatory process that causes RA in those individuals that are genetically predisposed. This inflammatory process becomes chronic, and the body cannot turn itself off.

The evaluation to diagnose RA includes:

• Recording your medical history and conducting a physical examination
• Performing  blood tests to evaluate inflammation and markers of arthritis
• Possibly drawing fluid from inflamed joints to analyze the extent of inflammation and rule out other arthritic conditions
• Taking x-rays of affected joints, especially the hands and feet
• Doing MRI on affected joints to assess joint problems that are harder to visualize on standard x-ray

Treatment of RA includes controlling joint inflammation and starting the patient on a medically-advised exercise program.  With treatment- pain, swelling and decreased joint mobility will improve.