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Rheumatoid Arthritis Symptoms and Treatment

What is rheumatoid arthritis?

Rheumatoid arthritis is a systemic disease, meaning it affects the entire body. It is a chronic disease, in which various joints in the body are inflamed, leading to swelling, pain, stiffness, and the possible loss of function. The joint inflammation begins in the synovium. Continuous inflammation of the synovium slowly destroys the cartilage, narrowing the joint space and eventually damaging bone. The inflammatory process can also occur in other parts of the body. RA can cause anemia and affect the nerves. Scleritis, an inflammation of the blood vessels in the eye can occur. The heart and lungs may also be affected.

Statistics

• Rheumatoid Arthritis affects more than two million Americans.

• More than 75 percent of people with RA are women.

• Peak onset is between age 20 and 45.

Image source: NIAMS

Inflammation is a byproduct of the body's immune system, which fights infection and heals injuries. When an injury or an infection occurs, white blood cells fight to rid the body of any foreign proteins, such as a virus. These masses of blood cells group at the injured or infected site and cause the area to become inflamed. Normally the inflammatory process is controlled and self-limited, but in people with chronic rheumatoid arthritis, something keeps this process going.

What exactly keeps this process going? No one really knows for sure, although theories abound. Scientists have found that certain genes that play a role in the immune system are associated with a tendency to develop rheumatoid arthritis. At the same time, some people with rheumatoid arthritis do not have these particular genes, and other people have these genes but never develop the disease. Stress, infectious agents, environment, and hormones are all suspected triggers.

What are the symptoms of rheumatoid arthritis?

The infamous symptom of rheumatoid arthritis is morning stiffness that lasts for at least an hour. Pain, redness and swelling may also occur in the joints. The joint symptoms are usually (but not always) symmetric, if the left knee is affected, so is the right, etc. Other symptoms can include weight loss, fatigue, and fever; a general flu like feeling. In about 20% of people with RA, inflammation of small blood vessels can cause nodules, or lumps, under the skin. They are about the size of a pea or slightly larger, and are often located near the elbow, although they can show up anywhere.

How is it diagnosed?

Rheumatoid arthritis may be difficult to diagnose. Many other conditions can resemble it and its symptoms can develop insidiously. Blood tests and x-rays may show normal results for months after the onset of joint pain.
According to the American College of Rheumatology, 4 of the following 7 symptoms indicate a diagnosis of rheumatoid arthritis:

1. Morning stiffness, lasting for at least an hour, present daily for at least 6 weeks
2. Arthritis of 3 or more joints, lasting for at least 6 weeks
3. Arthritis of the hand joints, lasting for at least 6 weeks
4. Symmetric arthritis, lasting for at least 6 weeks
5. Rheumatoid nodules
6. Positive rheumatoid factor (blood test)
7. Joint changes on x-ray

It is important to note that 20% of the people with RA will never have a positive rheumatoid factor; you can have RA and have a negative rheumatoid factor.

How is it treated?

Treatment of rheumatoid arthritis focuses on relieving pain, reducing inflammation, slowing or stopping joint damage, and improving the person's sense of well-being and ability to function. A combination of treatments is almost always used.

Rest and exercise:
Both rest and exercise help in important ways. People with rheumatoid arthritis need a good balance between the two, with more rest when the disease is active and more exercise when it is not. A physical therapist is useful in instructing the person with arthritis how to exercise without further damaging the joints.

Joint protection:
Splints, braces and supports can protect the joints and help prevent further damage. A doctor or a physical or occupational therapist can help get a splint and ensure that it fits properly. Other ways to reduce stress on joints include self-help devices, devices to help with getting on and off chairs, toilet seats, and beds; and changes in the ways that a person carries out daily activities.

Diet:
Everybody has a diet to "cure rheumatism," but there is no cure for rheumatoid arthritis, diet or otherwise. However some people are able to lessen their symptoms by a change in diet. Some claim that foods from the nightshade family--tomatoes, potatoes, green peppers, and eggplant--can exacerbate arthritis. About 5% of people with RA experience worse symptoms after drinking milk. Still others have an increase in symptoms after eating red meat. It is important to remember that no one diet will work on everyone and perhaps the best diet plan for a person with RA is simply a healthy balanced diet.

