Unlike osteoarthritis, which results from wear and tear on your joints, rheumatoid arthritis is an inflammatory condition. The exact cause of rheumatoid arthritis is unknown, but it’s believed to be the body’s immune logic attacking the tissue that lines your joints (synovium).
Rheumatoid arthritis is two to three times more common in women than in men and generally strikes between the ages of 20 and 50. But rheumatoid arthritis can also affect childish children and adults older than age 50.
Here’s no cure for rheumatoid arthritis. But with proper treatment, a strategy for joint protection and changes in lifestyle, you can live a long, productive life with this condition.
Signs and symptoms
The signs and symptoms of rheumatoid arthritis may come and go over time. They include:
* Pain and swelling in your joints, primarily in the smaller joints of your hands and feet
* Generalized aching or stiffness of the joints and muscles, primarily with sleep or with periods of rest
* Loss of motion of the affected joints
* Loss of strength in muscles attached to the affected joints
* Fatigue, which can be severe during a flare-up
* Low-grade fever
* Distortion of your joints over time
* General sense of not feeling well (depression)
Rheumatoid arthritis usually causes problems in several joints at the same time. Early in rheumatoid arthritis, the joints in your wrists, hands, feet and knees are the ones most often affected. As the disease progresses, your shoulders, elbows, hips, jaw and neck can become involved. It generally affects both sides of your body at the same time. The knuckles of both hands are one example.
Tiny lumps, called rheumatoid nodules, may form under your skin at pressure points and can occur at your elbows, hands, feet and Achilles tendons. Rheumatoid nodules may also occur elsewhere, including the back of your scalp, over your knee or even in your lungs. These nodules can range in size — from as tiny as a pea to as large as a walnut. Usually these lumps aren’t painful.
In draw a honor to osteoarthritis, which affects only your bones and joints, rheumatoid arthritis can cause inflammation of tear glands, salivary glands, the linings of your heart and lungs, your lungs themselves and, in rare cases, your blood vessels.
Although rheumatoid arthritis is often a recurring disease, it tends to vary in severity and may even come and go. Periods of increased disease activity — called flare-ups or flares — alternate with periods of relative remission, during which the swelling, pain, difficulty sleeping, and weakness fade or disappear.
Swelling or distortion may limit the flexibility of your joints. But even if you have a severe form of rheumatoid arthritis, you’ll probably retain flexibility in many joints.
Illustration comparing rheumatoid arthritis and osteoarthritis
Osteoarthritis, the most common form of arthritis, involves the wearing away of the cartilage that caps the bones in your joints. With rheumatoid arthritis, the synovial membrane that protects and lubricates joints becomes inflamed, causing pain and swelling. Joint wearing away may follow.
More On This Topic
* Osteoarthritis
Causes
As with other forms of arthritis, rheumatoid arthritis involves inflammation of the joints. A membrane called the synovium lines each of your changeable joints. When you have rheumatoid arthritis, white blood cells — whose usual job is to attack unwanted invaders, such as bacteria and viruses — go from your bloodstream into your synovium. Here, these blood cells appear to play an vital role in causing the synovial membrane to become inflamed (synovitis).
This inflammation results in the release of proteins that, over months or years, cause thickening of the synovium. These proteins can also hurt cartilage, bone, tendons and ligaments. Gradually, the joint loses its shape and alignment. Eventually, it may be ruined.
Some researchers suspect that rheumatoid arthritis is triggered by an infection — possibly a virus or bacterium — in people with an inherited susceptibility. Although the disease itself is not inherited, certain genes that make an increased susceptibility are. People who have inherited these genes won’t necessarily develop rheumatoid arthritis. But they may have more of a tendency to do so than others. The severity of their disease may also depend on the genes inherited. Some researchers also believe that hormones may be involved in the development of rheumatoid arthritis.
Illustration showing inflammation of rheumatoid arthritis
Rheumatoid arthritis typically strikes joints, causing pain, swelling and distortion. As your synovial membranes become inflamed and thickened, fluid builds up and joints erode and degrade.
Risk factors
The exact causes of rheumatoid arthritis are unclear, but these factors may increase your risk:
* Getting older, because incidence of rheumatoid arthritis increases with age. But, incidence starts to decline in women over the age of 80.
* Being female.
* Being exposed to an infection, possibly a virus or bacterium, that may trigger rheumatoid arthritis in those with an inherited susceptibility.
* Inheriting point genes that may make you more susceptible to rheumatoid arthritis.
* Smoking cigarettes over a long period of time.
