How To Tell If You Have Rheumatoid Arthritis
Scientists estimate that about 2.2 million people, or 1 percent
of the U.S. adult population, have rheumatoid arthritis. Interestingly,
some recent studies have suggested that the overall number of new cases
of rheumatoid arthritis may actually be going down. Scientists are now
investigating why this may be happening.
Rheumatoid arthritis occurs in all races and ethnic groups. Although
the disease often begins in middle age and occurs with increased
frequency in older people, children and young adults also develop it.
Like some other forms of arthritis, rheumatoid arthritis occurs much
more frequently in women than in men. About two to three times as many
women as men have the disease.
Rheumatoid arthritis is an inflammatory disease, in which there is
destruction of joints, that causes pain, swelling, stiffness, and loss
of function in the joints. It has several special features that make it
different from other kinds of arthritis. For example, rheumatoid
arthritis generally occurs in a symmetrical pattern. This means that if
one knee or hand is involved, the other one is also. The disease often
affects the wrist joints and the finger joints closest to the hand. It
can also affect other parts of the body besides the joints. In
addition, people with the disease may have fatigue, occasional fever,
and a general sense of not feeling well (malaise).
Considered by some to be an autoimmune disorder in which immune
complexes are formed in joints and excite an inflammatory response
(complex mediated hypersensitivity).
Many scientists think that something must occur to trigger the
disease process in people whose genetic makeup makes them susceptible
to rheumatoid arthritis. An infectious agent such as a virus or
bacterium appears likely, but the exact agent is not yet known. Note,
however, that rheumatoid arthritis is not contagious: A person cannot
"catch" it from someone else.
Another feature of rheumatoid arthritis is that it varies a lot from
person to person. For some people, it lasts only a few months or a year
or two and goes away without causing any noticeable damage. Other
people have mild or moderate disease, with periods of worsening
symptoms, called flares, and periods in which they feel better, called
remissions. Still others have severe disease that is active most of the
time, lasts for many years, and leads to serious joint damage and
disability.
Although rheumatoid arthritis can have serious effects on a person's
life and well-being, current treatment strategies-including pain relief
and other medications, a balance between rest and exercise, and patient
education and support programs-allow most people with the disease to
lead active and productive lives. In recent years, research has led to
a new understanding of rheumatoid arthritis and has increased the
likelihood that, in time, researchers can find ways to greatly reduce
the impact of this disease.
Features of Rheumatoid Arthritis:
A normal joint (the place where two bones meet) is surrounded by a
joint capsule that protects and supports it. Cartilage covers and
cushions the ends of the two bones. The joint capsule is lined with a
type of tissue called synovium, which produces synovial fluid. This
clear fluid lubricates and nourishes the cartilage and bones inside the
joint capsule.
In rheumatoid arthritis, the immune system, for unknown reasons,
attacks a person's own cells inside the joint capsule. White blood
cells that are part of the normal immune system travel to the synovium
and cause a reaction. This reaction, or inflammation, is called
synovitis, and it results in the warmth, redness, swelling, and pain
that are typical symptoms of rheumatoid arthritis. During the
inflammation process, the cells of the synovium grow and divide
abnormally, making the normally thin synovium thick and resulting in a
joint that is swollen and puffy to the touch.
As rheumatoid arthritis progresses, these abnormal synovial cells
begin to invade and destroy the cartilage and bone within the joint.
The surrounding muscles, ligaments, and tendons that support and
stabilize the joint become weak and unable to work normally. All of
these effects lead to the pain and deformities often seen in rheumatoid
arthritis. Doctors studying rheumatoid arthritis now believe that
damage to bones begins during the first year or two that a person has
the disease. This is one reason early diagnosis and treatment are so
important in the management of rheumatoid arthritis.
There is no treatment that can cure or reverse rheumatoid arthritis.
However, there are medications that can relieve its symptoms and slow
or halt its progression.
Nonsteroidal anti-inflammatory drugs (NSAIDs). This group of
medications, which includes aspirin, helps relieve pain and
inflammation. Side effects may include stomach upset and stomach
bleeding. Therefore, NSAIDs should always be taken with food.
