Disease: Rheumatoid Arthritis

What Is Rheumatoid Arthritis?

Rheumatoid arthritis strikes three times as many women as men, but its cause remains unknown.

Rheumatoid arthritis is a chronic disease of the joints.

It’s an autoimmune condition, in which your immune system mistakes the linings of your joints as “foreign,” attacking and damaging them, resulting in pain and inflammation.

The small joints of the hands and feet are usually the first affected by this disease.

About 1.5 million Americans have rheumatoid arthritis (RA), according to the Arthritis Foundation.

The condition usually strikes after the age of 40. About three times as many women as men develop RA.

Causes of Rheumatoid Arthritis

Like many other autoimmune diseases, researchers do not know exactly what causes RA.

Something — perhaps a virus or bacteria — triggers the immune system to attack the body’s own tissue.

Smokers and those with a family history of RA are at an increased risk of developing the condition, compared with non-smokers and those without a family history of RA.

Rheumatoid Arthritis vs. Osteoarthritis

There are several different types of arthritis, and rheumatoid arthritis and osteoarthritis are two of the most common types.

In RA, the joint lining becomes inflamed and eventually erodes the joint. 

But in osteoarthritis, the cartilage that covers the ends of the bones in a joint is damaged by wear and tear.

Complications

The risk of complications of RA increases over time or when treatment is inadequate.

These complications include:

  • Deformed joints and loss of function
  • Nerve pain, causing numbness and tingling in hands and feet
  • Low red blood cell count, or anemia, which increases fatigue and weakness
  • High risk for infection
  • Skin conditions, such as blisters; rashes; bumps under the skin, especially around joints; and ulcers
  • Sjögren’s syndrome, which interferes with tears and saliva production and causes severely dry eyes, eye irritation and burning and increased risk of infection.
  • Weak bones, or osteoporosis, which some of the medications used to treat RA may worsen
  • Shortness of breath and pain with breathing, indicating inflammation of the lining of the lungs, or pleurisy, or swelling and scarring of lung tissue
  • Heart problems if RA affects either the sac that holds the heart or the arteries that carry blood to the heart. People with RA have a higher risk of blockage in their heart arteries.
  • Carpal tunnel syndrome, or swelling in the wrists that puts pressure on nerves of the hands, causing numbness, tingling, and difficulty using the hands and fingers.
  • Gum swelling and gum disease, or periodontal disease
  • Kidney or liver impairment caused by medications used to treat RA
  • Decrease in function of organs or tissues supplied by inflamed blood vessels
  • Mood and anxiety problems, related to the stress of having a chronic illness and loss of a body function
  • Increased risk of non-Hodgkin’s lymphoma
  • Pregnancy complications, such as high blood pressure in the mother late in pregnancy or a symptom flare after delivery

Sources:

  • Rheumatoid Arthritis, American College of Rheumatology.
  • Rheumatoid Arthritis, Arthritis Foundation.
  • Handout on Health: Rheumatoid Arthritis, National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Symptoms of Rheumatoid Arthritis

The main symptoms of rheumatoid arthritis are joint swelling, pain, and stiffness.

Rheumatoid arthritis (RA) usually begins in the small bones of the hands and wrists.

The condition is symmetrical, that is, the condition and its symptoms typically occur on both sides of the body.

Joint symptoms include:

  • Pain
  • Swelling
  • Stiffness
  • Redness
  • Warmth
  • Deformity
  • Noticeable bumps, or nodules, around joints

Constitutional symptoms are those that affect the whole body.

People with RA may notice the following constitutional symptoms:

  • Fatigue/tiredness
  • Feeling ill and weak
  • Low-grade fever
  • Decreased appetite

Less common symptoms, or symptoms of progressive RA, include:

  • Neck pain
  • Dry eyes
  • Dry mouth
  • Shortness of breath
  • Painful breathing
  • Tingling, pain, numbness, or burning sensation in hands and feet
  • Weight loss

Diagnosis of Rheumatoid Arthritis

There is no single test that can definitively diagnose RA.

Your doctor will make the diagnosis based on your description of your symptoms, your physical exam, a variety of blood tests, and perhaps an X-ray or other imaging technique.

Blood tests that may indicate whether or not you have RA include:

  • Erythrocyte sedimentation rate or C-reactive protein, tests that gauge the amount of inflammation in the body
  • Rheumatoid factor, an antibody that few have in the early phase of RA but is present eventually in about 80 percent of people with the disease
  • Other antibodies
  • Low red blood cell count

Although an X-ray, MRI, or ultrasound can demonstrate joint inflammation and destruction, these signs may not be evident until the RA has progressed to a later phase.

Sources:

  • Rheumatoid Arthritis; American College of Rheumatology.
  • Rheumatoid Arthritis; Arthritis Foundation.
  • Handout on Health: Rheumatoid Arthritis; National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Rheumatoid Arthritis Treatment

Drugs, surgery, and physical therapy are proven therapies for rheumatoid arthritis.

Rheumatoid arthritis treatment starts with inflammation-reducing drugs.

Doctors prescribe three main categories of medications for rheumatoid arthritis (RA):

  • Disease-modifying anti-rheumatic drugs (DMARDs)
  • Corticosteroids
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

Rheumatoid Arthritis Medications

DMARDs are either nonbiologic or biologic.

Nonbiologic DMARDs slow the inflammatory process of RA, protecting the joints from further damage.

The most common nonbiologic DMARDs are:

  • Methotrexate (Trexall)
  • Leflunomide (Arava)
  • Hydroxychloroquine (Plaquenil)
  • Sulfasalazine (Azulfidine)

Biologic DMARDs interfere with the immune system’s ability to launch the damaging inflammatory process.