When to seek medical advice
See your doctor if you have persistent discomfort and swelling in multiple joints on both sides of your body. Your doctor can work with you to develop a pain management and treatment plot. Also seek medical advice if you experience side effects from your arthritis medications. Side effects may include vomiting, abdominal discomfort, black or tarry stools, changes in bowel habits, constipation and drowsiness.
Screening and diagnosis
If you have signs and symptoms of rheumatoid arthritis, your doctor will likely conduct a physical examination and request laboratory tests to determine if you have this form of arthritis. These tests may include:
*
Blood tests. A blood test that measures your erythrocyte sedimentation rate (ESR or sed rate) can indicate the presence of an inflammatory process in your body. People with rheumatoid arthritis tend to have elevated ESRs. The ESRs in those with osteoarthritis tend to be normal.
A further blood test looks for an antibody called rheumatoid business. Most people with rheumatoid arthritis eventually have this abnormal antibody, although it may be absent early in the disease. It’s also possible to have the rheumatoid business in your blood and not have rheumatoid arthritis.
* Imaging. Doctors may take X-rays of your joints to differentiate between osteoarthritis and rheumatoid arthritis. A logic of X-rays obtained over time can show the progression of arthritis.
Complications
Rheumatoid arthritis causes stiffness and pain and may also cause fatigue. It can lead to difficulty with everyday tasks, such as turning a doorknob or holding a pen. Production with the pain and the volatility of rheumatoid arthritis can also cause symptoms of depression.
Rheumatoid arthritis may also increase your risk of developing osteoporosis, primarily if you take corticosteroids. Some researchers believe that rheumatoid arthritis can increase your risk of heart disease. This may be because the inflammation that rheumatoid arthritis causes can also affect your arteries and heart muscle tissue.
In the past, people with rheumatoid arthritis may have finished up confined to a wheelchair because hurt to joints made it hard or impossible to walk. That’s not as likely today because of better treatments and self-care methods.
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* Osteoporosis
Treatment
Treatments for arthritis have improved in recent years. Most treatments involve medications. But in some cases, surgical procedures may be necessary.
Medications
Medications for rheumatoid arthritis can relieve its symptoms and slow or halt its progression. They include:
* Nonsteroidal anti-inflammatory drugs (NSAIDs). This group of medications, which includes aspirin, helps relieve both pain and inflammation if you take the drugs regularly. NSAIDs that are available over-the-counter include aspirin, ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve). These are available at higher dosages, and other NSAIDs are available by prescription — such as ketoprofen, naproxen (Anaprox, Naprosyn), tolmetin (Tolectin), diclofenac (Voltaren), nabumetone (Relafen) and indomethacin (Indocin). Taking NSAIDs can lead to side effects such as indigestion and stomach flow of blood. Other potential side effects may include hurt to the liver and kidneys, ringing in your ears (tinnitus), fluid retention and high blood pressure. NSAIDs, except aspirin, may also increase your risk of cardiovascular events such as heart attack or stroke.
* COX-2 inhibitors. This class of NSAIDs may be less damaging to your stomach. Like other NSAIDs, COX-2 inhibitors — such as celecoxib (Celebrex) — suppress an enzyme called cyclooxygenase (COX) that’s active in joint inflammation. Other types of NSAIDs work hostile to two versions of the COX enzyme that are present in your body: COX-1 and COX-2. But, here’s evidence that by suppressing COX-1, NSAIDs may cause stomach and other problems because COX-1 is the enzyme that protects your stomach lining. Unlike other NSAIDs, COX-2 inhibitors suppress only COX-2, the enzyme involved in inflammation. Side effects may include fluid retention and causing or exacerbating high blood pressure. Furthermore, this class of drugs has been linked to an increased risk of heart attack and stroke.
* Corticosteroids. These medications, such as prednisone and methylprednisolone (Medrol), reduce inflammation and pain, and slow joint hurt. In the fleeting term, corticosteroids can make you feel dramatically better. But when used for many months or years, they may become less effective and cause honest side effects. Side effects may include simple bruising, thinning of bones, cataracts, weight gain, a round face and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually contraction off the medication.
* Disease-modifying antirheumatic drugs (DMARDs). Physicians prescribe DMARDs to limit the amount of joint hurt that occurs in rheumatoid arthritis. Taking these drugs at early stages in the development of rheumatoid arthritis is primarily vital in the try to slow the disease and save the joints and other tissues from permanent hurt. Because many of these drugs act slowly — it may take weeks to months before you notice any subsidy — DMARDs typically are used with an NSAID or a corticosteroid. While the NSAID or corticosteroid handles your immediate symptoms and limits inflammation, the DMARD goes to work on the disease itself. Some commonly used DMARDs include hydroxychloroquine (Plaquenil), the gold compound auranofin (Ridaura), sulfasalazine (Azulfidine), minocycline (Dynacin, Minocin) and methotrexate (Rheumatrex). Other forms of DMARDs include immunosuppressants and tumor necrosis business (TNF) blockers.