Cox-2 inhibitors. This new class of medications is similar to
NSAIDs, but may be less damaging to your stomach. Like NSAIDs, cox-2
inhibitors suppress an enzyme called cyclooxygenase (cox) that triggers
joint inflammation and pain. Cox-2 inhibitors work selectively,
suppressing only cox-2, the enzyme involved in inflammation. Two
versions of cox-2 inhibitors, celecoxib (Celebrex) and rofecoxib
(Vioxx), have been approved by the Food and Drug Administration for
pain related to arthritis.
Corticosteroids. These medications (cortisone, prednisone and
others) reduce inflammation and slow joint damage. In the short term,
corticosteroids can make you feel dramatically better. However, when
used for many months or years, they may become less effective and also
cause serious side effects. Side effects may include easy bruising,
thinning of your bones, cataracts, weight gain, a round face, diabetes
and high blood pressure. Doctors will often prescribe a corticosteroid
to relieve acute symptoms, with the goal of gradually tapering you off
the medication.
Disease-modifying antirheumatic drugs (DMARDs). These medications
have been shown to slow or halt the progression of rheumatoid
arthritis. In the past, they were used only if you had severe
rheumatoid arthritis and noticeable joint destruction. Today, DMARDs
are prescribed early to try to prevent destruction. When taken in
proper doses, the drugs aren't as toxic as once believed. Depending on
the drug used, side effects can range from blurry vision to increased
susceptibility to infection.
Several of the most commonly prescribed DMARDs are
hydroxychloroquine (Plaquenil), gold (Myochrysine, Solganal),
sulfasalazine (Azulfidine), and minocycline (Minocin). Sometimes, a
combination of DMARDs may be used if one alone isn't effective.
Because they don't relieve symptoms, DMARDs are taken in addition to
an NSAID, a corticosteroid, or both. The drugs are slow-acting, so it
may take a few months before you notice benefits.
TNF blockers. One of the most talked-about new medications for
arthritis is the TNF blocker. TNF (tumor necrosis factor) is a
cytokine, or cell protein, which acts as an inflammatory agent in
rheumatoid arthritis. "Anti-TNF" medications target or block this
cytokine and can help reduce pain, morning stiffness and tender or
swollen joints. These medications often are taken with methotrexate.
Two TNF blockers approved for treatment of rheumatoid arthritis are
etanercept (Enbrel) and infliximab (Remicade). If you have an active
infection, you should not take these medications.
Studies indicate that eating large amounts of omega-3 fatty acids
from cold-water fish (salmon, mackerel, herring) and plant oils may
reduce joint tenderness. But check with your doctor before taking
omega-3 fatty acid supplements (fish oil capsules). Two other popular
therapies are the dietary supplements glucosamine and chondroitin
sulfate.
By all measures, the financial and social impact of all types of
arthritis, including rheumatoid arthritis, is substantial, both for the
Nation and for individuals. From an economic standpoint, the medical
and surgical treatment for rheumatoid arthritis and the wages lost
because of disability caused by the disease add up to millions of
dollars. Daily joint pain is an inevitable consequence of the disease,
and most patients also experience some degree of depression, anxiety,
and feelings of helplessness. In some cases, rheumatoid arthritis can
interfere with a person's ability to carry out normal daily activities,
limit job opportunities, or disrupt the joys and responsibilities of
family life. However, there are arthritis self-management programs that
help people cope with the pain and other effects of the disease and
help them lead independent and productive lives.
Scientists are making rapid progress in understanding the
complexities of rheumatoid arthritis-how and why it develops, why some
people get it and others do not, why some people get it more severely
than others. Results from research are having an impact today, enabling
people with rheumatoid arthritis to remain active in life, family, and
work far longer than was possible 20 years ago. There is also hope for
tomorrow, as researchers continue to explore ways of stopping the
disease process early, before it becomes destructive, or even
preventing rheumatoid arthritis altogether.
Scientists estimate that about 2.2 million people, or 1 percent
of the U.S. adult population, have rheumatoid arthritis. Interestingly,
some recent studies have suggested that the overall number of new cases
of rheumatoid arthritis may actually be going down. Scientists are now
investigating why this may be happening.
Rheumatoid arthritis occurs in all races and ethnic groups. Although
the disease often begins in middle age and occurs with increased
frequency in older people, children and young adults also develop it.
Like some other forms of arthritis, rheumatoid arthritis occurs much
more frequently in women than in men. About two to three times as many
women as men have the disease.
