Definition of Rheumatoid Arthritis
Rheumatoid arthritis is considered one of the most crippling types of arthritis. This type of Arthritis is seen to occur worldwide, and affects more than 6.5 million in the U.S. Interestingly; Rheumatoid arthritis is more common among women then men. Rheumatoid arthritis is a type of chronic inflammatory disease, which involves the peripheral joints, encompassing the wrists, toes, fingers, joints, and knees. Rheumatoid arthritis is an autoimmune disorder, which can occur at almost any age, though it is mostly seen in the age group of 35 to 50.
Rheumatoid arthritis has no permanent cure and requires lifelong treatment and attention. Painful deformities in the joints, extreme to mild pain and swelling are some of the affects of the disease. Usually associated with wear and tear of joints, or old age related immobility problems, the Rheumatoid arthritis can be come more prominent due to factors such as smoking, old age and high rheumatoid factor.
In some patients with rheumatoid arthritis, chronic inflammation leads to the destruction of the cartilage, bone, and ligaments, causing deformity of the joints. Damage to the joints can occur early in the disease and be progressive. Moreover, studies have shown that the progressive damage to the joints does not necessarily correlate with the degree of pain, stiffness, or swelling present in the joints.
Symptoms of Rheumatoid arthritis
An early diagnosis, of Rheumatoid arthritis would help in better treatment and relief. It is therefore necessary to know about the symptoms that are associated with Rheumatoid arthritis.
People with Rheumatoid arthritis; usually have problems in their joints, with the joints remaining tender, warm, and swollen. This mostly occurs in a "symmetrical" pattern, hence if the right knee is affected, then the left knee is also affected.
Affects of Rheumatoid arthritis can also be seen in the finger joints, the wrist the hand, neck and shoulders, elbows, hips, knees, feet and ankles can also may be affected. Some other symptoms of Rheumatoid arthritis are pain or stiffness in the mornings or after long spells of inactivity. Those with Rheumatoid arthritis also experience occasional bouts of fever and a general sense of being unwell.
The symptoms of rheumatoid arthritis come and go, depending on the degree of tissue inflammation. When body tissues are inflamed, the disease is active. When tissue inflammation subsides, the disease is inactive (in remission). Remissions can occur spontaneously or with treatment, and can last weeks, months, or years. During remissions, symptoms of the disease disappear, and patients generally feel well. When the disease becomes active again (relapse), symptoms return. The return of disease activity and symptoms is called a flare. The course of rheumatoid arthritis varies from patient to patient, and periods of flares and remissions are typical.
When the disease is active, symptoms can include fatigue, lack of appetite, low-grade fever, muscle and joint aches, and stiffness. Muscle and joint stiffness are usually most notable in the morning and after periods of inactivity. Arthritis is common during disease flares. Also during flares, joints frequently become red, swollen, painful, and tender. This occurs because the lining tissue of the joint (synovium) becomes inflamed, resulting in the production of excessive joint fluid (synovial fluid). The synovium also thickens with inflammation (synovitis).
In rheumatoid arthritis, multiple joints are usually inflamed in a symmetrical pattern (both sides of the body affected). The small joints of both the hands and wrists are often involved. Simple tasks of daily living, such as turning door knobs and opening jars can become difficult during flares. The small joints of the feet are also commonly involved. Occasionally, only one joint is inflamed. When only one joint is involved, the arthritis can mimic the joint inflammation caused by other forms of arthritis, such as gout or joint infection. Chronic inflammation can cause damage to body tissues, cartilage and bone. This leads to a loss of cartilage and erosion and weakness of the bones as well as the muscles, resulting in joint deformity, destruction, and loss of function. Rarely, rheumatoid arthritis can even affect the joint that is responsible for the tightening of our vocal cords to change the tone of our voice, the cricoarytenoid joint. When this joint is inflamed, it can cause hoarseness of voice.
Since rheumatoid arthritis is a systemic disease, its inflammation can affect organs and areas of the body other than the joints. Inflammation of the glands of the eyes and mouth can cause dryness of these areas and is referred to as Sjogren's syndrome. Rheumatoid inflammation of the lung lining (pleuritis) causes chest pain with deep breathing or coughing. The lung tissue itself can also become inflamed, and sometimes nodules of inflammation (rheumatoid nodules) develop within the lungs. Inflammation of the tissue (pericardium) surrounding the heart, called pericarditis, can cause a chest pain that typically changes in intensity when lying down or leaning forward. The rheumatoid disease can reduce the number of red blood cells (anemia) and white blood cells. Decreased white cells can be associated with an enlarged spleen (referred to as Felty's syndrome) and can increase the risk of infections. Firm lumps under the skin (rheumatoid nodules) can occur around the elbows and fingers where there is frequent pressure. Even though these nodules usually do not cause symptoms, occasionally they can become infected. A rare, serious complication, usually with long-standing rheumatoid disease, is blood-vessel inflammation (vasculitis). Vasculitis can impair blood supply to tissues and lead to tissue death. This is most often initially visible as tiny black areas around the nail beds or as leg ulcers.
Types of Rheumatoid arthritis
The different types of Rheumatoid arthritis that have been encountered are:
- Juvenile rheumatoid arthritis - Rheumatoid arthritis in children below the age group of 16.
- Pauciarticular JRA – This is a common type of Juvenile rheumatoid arthritis, usually found among girls under the age of eight. In most such cases, it has been observed that a minimum of 4 or lesser joints, including the larger ones are affected.
- Polyarticular JRA – Is seen to affect about 30% of the JRA cases identified. In such cases, it is mostly the small joints that are affected. The affect is to be seen in symmetrical form.