These biologic DMARDs include:

  • Abatacept (Orencia)
  • Adalimumab (Humira)
  • Anakinra (Kineret)
  • Certolizumab (Cimzia)
  • Etanercept (Enbrel)
  • Golimumab (Simponi)
  • Infliximab (Remicade)
  • Rituximab (Rituxan)
  • Tocilizumab (Actemra)
  • Tofacitinib (Xeljanz, Jakvinus)

While DMARDs are a longer-term solution for RA, they take weeks or months to become fully effective.

Therefore, doctors may also prescribe drugs for short-term symptom and inflammatory relief, such as corticosteroids and NSAIDs.

Corticosteroids, such as prednisone and prednisolone, are strong anti-inflammatory drugs, but have a number of side effects that limit their long-term use.

Over-the-counter NSAIDs include:

  • Ibuprofen (Motrin, Advil)
  • Naproxen sodium (Aleve)
  • Aspirin

Prescription NSAIDs include:

  • Sulindac (Clinoril)
  • Tolmetin (Tolectin)
  • Choline magnesium trisalicylate (Trilisate)
  • Diclofenac (Cataflam, Voltaren, Cambia)
  • Diflunisal (dolobid)
  • Indomethacin (Indocin)
  • Ketoprofen (Orudis, Oruvail)
  • Meloxicam (Mobic)
  • Oxaprozin (Daypro)
  • Piroxicam (Feldene)

Physical and Occupational Therapy

A therapist can show you exercises to keep your joints movable and strengthen your muscles.

These exercises help you preserve the function of the affected joints.

Therapy can also help you learn alternative ways to do everyday tasks without stressing painful joints.

A therapist may also provide splints or braces that help support weakened and painful joints.

Joint Surgery

When RA damages a joint, surgery may be the only way to improve its function.

A surgeon may operate to:

  • Remove some or all of the inflamed joint lining (synovectomy)
  • Tighten and repair loose and damaged fibrous bands, or tendons, that support joints
  • Fuse a joint (arthrodesis) so that it no longer bends and is properly aligned and stabilized
  • Replace a joint (arthroplasty) with an artificial one made of plastic, ceramic, or metal

Home Remedies

Lifestyle changes and home treatments help decrease RA symptoms and improve functioning.

These home remedies include:

  • A medically approved exercise regimen to keep joints as flexible as possible and build supportive muscles
  • Applying heat or cold to soothe painful joints
  • Applying over-the-counter warming ointments and creams for pain relief
  • Learning relaxation techniques help you cope with pain
  • Using special devices designed to help you accomplish daily such as holding a fork, opening a bottle, and buttoning a shirt
  • Participating in a support group, which provides an emotional outlet  

Alternative Therapies

People should always check with their medical provider before using any complementary or alternative treatments.

Research has not proven these treatments to be beneficial.

Alternative therapies you may hear about include:

  • Dietary supplement that contain fatty-acid plant oils from borage, evening primrose, and black currants
  • Fish oil supplements
  • Supplements containing turmeric, a spice that has some natural anti-inflammatory properties.
  • Hydrotherapy with mineral-infused water
  • Acupuncture
  • Special diets
  • Tai chi, a kind of moving meditation
  • Yoga

Sources:

  • Rheumatoid Arthritis; American College of Rheumatology.
  • Rheumatoid Arthritis; Arthritis Foundation.
  • Handout on Health: Rheumatoid Arthritis; National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Rheumatoid Arthritis Diet

People with rheumatoid arthritis might benefit from selecting certain foods, though the evidence is inconclusive.

Diets that help people with rheumatoid arthritis, or RA, have been promoted for years.

However, no rigorous scientific studies have proved that any particular diet is beneficial.

Also, some controversy exists regarding the effects of these diets on RA and its symptoms.

Prior to trying any of the diets that have been used for symptom relief in RA, check with your provider to make sure it’s medically safe for you.

Some dietary approaches that allegedly have helped some people with RA have included:

Fish oil supplements: Studies have shown that omega-3 fatty acids are anti-inflammatory.

Fish oil is present naturally in oily fishes such as salmon, mackerel, and herring.

Vegan diet: Some people with RA eat a diet that avoids all animal products, such as meat, and anything that requires an animal to produce, such as honey and dairy products.

Some people report that the diet relieves their symptoms.

Gluten-free, lactose-free, or another elimination diet: Some individuals report benefit from excluding certain food groups from their diet.

This suggests that an allergy or sensitivity worsens their RA symptoms.

Mediterranean diet: This high-fiber diet is rich in seafood, vegetables, and nuts and relies on olive oil for fat.

There are anecdotal reports that following a Mediterranean diet might help control RA symptoms.

Fasting: The safety and efficacy of periods of fasting are very controversial.

Do not fast or get your nutrition from juice alone without consulting a physician first.

The most important thing to do, until well-designed studies prove or disprove the various claims made for specific diets, is to eat a healthy, well-balanced diet.

Choose whole foods that are nutrient-dense, and avoid foods that are processed, artificially dyed, or contain excess additives.

If you have any dietary questions or concerns, consider consulting a licensed dietician.

Remember to always verify with your healthcare provider that any dietary change is safe for you.

Sources:

  • Rheumatoid Arthritis; American College of Rheumatology.
  • Rheumatoid Arthritis; Arthritis Foundation.
  • Handout on Health: Rheumatoid Arthritis; National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Source: http://www.everydayhealth.com

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