Rheumatoid arthritis is an inflammatory disease, in which there is
destruction of joints, that causes pain, swelling, stiffness, and loss
of function in the joints. It has several special features that make it
different from other kinds of arthritis. For example, rheumatoid
arthritis generally occurs in a symmetrical pattern. This means that if
one knee or hand is involved, the other one is also. The disease often
affects the wrist joints and the finger joints closest to the hand. It
can also affect other parts of the body besides the joints. In
addition, people with the disease may have fatigue, occasional fever,
and a general sense of not feeling well (malaise).
Considered by some to be an autoimmune disorder in which immune
complexes are formed in joints and excite an inflammatory response
(complex mediated hypersensitivity).
Many scientists think that something must occur to trigger the
disease process in people whose genetic makeup makes them susceptible
to rheumatoid arthritis. An infectious agent such as a virus or
bacterium appears likely, but the exact agent is not yet known. Note,
however, that rheumatoid arthritis is not contagious: A person cannot
"catch" it from someone else.
Another feature of rheumatoid arthritis is that it varies a lot from
person to person. For some people, it lasts only a few months or a year
or two and goes away without causing any noticeable damage. Other
people have mild or moderate disease, with periods of worsening
symptoms, called flares, and periods in which they feel better, called
remissions. Still others have severe disease that is active most of the
time, lasts for many years, and leads to serious joint damage and
disability.
Although rheumatoid arthritis can have serious effects on a person's
life and well-being, current treatment strategies-including pain relief
and other medications, a balance between rest and exercise, and patient
education and support programs-allow most people with the disease to
lead active and productive lives. In recent years, research has led to
a new understanding of rheumatoid arthritis and has increased the
likelihood that, in time, researchers can find ways to greatly reduce
the impact of this disease.
Features of Rheumatoid Arthritis:
- Tender, warm, swollen joints.
- Symmetrical pattern. For example, if one knee is affected, the other one is also.
- Joint inflammation often affecting the wrist and finger joints
closest to the hand; other affected joints can include those of the
neck, shoulders, elbows, hips, knees, ankles, and feet. - Fatigue, occasional fever, a general sense of not feeling well (malaise).
- Pain and stiffness lasting for more than 30 minutes in the morning or after a long rest.
- Symptoms that can last for many years.
- Symptoms in other parts of the body besides the joints.
- Variability of symptoms among people with the disease.
A normal joint (the place where two bones meet) is surrounded by a
joint capsule that protects and supports it. Cartilage covers and
cushions the ends of the two bones. The joint capsule is lined with a
type of tissue called synovium, which produces synovial fluid. This
clear fluid lubricates and nourishes the cartilage and bones inside the
joint capsule.
In rheumatoid arthritis, the immune system, for unknown reasons,
attacks a person's own cells inside the joint capsule. White blood
cells that are part of the normal immune system travel to the synovium
and cause a reaction. This reaction, or inflammation, is called
synovitis, and it results in the warmth, redness, swelling, and pain
that are typical symptoms of rheumatoid arthritis. During the
inflammation process, the cells of the synovium grow and divide
abnormally, making the normally thin synovium thick and resulting in a
joint that is swollen and puffy to the touch.
As rheumatoid arthritis progresses, these abnormal synovial cells
begin to invade and destroy the cartilage and bone within the joint.
The surrounding muscles, ligaments, and tendons that support and
stabilize the joint become weak and unable to work normally. All of
these effects lead to the pain and deformities often seen in rheumatoid
arthritis. Doctors studying rheumatoid arthritis now believe that
damage to bones begins during the first year or two that a person has
the disease. This is one reason early diagnosis and treatment are so
important in the management of rheumatoid arthritis.
There is no treatment that can cure or reverse rheumatoid arthritis.
However, there are medications that can relieve its symptoms and slow
or halt its progression.
Nonsteroidal anti-inflammatory drugs (NSAIDs). This group of
medications, which includes aspirin, helps relieve pain and
inflammation. Side effects may include stomach upset and stomach
bleeding. Therefore, NSAIDs should always be taken with food.
