What is rheumatoid arthritis?

Causes and Symptoms

Rheumatoid arthritis is one of these most common forms of arthritis.
Most experts believe that rheumatoid arthritis (RA) occurs as a result of a
complex interplay between environmental and genetic factors, although the initial
event triggering the inflammatory response is unknown. Some type of stress on the
body, possibly an autoimmune reaction or infection, triggers an autoimmune
response characterized by chronic inflammation, swelling, and pain in joint spaces
as cartilage erodes and bony cysts cause deformities in the joints and joint
motion is lost. Certain genes associated with the immune system have been found to
increase the possibility of developing RA. Changes in the STAT4
gene and human leukocyte antigen (HLA) genes are associated with
an increased risk for RA. Smoking also increases the risk for RA. Women are three
times more likely than men to develop RA than men, and onset typically occurs
between the ages of thirty to fifty years. The global prevalence of RA is
estimated to be 0.24 percent.

Initially, persons with RA may have general, vague complaints such as fatigue,
weakness, weight loss, anorexia, low-grade fever, and tingling in the hands and
feet. Joint stiffness lessens as the day progresses but may recur after inactivity
and is worse after strenuous activity. Although all joints may be affected, the
proximal interphalangeal or metacarpophalangeal joints and joints of the wrists,
knees, ankles, and toes are most often affected. Rheumatoid nodules may be found
on the hands and elbows. Sjögren’s syndrome, a chronic
autoimmune disease, or psoriasis may also be present. There is
also potential for renal, cardiovascular, pulmonary, neurological, and
ophthalmological involvement.

Diagnosis of RA involves identifying at least two painful or swollen joints that
has been that way for at least six weeks, as well as a variety of blood tests
intended to identify autoimmune disease. These tests may measure rheumatoid
factor, anticitrullinated protein antibodies (ACPA), erythrocyte sedimentation
rate, and c-reactive protein. X-rays to identify erosions, bony calcifications,
and narrowing in affected joints may also be undertaken.

Treatment and Therapy

The goals of rheumatoid arthritis treatment are to reduce inflammation and pain,
slow the disease process, improve function, and maintain quality of life.
Medications are used for their analgesic, anti-inflammatory, cytotoxic, and
immunosuppressive effects. The three main categories of medication used in the
treatment of RA are nonsteroidal anti-inflammatory drugs (NSAIDs),
disease-modifying antirheumatic drugs (DMARDs), and corticosteroids. NSAIDS such
as aspirin, ibuprofen, and naproxen reduce joint pain and swelling but do nothing
to slow the progression of RA. DMARDs, which include methotrexate,
hydroxychloroquine, leflunomide, sulfasalazine, and minocycline, can actually slow
the progression of RA. Biologic DMARDs called tumor necrosis factor (TNF)
inhibitors target areas of the immune system that cause joint and tissue damage.
Examples include etanercept, infliximab, adalimumab, and golimumab. The short-term
use of corticosteroids is effective for rapidly reducing joint inflammation.
Research has shown that fish oils containing omega-3 fatty acids may also decrease
inflammation in joints.

Education for the management of RA includes aerobic and strengthening exercises,
stress control, methods to protect joint integrity, and support groups that assist
individuals and their families to maintain independence and to plan for care
during exacerbations of RA. Surgical interventions to repair damaged joints and
joint replacement may also part of RA therapy.

Perspective and Prospects

In the United States, an estimated 0.6 percent of adults over the age of eighteen
suffer from rheumatoid arthritis. The highest incidence of RA occurs in women over
the age of sixty-five years. Juvenile rheumatoid
arthritis occurs in children aged seventeen years or younger.
Research has indicated a possible link between infections and the development of
rheumatoid arthritis.

Bibliography

Arthritis Foundation.
Raising a Child with Arthritis: A Parent’s Guide.
Lanham: Natl. Book Network, 1998. Print.

Bagchi, Debasis, Hiroyoshi Moriyama, and
Siba P. Raychaudhuri, eds. Arthritis: Pathophysiology, Prevention,
and Therapeutics. Boca Raton: CRC, 2011. Print.

Firestein, Gary S.,
Gabriel S. Panayi, and Frank A. Wollheim, eds. Rheumatoid
Arthritis. 2nd ed. New York: Oxford UP, 2006. Print.

Firestein, Gary S., et al.
Kelley's Textbook of Rheumatology. 9th ed. Philadelphia:
Elsevier, 2013. Print.

Foltz-Gray, Dorothy.
The Arthritis Foundation’s Guide to Good Living with Rheumatoid
Arthritis. 3rd ed. Atlanta: Arthritis Foundation, 2006.
Print.

Paget, Stephen A.,
Michael D. Lockshin, and Suzanne Loebl. The Hospital for Special
Surgery Rheumatoid Arthritis Handbook. New York: Wiley, 2002.
Print.

Pelt, Marc N., ed. Arthritis:
Types, Treatment and Prevention. New York: Nova, 2011.
Print.

Poehlmann, Katherine
M. Rheumatoid Arthritis: The Infection Connection. Durham:
Satori, 2002. Print.

Weisman, Michael H. Rheumatoid
Arthritis. Oxford: Oxford UP, 2011. Print.