Understanding Rheumatoid Arthritis
What is rheumatoid arthritis (RA)?
Rheumatoid arthritis (RA) is an autoimmune disease in which the body's natural immune response wreaks havoc on the lining of the joints (called the synovial membrane), causing chronic inflammation and pain.1 The inflammation may eventually damage the joint's cartilage and bone, weaken the soft tissue around the joint (cartilage, ligaments and tendons) and prevent the joint from working properly.1
Who does RA affect?
More than two million people in the United States have been diagnosed with RA.2 RA can affect anyone at any age, but women appear especially at risk. In fact, women develop RA more than twice as often as men.3Although the medical community does not know what causes RA, today's best research has identified a genetic marker, found in white blood cells, that may help doctors determine if a particular person is at an increased risk.2, 3
What are the symptoms of RA?
RA is a chronic, persistent disease that seems to take its own course over an affected person's lifetime. It may progress slowly, sometimes produce "flare ups" of symptoms, and then at times go into "remission" during which the symptoms may greatly diminish or disappear. Unfortunately, RA never seems to go away completely.
Doctors sometimes talk about the three stages of RA. Those stages are identified by specific symptoms. In the first stage, RA causes pain, warmth, redness and swelling in affected joints. In the second stage, it causes thickening of the joint lining. In the third, permanent joint damage begins to occur as bone and cartilage are attacked by the enzymes released by the inflamed cells in the affected joint's once-healthy cushioning fluid (called synovial fluid).1, 4
In addition to joint pain, swelling and stiffness, the symptoms of RA commonly include fatigue, weakness, flu-like symptoms accompanied by a low-grade fever, loss of appetite, depression, chronic dry eye or dry mouth and, in people with more advanced RA, bumps (called rheumatoid nodules) under the skin.1, 5
Without question, left untreated, RA can greatly reduce your quality of life. You may have already begun to decrease your activity level just to avoid the pain caused by a joint affected by RA. It's not uncommon for the joint damage caused by RA to lead to a loss of movement, an inability to work, and even the need for surgery to repair the damage.4
In order to diagnose you properly, your doctor will consider your symptoms and your medical history, examine your joint(s) and order one or more diagnostic tests. Your doctor may order blood work, X-rays, a CT scan or an MRI to get a clear view of your condition.
How is RA treated?
Your primary doctor will refer you to a rheumatologist, a doctor who specializes in inflammatory diseases like RA. Your rheumatologist may recommend different treatment options depending on the severity of your RA and its impact on your joint(s) and your body as a whole. And while there is no cure, RA can be controlled through the use of new drugs, exercise, joint protection techniques and self-management techniques.
Manage the pain and preserve your joint.
Today, most doctors understand the value of treating RA more aggressively with very specific medications in order to slow the progression of the disease, joint deformity and loss of function.1 Your doctor may prescribe any one of these medications, or a combination of several: non-steroidal anti-inflammatory medications (NSAIDs), analgesics, steroids, disease modifying anti-rheumatic drugs (DMARDs) or biologic response modifiers that work on the immune system.
Look at the big picture.
Your doctor may recommend that you modify your diet, take certain nutritional supplements, exercise and get adequate sleep. Your doctor may also encourage you to learn about how managing your stress and learning some relaxation techniques may help improve your quality of life and help you to handle your RA symptoms with greater ease.6
Understand your surgical options.
If you are still experiencing arthritis pain and joint damage that's affecting your quality of life even after all other conservative measures have been taken, your doctor may suggest surgery to help relieve your pain and restore your mobility. Your doctor will determine the proper surgical treatment based on the severity of your arthritis. Today, a full range of surgical solutions exist that enable your doctor to customize surgical procedures to your particular needs and anatomy, whether you need arthroscopic debridement (removing inflamed and/or irritating debris from the joint), arthrodesis (fusing the joint for greater support) or arthroplasty (replacing the arthritic joint).
Be sure to talk with your doctor about the best treatment option for you.
References:
1. NIAMS: National Institute of Arthritis and Musculoskeletal and Skin Diseases. Handout on Health: Rheumatoid Arthritis. National Institutes of Health, Department of Health and Human Services. Available at: http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp. Accessed February 6, 2008.
2. Arthritis Foundation. Rheumatoid Arthritis: Overview. Accessed February 5, 2008.
3. Arthritis Foundation. Rheumatoid Arthritis: Who Gets It? Available at: http://www.arthritis.org/disease-center.php?disease_id=31&df=whos_at_risk. Accessed November 5, 2008.
4. Arthritis Foundation. Rheumatoid Arthritis: What Is It? Available at: http://www.arthritis.org/disease-center.php?disease_id=31. Accessed February 6, 2008.
5. Arthritis Foundation. Rheumatoid Arthritis: Symptoms. Accessed February 6, 2008.
6. Haaz S. Patient Education: Counseling RA Patients about Lifestyle and Diet Changes. Arthritis Practitioner. Available at: http://www.arthritispractitioner.com/article/4602. Accessed February 4, 2008.
© Stryker Orthopaedics 2008