* Immunosuppressants. These medications act to tame your immune logic, which is out of control in rheumatoid arthritis. In addition, some of these drugs attack and eliminate cells that are associated with the disease. Some of the commonly used immunosuppressants include leflunomide (Arava), azathioprine (Imuran), cyclosporine (Neoral, Sandimmune) and cyclophosphamide (Cytoxan). These medications can have potentially honest side effects such as increased susceptibility to infection.
* TNF blockers. These are a class of DMARDs known as biologic response modifiers. TNF is a cytokine, or cell protein, that acts as an inflammatory agent in rheumatoid arthritis. TNF blockers, or anti-TNF medications, target or block this cytokine and can help reduce pain, morning stiffness and tender or swollen joints — usually within one or two weeks with treatment starts. Here is evidence that TNF blockers may halt progression of disease. These medications often are full with methotrexate. TNF blockers approved for treatment of rheumatoid arthritis are etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira). Potential side effects include injection site irritation (adalimumab and etanercept), worsening congestive heart failure (infliximab), blood disorders, lymphoma, demyelinating diseases, and increased risk of infection. If you have an active infection, don’t take these medications.
* Interleukin-1 receptor antagonist (IL-1Ra). IL-1Ra is a further type of biologic response modifier and is a recombinant form of the naturally occurring interleukin-1 receptor antagonist (IL-1Ra). Interleukin-1 (IL-1) is a cell protein that promotes inflammation and occurs in excess amounts in people who have rheumatoid arthritis or other types of inflammatory arthritis. If IL-1 is prevented from binding to its receptor, the inflammatory response decreases. The initially IL-1Ra that has been approved by the Food and Drug Administration for use in people with moderate to severe rheumatoid arthritis who haven’t responded adequately to conventional DMARD therapy is anakinra (Kineret). It may be used alone or in combination with methotrexate. Anakinra is given as a daily self-administered injection under the skin. Some potential side effects include injection site reactions, decreased white blood cell counts, headache and an increase in upper respiratory infections. Here may be a slightly higher rate of respiratory infections in people who have asthma or recurring obstructive pulmonary disease. If you have an active infection, don’t use anakinra.
* Abatacept (Orencia). Abatacept, a type of costimulation modulator approved in late 2005, reduces the inflammation and joint hurt caused by rheumatoid arthritis by inactivating T cells — a type of white blood cell. People who haven’t been helped by TNF blockers might consider abatacept, which is administered monthly through a vein in your arm (intravenously). Side effects may include headache, vomiting and mild infections, such as upper respiratory tract infections. Honest infections, such as pneumonia, can occur.
* Rituximab (Rituxan). Rituximab reduces the digit of B cells in your body. B cells are involved in inflammation. Though originally approved for use in people with non-Hodgkin’s lymphoma, rituximab was approved for rheumatoid arthritis in early 2006. People who haven’t found relief by TNF blockers might consider by rituximab, which is usually given along with methotrexate. Rituximab is administered as an mix into a vein in your arm. Side effects include flu-like signs and symptoms, such as fever, chills and vomiting. Some people experience extreme reactions to the mix, such as difficulty breathing and heart problems.
* Antidepressant drugs. Some people with arthritis also experience symptoms of depression. The most common antidepressants used for arthritis pain and nonrestorative sleep are amitriptyline, nortriptyline (Aventyl, Pamelor) and trazodone (Desyrel).
Surgical or other procedures
Although a combination of medication and self-care is the initially way of action for rheumatoid arthritis, other methods are available for severe cases:
* Prosorba column. This blood-filtering technique removes certain antibodies that say to pain and inflammation in your joints and muscles and is usually performed once a week for 12 weeks as an outpatient procedure. Some of the side effects include fatigue and a brief increase in joint pain and swelling for the initially few days with the treatment. The Prosorba column treatment isn’t recommended if you’re taking angiotensin-converting enzyme (ACE) inhibitors or if you have heart problems, high blood pressure or blood-clotting problems.
* Joint substitution surgery. For many people with rheumatoid arthritis, medicines and therapies can’t prevent joint destruction. When joints are severely smashed, joint substitution surgery can often help restore joint function, reduce pain or right a distortion. You may need to have an entire joint replaced with a metal or plastic prosthesis. Surgery may also involve tightening tendons that are too loose, loosening tendons that are too tight, fusing bones to reduce pain or removing part of a diseased bone to increase mobility. Your doctor may also remove the inflamed joint lining (synovectomy).