- The systemic JRA is to be found in about 20% of the JRA cases registered. It is often called Still's disease also.
Rheumatoid Arthritis Causes
Scientific research suggests that Rheumatoid arthritis is probably a culmination of several factors that involve environmental, genetic and hormonal factors.
Genetic Factors: Researchers conclude that the development of Rheumatoid arthritis is co-related with that of specific hereditary genes. It is seen that up to 30% of the second twins are prone to developing Rheumatoid arthritis in the near future.
Environmental Factors play a pivotal role in developing Rheumatoid arthritis. Exposure to bacteria, viral infections or a particular type of food may lead to Rheumatoid arthritis in some parts of the body.
Hormonal Factors: Often excessive of hormones, like estrogen and progesterone, lead to development of Rheumatoid arthritis. In some cases women contract the disease as a result ofpregnancy, during which excessive hormones may be released temporarily.
Risk Factors of Rheumatoid arthritis
Risk factors for Rheumatoid arthritis are factors that do not seem to be a direct cause of the disease, but seem to be associated in some way with the disease. Having a risk factor for Rheumatoid arthritis makes the chances of getting the condition higher but this does not always lead to Rheumatoid arthritis. Also, the absence of any risk factors or having a protective factor does not necessarily guard you from getting Rheumatoid arthritis.
Risk Factors that may make a person more prone to contracting Rheumatoid arthritis are:
- Women are more prone to the disease.
- Rheumatoid arthritis is often an age related syndrome. People in the age group of 40 to 60 are prone to contracting the disease.
- A family history of Rheumatoid arthritis, may be the prime cause of the disease developing in you. It is believed that a person might inherit a predisposition for Rheumatoid arthritis.
- Smokers are at a higher risk of having Rheumatoid arthritis.
Conventional Treatments of Rheumatoid arthritis
Since Rheumatoid arthritis, is yet without a permanent cure, the aim of the treatment is at minimizing the level of arthritis activity and minimum joint damage while increasing physical activity. The balanced treatment of Rheumatoid arthritis combines the benefits of social, medical and emotional support for the patient. Prevention of deformities and loss of joint functions, while being able to lead an active life are of prime importance, while treatment is being decided. Treatment for Rheumatoid arthritis is conducted by reduction of joint stress, medication, surgery, physical and occupational therapy also.
The goal of treatment aims toward achieving the lowest possible level of arthritis disease activity and remission if possible, the minimization of joint damage, and enhancing physical function and quality of life. The optimal treatment of RA requires a comprehensive program that combines medical, social, and emotional support for the patient. It is essential that the patient and the patient’s family be educated about the nature and course of the disease. Strategies are all aimed at reducing pain and discomfort, preventing deformities and loss of joint function, and maintaining a productive and active life. Inflammation must be suppressed and mechanical and structural abnormalities corrected or compensated by assistive devices. Treatment options include medications, reduction of joint stress, physical and occupational therapy, and surgical intervention.
There are three general classes of drugs commonly used in the treatment of rheumatoid arthritis: non-steroidal anti-inflammatory agents (NSAIDs), corticosteroids, and disease modifying anti-rheumatic drugs (DMARDs). NSAIDs and corticosteroids have a short onset of action while DMARDs can take several weeks or months to demonstrate a clinical effect. DMARDs include methotrexate, sulfasalazine, leflunomide (Arava®), etanercept (Enbrel®), infliximab (Remicade®), adalimumab (Humira®), abatacept (Orencia®), rituximab (Rituxan®), anakinra (Kineret®), antimalarials, gold salts, d-penicillamine, cyclosporin A, cyclophosphamide and azathioprine (Imuran). Because cartilage damage and bony erosions frequently occur within the first two years of disease, rheumatologists now move more aggressively to a DMARD agent early in the course of disease, usually as soon as a diagnosis is confirmed. Analgesic drugs are also sometimes helpful in decreasing pain until DMARDs take effect.
Although rheumatoid arthritis is generally an inflammatory process of the synovium, structural or mechanical derangement is a frequent cause of pain or loss of joint function. Pain and joint mobility may be improved by a surgical approach. The primary physician, the rheumatologist, and the orthopedist all help the patient to understand the risks and benefits of the surgical procedure. The decision to have surgery is a complex one that must take into consideration the motivation and goals of the patient, their ability to undergo rehabilitation, and their general medical status.
Synovectomy is ordinarily not recommended for patients with rheumatoid arthritis, primarily because relief is only transient. However, an exception is synovectomy of the wrist, which is recommended if intense synovitis is persistent despite medical treatment over 6 to 12 months. Persistent synovitis involving the dorsal compartments of the wrist can lead to extensor tendon sheath rupture resulting in severe disability of hand function.
Total joint arthroplasties, particularly of the knee, hip, wrist, and elbow, are highly successful. Arthroplasty of the metacarpophalangeal (knuckle) joints also can reduce pain and improve function. Other operations include release of nerve entrapments (e.g., carpal tunnel syndrome), arthroscopic procedures, and, occasionally, removal of a symptomatic rheumatoid nodule.
Patients Medical Treatment of Rheumatoid Arthritis
When you come to patients medical all your confusion about the type of treatment you should opt for or what will help you is taken care of by our team of experts.
A personal consultation with one of our physicians, will initiate your treatment program whereby your medical history will be checked and testing for Rheumatoid arthritis, will be conducted.
Personal recommendations by our health practitioners in tune with those attending to your case will set you at ease about the various related issues of exercise, diet, lifestyle etc.
Patients medical has its own joint and muscle formulas designed to try to minimize the affects of pain, swelling or any deformities caused by the disease.
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