Rheumatoid Arthritis

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a disease that causes pain, stiffness, swelling, and loss of motion in the joints between your bones. It occurs most often in the fingers, wrists, elbows, shoulders, jaw, hips, knees, and toes. It can also affect other organs of the body.

RA usually appears first in early adulthood or middle age. However, sometimes it does not occur until later. You may have just one single attack, but more often the symptoms come and go. The disease cannot be cured, but medicine can help you have fewer and less severe attacks.

RA affects 1 in every 100 Americans. It is more common in women than in men.

How does it occur?

RA is an autoimmune disease. This means that the body's defenses against infection attack the body's own tissue. In rheumatoid arthritis, the lining of joints becomes inflamed, causing swelling, stiffness, and misshapen joints.

The exact cause of rheumatoid arthritis is not known. Things that may cause rheumatoid arthritis are:

• genes (passed from parent to child)
• infections
• hormones
• smoking
• long-term exposure to silica or asbestos.

What are the symptoms?

The symptoms may include:

• joint pain and stiffness, particularly morning stiffness
• red, warm, or swollen joints
• misshapen joints
• mild fever
• tiredness
• loss of appetite
• small lumps or nodules under the skin.

How is it diagnosed?

Your healthcare provider will review your medical history and examine you. You may have blood tests and X-rays.

How is it treated?

The goal of treatment is to keep the joints working properly by:

• reducing inflammation
• relieving pain and stiffness
• reducing swelling
• stopping or slowing down damage to the joints.

There are many ways to treat rheumatoid arthritis. Finding the treatments that will be most helpful for you depends on:

• how severe your symptoms are
• if your symptoms are getting worse
• the effect of the disease on your daily activities.

Many drugs are used to treat the symptoms of rheumatoid arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen can help relieve pain and inflammation. Adults over the age of 65 should not take NSAIDs for more than 7 days without their healthcare provider's approval. NSAIDs help reduce pain and swelling but can cause kidney and stomach problems.

COX-2 inhibitors such as celecoxib (Celebrex) are prescription NSAIDs. COX-2 inhibitors can help arthritis symptoms and may cause fewer stomach problems than other NSAIDs, but they have been linked to a greater risk of heart attack and stroke. Talk with your healthcare provider to learn more about taking NSAIDs.

When NSAIDs do not relieve symptoms, disease-modifying antirheumatic drugs (DMARDs) may be used. One example of a DMARD is methotrexate (Rheumatrex or Trexall). Treatment with DMARDs has to be watched carefully by your provider to avoid serious side effects. Steroid medicines, such as prednisone or cortisone, are very effective, but they also can have serious side effects.

Other, new medicines have been developed in recent years that can offer help to some people with rheumatoid arthritis. Talk to your healthcare provider about these medicines. Or ask to see a rheumatologist, which is a doctor who specializes in treating inflammatory diseases such as rheumatoid arthritis.

If you have arthritis in your knee, hyaluronic acid can be injected into the knee to act as a lubricant. It helps the knee to move without pain.

Physical therapy helps you to have better use of affected joints and muscles. Occupational therapy teaches you how to overcome disability and manage everyday tasks.

You may wear splints to rest inflamed joints and to prevent them from becoming misshapen.

Very severe RA may be treated by filtering harmful antibodies out of the blood. Sometimes severely damaged hips and knees are surgically replaced.

How long will the effects last?

You may have just 1 attack of RA in your life or you may have repeated flare-ups, which can lead to permanent joint damage. Fortunately, early treatment with DMARD medications can prevent this most of the time. If necessary, Splinting and surgery may help to restore damaged joints to a more natural appearance.

How can I take care of myself?

You can relieve symptoms and help prevent permanently misshapen joints by following these guidelines:

• Take the medicine your healthcare provider recommends.
• Rest your joints when they are warm, swollen, or painful.
• Follow the advice given by your healthcare provider or a physical therapist for keeping the affected joints mobile.
• Ask an occupational therapist about ways to do everyday tasks. Be open to using tools or other equipment that make everyday tasks easier on your joints.
• Keep your body healthy by eating a healthy diet.
• Follow any other recommendations from your healthcare provider.

How can I help prevent rheumatoid arthritis?

If you are a smoker, stopping smoking can reduce the risk of RA.