More On This Topic
* Steroid use: Balancing the risks and benefits
* Are COX-2 drugs safe for you? An interview with a Mayo Clinic specialist
* Knee substitution: Surgery can relieve pain
Self-care
Treating rheumatoid arthritis typically involves by a combination of medical treatments and self-care strategies. The following self-care procedures are vital elements for managing the disease:
*
Exercise regularly. Uncommon types of exercise achieve uncommon goals. Check with your doctor or physical therapist initially and then start a fixed exercise program for your point needs. If you can walk, walking is a excellent starter exercise. If you can’t walk, try a stationary bicycle with small or no resistance or do hand or arm exercises. A chair exercise program may be helpful. Aquatic exercise is a further option, and many health clubs with pools offer such classes.
It’s excellent to go each joint in its full range of motion every day. As you go, maintain a slow, steady rhythm. Don’t jerk or bounce. Also, remember to breathe. Holding your breath can temporarily deprive your muscles of oxygen and tire them. It’s also vital to maintain excellent posture while you exercise. Avoid exercising tender, injured or severely inflamed joints. If you feel new joint pain, stop. New pain that lasts more than two hours with you exercise probably earnings you’ve overdone it. If pain persists for more than a few days, call your doctor.
* Control your weight. Excess weight puts added stress on joints in your back, hips, knees and feet — the places where arthritis pain is commonly felt. Excess weight can also make joint surgery more hard and risky.
* Eat a healthy diet. A healthy diet emphasizing fruit, vegetables and whole grains can help you control your weight and maintain your overall health, allowing you to deal better with your arthritis. But, here’s no special diet that can be used to treat arthritis. It hasn’t been proved that intake any particular food will make your joint pain or inflammation better or worse.
* Apply heat. Heat will help ease your pain, relax tense, painful muscles and increase the regional flow of blood. One of the simplest and most effective ways to apply heat is to take a hot shower or bath for 15 minutes. Other options include by a hot pack, an electric heat pad set on its lowest setting or a radiant heat lamp with a 250-watt reflector heat bulb to warm point muscles and joints. If your skin has poor sensation or if you have poor circulation, don’t use heat treatment.
* Apply cold for occasional flare-ups. Cold may dull the sensation of pain. Cold also has a numbing effect and decreases muscle spasms. Don’t use cold treatments if you have poor circulation or numbness. Techniques may include by cold packs, soaking the affected joints in cold fill up and ice massage.
* Practice relaxation techniques. Hypnosis, guided imagery, deep breathing and muscle relaxation can all be used to control pain.
* Take your medications as recommended. By taking medications regularly instead of waiting for pain to build, you will lessen the overall intensity of your discomfort.
Coping skills
The degree to which rheumatoid arthritis affects your daily activities depends in part on how well you cope with the disease. Physical and occupational therapists can help you devise strategies to cope with point limitations you may experience as the result of weakness or pain. Here are some general suggestions to help you cope:
* Keep a positive attitude. With your doctor, make a plot for managing your arthritis. This will help you feel in charge of your disease. Studies show that people who take control of their treatment and actively manage their arthritis experience less pain and make fewer visits to the doctor.
* Use assistive devices. A painful knee may need a brace for support. You might also want to use a cane to take some of the stress off the joint as you walk. Use the cane in the hand opposite the affected joint. If your hands are affected, various helpful tools and gadgets are available to help you maintain an active lifestyle. Contact your pharmacy or doctor for in rank on ordering items that may help you the most.
* Know your limits. Rest when you’re tired. Arthritis can make you prone to fatigue and muscle weakness. A rest or fleeting nap that doesn’t interfere with nighttime sleep may help.
* Avoid grasping actions that strain your finger joints. Instead of by a clutch purse, for example, select one with a shoulder strap. Use hot fill up to come undone a jar lid and pressure from your palm to open it, or use a jar opener. Don’t twist or use your joints forcefully.
* Spread the weight of an object over several joints. For instance, use both hands to lift a heavy pan.
* Take a break. Periodically relax and stretch.
* Maintain excellent posture. Poor posture causes uneven weight distribution and may strain ligaments and muscles. The simplest way to increase your posture is by walking. Some people find that swimming also helps increase their posture.
* Use your strongest muscles and favor large joints. Don’t push open a heavy glass door. Lean into it. To pick up an object, bend your knees and squat while keeping your back straight.
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