Medications:
NSAIDS (Nonsteroidal anti-inflammatory drugs) are commonly used to treat rheumatoid arthritis. Available over the counter or by prescription, they fight inflammation or swelling and relieve pain. NSAIDS are usually the first drug prescribed to a person newly diagnosed with rheumatoid arthritis. NSAIDS may relieve pain and swelling, but they do not slow the disease process.

DMARDS (disease modifying anti-rheumatic drugs) are also known as SAARDS (slow acting anti rheumatic drugs. As their name might suggest these medications take some time to be effective, up to several months. Most of them were originally invented to treat other diseases but were noted to have a positive effect on rheumatoid arthritis. Most of them do not have any common properties other than their ability to slow down the progression of the disease. The most common DMARDS used include methotrexate, hydroxychloroquine, sulfasalazine, gold and leflunomide (Arava).

The newest RA medications, biologic response modifiers, are drugs that interfere with the autoimmune response in RA. These are drugs that are genetically engineered to target the immune factors known as cytokines, particularly tumor necrosis factor (TNF) and certain interleukins, which play a major role in the destructive RA process. Enbrel and Remicade fall into this category.

Another new treatment is a device called the Prosorba column. It mechanically removes inflammatory antibodies from the blood. The blood is first removed from the body through a catheter (a process called apheresis) and then passes through a column coated with a substance called protein A, which binds to the antibodies. The blood is then returned to the patient.

Oral corticosteroids, such as prednisolone and prednisone (Deltasone, Orasone) usually work quickly to control inflammation. Due to the potential for serious side effects, long term use is usually discouraged. However if long term use is needed to maintain the control of inflammation, the lowest possible dose should be used. Corticosteroids can also be injected directly into the joint for relief of inflammation limited to one particular joint.

Recent studies have shown the antibiotics in the tetracycline family to have a positive impact on the progression of rheumatoid arthritis.

Topical pain-relieving creams, rubs, and sprays can be applied directly to the skin for temporary relief. There are many brands available over the counter.

Surgery:
Several types of surgery are available to patients with severe joint damage. These procedures can help reduce pain, improve the affected joint's function and appearance, and improve the patient's ability to perform daily activities. Surgical procedures include joint replacement, tendon reconstruction, and synovectomy.

What research is being done?

Researchers are studying genetic factors that predispose some people to developing rheumatoid arthritis, as well as factors connected with disease severity. Findings from these studies should increase our understanding of the disease and will help develop new therapies as well as guide treatment decisions.

Scientists are studying the relationships among the hormonal, nervous, and immune systems in rheumatoid arthritis. They are exploring whether and how the normal changes in the levels of steroid hormones (such as estrogen and testosterone) during a person's lifetime may be related to the development, improvement, or flares of the disease. Scientists are also looking at how these systems interact with environmental and genetic factors. Results from these studies may suggest new treatment strategies.

Some evidence indicates that infectious agents, such as viruses and bacteria, may trigger rheumatoid arthritis in people who have an inherited predisposition to the disease. Investigators are trying to discover which infectious agents may be responsible. They are also working to understand the basic mechanisms by which these agents might trigger the onset of rheumatoid arthritis.

Some of the related information found on Arthritis Insight:

Featured Discussion-Rheumatoid Arthritis
For support visit our Chat Room and Message Boards.
For medication information see our Medication Index.
For information about tests and blood work go to Tests & Labs.
To find tips for getting through the day, stop by our Better Living section.
To find out about surgeries and joint replacements see Surgeries.
For more sites about Rheumatoid Arthritis check out our Web Links.

For more information:

References:
Well-Connected Report-Rheumatoid Arthritis, Copyright ? Nidus Information Services, Inc. 1999
American College of Rheumatology
Arthritis Foundation
The National Institute of Arthritis and Musculoskeletal diseases, Handout On Health-Rheumatoid Arthritis

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Tina J. Underwood
Page last updated on May 8, 2000