Cox-2 inhibitors. This new class of medications is similar to
NSAIDs, but may be less damaging to your stomach. Like NSAIDs, cox-2
inhibitors suppress an enzyme called cyclooxygenase (cox) that triggers
joint inflammation and pain. Cox-2 inhibitors work selectively,
suppressing only cox-2, the enzyme involved in inflammation. Two
versions of cox-2 inhibitors, celecoxib (Celebrex) and rofecoxib
(Vioxx), have been approved by the Food and Drug Administration for
pain related to arthritis.
Corticosteroids. These medications (cortisone, prednisone and
others) reduce inflammation and slow joint damage. In the short term,
corticosteroids can make you feel dramatically better. However, when
used for many months or years, they may become less effective and also
cause serious side effects. Side effects may include easy bruising,
thinning of your bones, cataracts, weight gain, a round face, diabetes
and high blood pressure. Doctors will often prescribe a corticosteroid
to relieve acute symptoms, with the goal of gradually tapering you off
the medication.
Disease-modifying antirheumatic drugs (DMARDs). These medications
have been shown to slow or halt the progression of rheumatoid
arthritis. In the past, they were used only if you had severe
rheumatoid arthritis and noticeable joint destruction. Today, DMARDs
are prescribed early to try to prevent destruction. When taken in
proper doses, the drugs aren't as toxic as once believed. Depending on
the drug used, side effects can range from blurry vision to increased
susceptibility to infection.
Several of the most commonly prescribed DMARDs are
hydroxychloroquine (Plaquenil), gold (Myochrysine, Solganal),
sulfasalazine (Azulfidine), and minocycline (Minocin). Sometimes, a
combination of DMARDs may be used if one alone isn't effective.
Because they don't relieve symptoms, DMARDs are taken in addition to
an NSAID, a corticosteroid, or both. The drugs are slow-acting, so it
may take a few months before you notice benefits.
TNF blockers. One of the most talked-about new medications for
arthritis is the TNF blocker. TNF (tumor necrosis factor) is a
cytokine, or cell protein, which acts as an inflammatory agent in
rheumatoid arthritis. "Anti-TNF" medications target or block this
cytokine and can help reduce pain, morning stiffness and tender or
swollen joints. These medications often are taken with methotrexate.
Two TNF blockers approved for treatment of rheumatoid arthritis are
etanercept (Enbrel) and infliximab (Remicade). If you have an active
infection, you should not take these medications.
Studies indicate that eating large amounts of omega-3 fatty acids
from cold-water fish (salmon, mackerel, herring) and plant oils may
reduce joint tenderness. But check with your doctor before taking
omega-3 fatty acid supplements (fish oil capsules). Two other popular
therapies are the dietary supplements glucosamine and chondroitin
sulfate.
By all measures, the financial and social impact of all types of
arthritis, including rheumatoid arthritis, is substantial, both for the
Nation and for individuals. From an economic standpoint, the medical
and surgical treatment for rheumatoid arthritis and the wages lost
because of disability caused by the disease add up to millions of
dollars. Daily joint pain is an inevitable consequence of the disease,
and most patients also experience some degree of depression, anxiety,
and feelings of helplessness. In some cases, rheumatoid arthritis can
interfere with a person's ability to carry out normal daily activities,
limit job opportunities, or disrupt the joys and responsibilities of
family life. However, there are arthritis self-management programs that
help people cope with the pain and other effects of the disease and
help them lead independent and productive lives.
Scientists are making rapid progress in understanding the
complexities of rheumatoid arthritis-how and why it develops, why some
people get it and others do not, why some people get it more severely
than others. Results from research are having an impact today, enabling
people with rheumatoid arthritis to remain active in life, family, and
work far longer than was possible 20 years ago. There is also hope for
tomorrow, as researchers continue to explore ways of stopping the
disease process early, before it becomes destructive, or even
preventing rheumatoid arthritis altogether.
- John H. Klippel, M.D., Reva Lawrence, M.P.H., Amye L. Leong,
Michael D. Lockshin, M.D., Kate Lorig, R.N., Dr.P.H., J. Lee Nelson,
M.D., Stanley R. Pillemer, M.D., Paul H. Plotz, M.D., Paul G. Rochmis,
M.D., Ronald L. Wilder, M.D., Ph.D., and Cheryl Yarboro, R.N.,
B.S.P.A., NIAMS, NIH - Handout on Health: Rheumatoid Arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
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