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Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a chronic and autoimmune type of arthritis. It results when your immune system attacks the synovial lining of your joints. This lining is supposed to produce a fluid that keeps your joints properly lubricated and moving smoothly. Consequently, the effect of RA is to cause joint stiffness and pain, among other things.
The initial impact of rheumatoid arthritis is on the lining of your joints. However, its ultimate impact can go well beyond them. As the disease progresses, people with RA can eventually develop bone erosion and joint deformities.
In addition to damaging your joints, RA causes a generally high level of inflammation in the body. This can have adverse impacts on your organs (especially the heart and lungs), blood vessels and eyes, among other things.
Causes of RA
The human body’s immune system is programmed to detect and fight the presence of foreign agents. Typically, these are viruses and/or bacteria that have invaded the body. The immune system, when functioning properly, is supposed to detect and destroy viruses and bacteria. Specifically, it is supposed to destroy them before they cause damage to the body or its systems.
However, the immune system sometimes becomes over aggressive. It then attacks parts of the body that actually belong to it. This type of malfunction is called an auto immune disease.
Examples of other common auto immune diseases include the type 1 form of diabetes and lupus. In type 1 diabetes, the immune system attacks the pancreas while with lupus, it actually attacks the entire body itself.
Researchers still don’t fully understand the reasons why the immune system starts to malfunction as described above. Some scientists believe that it is triggered by environmental factors like a virus or bacteria. These factors probably interact with the genes of certain people and cause the immune system to go awry
Other possible causes being investigated by scientists include physical or emotional stress suffered by the affected person.
Risk Factors
Two possible risk factors that can increase your risk of developing RA include:
- Having a family member who has suffered from rheumatoid arthritis. This is why some researchers suspect that it may be linked to your genetic profile;
- Going through a prolonged period of physical or emotional stress.
Other risk factors that can increase your risk of developing rheumatoid arthritis include the following:
- Being female. RA tends to occur more often in women than it does in men. However, when it appears in men, the symptoms are usually more severe;
- Smoking. There appears to be a correlation between this habit and the incidence of the disease;
- Being middle aged. This is when the disease seems to appear most often. However, it sometimes appears either in the young or in the elderly;
- Being overweight also appears to increase RA risk. This association appears to be particularly noticeable among those under age 55.
Symptoms of Rheumatoid Arthritis
We now discuss the signs and symptoms typically experienced by people with RA. Please note that, unlike osteoarthritis, RA symptoms usually simultaneously affect joints on both sides of the body. For example, joint pain and stiffness may appear in both the right and left knees at the same time.
RA symptoms typically include:
- Joint pain when you try to move the joint;
- Joint stiffness that is usually at its most severe upon awakening in the morning or after any period of inactivity;
- Joint swelling;
- Joints that are warm and “tender to the touch”;
- In addition to the joint conditions described above, tiredness, fever and a loss of appetite.
In its early stages, RA tends to first attack the small joints of the body such as the fingers and toes. It then tends to spread to the larger joints such as the wrists, knees, ankles, etc. After a while, people with RA can find that their joints are becoming deformed and shifting out of place.
As we have mentioned above, rheumatoid arthritis tends to cause generally high levels of inflammation in the body. As a result, its effects can go well beyond the joint damage described above.
The body parts other than joints that may be affected include the skin, eys, lungs, heat and kidneys. Even the salivary glands, nerves, bone marrow and blood vessels can suffer the effects of RA.
Another noticeable aspect of RA symptoms is their tendency to vary in severity over time. In some individuals, the disease can sometimes go completely into remission, i.e. the symptoms can vanish completely. This may continue for a while, only for the symptoms to suddenly flare up again.
Complications of RA
Rheumatoid arthritis can cause the development of several other health conditions. These may include:
- Osteoporosis, in which your bones become more brittle and you suffer increased risk of fractures;
- Firm bumps of tissue forming at or near pressure points such as your elbows as well as other areas;
- Dry eyes and mouth;
- An abnormally high proportion of fat to lean body mass;
- Carpal tunnel syndrome, in which the hands and wrists become stiff and painful to open upon awakening;
- Heart & lung problems;
- Lymphoma – a family of cancers of the blood.
These complications make it important that anyone suffering some or all of the above symptoms should seek medical advice urgently.
Diagnosing RA
The diagnosis of RA will normally include several stages – a physical examination, blood testing and imaging studies.
Physical Exam
The physician conducting the diagnosis will probably review your medical history and ask you detailed questions about your symptoms. He or she will probably want to know what makes them worse or the times of the day when they are most severe.
The doctor will also likely check your joints for signs of swelling and redness. Checks may also be done on your reflexes and/or muscle strength, partially to rule out other possible causes of your symptoms.
Blood Tests
Blood tests may be done with the aim of detecting the presence of elements that appear in the blood as reactions to RA.
For example, C-reactive protein (CRP) often appears in the blood in response to a process that is generating inflammation.
Other elements that may appear in the blood indicate the possible presence of RA include rheumatoid factor and anti CPP antibodies.
Imaging Studies
X rays can help your doctor assess the amount of bone damage in your joints, and to monitor its progress over time. MRI and ultrasound imaging can also be helpful in assessing other types of damage, such as to soft tissues.
Treatment
It should first be noted that there are presently no known effective treatments for any type of arthritis, including rheumatoid arthritis. The symptoms cannot be reversed or even stopped. Instead, doctors focus on managing the rate of progression of the disease. They also try to preserve as much of your quality of life as possible.
The treatment options used to accomplish this involve use of medications, physical therapy/exercise and surgery.
Medications
The medications currently used to control the progression of RA symptoms are:
- Non steroidal anti inflammatory medications (NSAIDs) such as Ibuprofen or Naproxen (over the counter). Doctors can also prescribe stronger NSAIDs if needed.
- Disease Modifying Anti Rheumatic Drugs (DMARDs) which slow the rate of damage done by RA to the joints;
- Corticosteroid medications that directly attack the inflammation caused by RA;
- Biologic agents, which are actually a new type of DMARD.They tamp down the aggressiveness of your immune system and are frequently used in tandem with conventional DMARDs. However, one drawback to be noted is their tendency to increase your infection risk;
- Targeted synthetic DMARDs are sometimes used if conventional DMARDs & Biologic agents fail to slow down RA progression. However, some of these drugs can have serious side effects such as pulmonary blood clots (in the lungs), heart malfunction and even cancer.
Physical Therapy
Doctors can refer you to a physical therapist who can design an exercise program to keep your joints flexible. Occupational therapists can also educate you on modifying the way you do regular tasks in order to relieve pain. They can also help you identify special tools or modifications to your home to make daily life less painful.
Surgery
If all else fails, doctors can suggest a range of surgical options including:
- Removal of the inflamed joint lining;
- Fusion of joints for pain relief or to stabilize the joint;
- Joint replacement with an artificial substitute made from plastic or metal. The best known examples of these are knee and hip replacement operations.