Understanding Rheumatoid Arthritis

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Arthritis is a general term that describes inflammation in joints. That inflammation is characterized by redness, warmth, swelling and pain.

Rheumatoid arthritis is a type of chronic arthritis that occurs in joints on both sides of the body (such as hands, wrists or knees). This symmetry helps distinguish rheumatoid arthritis from other types of arthritis.

In addition to affecting the joints, rheumatoid arthritis may occasionally affect the skin, eyes, lungs, heart, blood, nerves or kidneys.

What are the symptoms of rheumatoid arthritis?

Symptoms of rheumatoid arthritis include:

    * Joint pain and swelling
    * Stiffness, especially in the morning or after sitting for long periods
    * Fatigue

Rheumatoid arthritis affects everyone differently. In most people, joint symptoms develop gradually over several years. But in some, rheumatoid arthritis may progress rapidly and yet other people may have rheumatoid arthritis for a limited period of time and then enter a period of remission.

Who gets rheumatoid arthritis?

Rheumatoid arthritis affects about 1% of the U.S. population. While it is two to three times more common in women than in men, men tend to be more severely affected when they get it. It usually occurs in middle age, however, young children and the elderly also can develop rheumatoid arthritis.

What causes rheumatoid arthritis?

The exact cause of rheumatoid arthritis is unknown, but it is thought to be due to a combination of genetic, environmental and hormonal factors. With rheumatoid arthritis, something seems to trigger the immune system to attack the joints and sometimes other organs. Some theories suggest that a virus or bacteria may alter the immune system, causing it to attack the joints.

Research hasn't been able to determine exactly what role genetics plays in rheumatoid arthritis. However, some people do seem to have a genetic or inherited factor that increases their chance of developing rheumatoid arthritis.

How does rheumatoid arthritis affect the body?

Once the immune system is triggered, immune cells migrate from the blood into the joints and produce substances that cause inflammation. The increased number of cells and inflammatory substances within the joint cause irritation, wearing down cartilage (cushioning material at the end of bones), swelling the joint lining (synovium) and causing the joint lining to produce fluid.

As the cartilage wears down, the space between the bones narrows. If the condition worsens, the bones could rub against each other.

As the joint lining grows, it may invade or erode into the bone, resulting in irreversible damage to the bone. All of these factors cause the joint to become very painful, swollen and warm to the touch.

How is rheumatoid arthritis diagnosed?

The diagnosis of rheumatoid arthritis is based on a combination of factors, including:

    * The specific location and symmetry of painful joints
    * The presence of joint stiffness in the morning
    * Presence of bumps and nodules under the skin (rheumatoid nodules)
    * Results of X-ray tests that suggest rheumatoid arthritis
    * Positive results of a blood test called the rheumatoid factor

Most but not all, people with rheumatoid arthritis have the rheumatoid-factor antibody in their blood. The rheumatoid factor may be present in people who do not have rheumatoid arthritis. Other diseases also can cause the rheumatoid factor to be produced in the blood. Therefore, the diagnosis of rheumatoid arthritis is based on a combination of several factors and not just the presence of the rheumatoid factor in the blood.

People with RA may have a mild anemia. Blood tests may also reveal an elevated erythrocyte sedimentation rate (ESR), a marker of inflammation.

A few people with RA may also have a positive antinuclear antibody test (ANA). This test is positive in people with lupus.

How is rheumatoid arthritis treated?

There are many different ways to treat rheumatoid arthritis. Treatments include medications], rest and exercise, and surgery to correct damage to the joint.

The type of treatment will depend on several factors including the person's age, overall health, medical history and severity of the arthritis.

Medications

There are many medications available to decrease joint pain, swelling and inflammation, and possibly prevent or minimize the progression of the disease.

Medications that offer relief of arthritis symptoms (joint pain, stiffness and swelling) include:

    * Anti-inflammatory painkiller drugs, such as aspirin, ibuprofen or naproxen
    * Topical (applied directly to the skin) pain relievers
    * Corticosteroids, such as prednisone
    * Narcotic pain relievers

There are also many strong medications called disease-modifying antirheumatic drugs (DMARDs) that are used to treat RA. These medicines usually work by interfering with or suppressing the immune system attack on the joints. They include:

    * Arava
    * Anti-malaria medications, such as Plaquenil
    * Chemotherapy drugs, such as methotrexate, Imuran and Cytoxan and Rituxan
    * Organ rejection drugs, such as cyclosporine
    * Biologic treatments, such as Enbrel, Humira, Remicade and Kineret
    * Miscellaneous drugs, such as Azulfidine and gold

Another medication, Orencia, was approved in December 2005 for the treatment of moderate to severe rheumatoid arthritis. It is the first in a new class of drugs that also focuses on the immune system. Orencia is approved to reduce the symptoms of RA in patients not helped by other RA drugs.

In February 2006, the U.S. Food and Drug Administration (FDA) approved another new medication, Rituxan, in combination with methotrexate, for the treatment of moderate to severe RA. Rituxan is a biological agent that targets a different immune cell, the B-cell, and is specifically geared towards people with RA who have not improved with other biological agents, such as Remicade and Enbrel.

Some of these medications are traditionally used to treat other conditions such as cancer or inflammatory bowel disease, or to reduce the risk of rejection of a transplanted organ. However, when chemotherapy medications (such as methotrexate or Cytoxan) are used to treat rheumatoid arthritis, the doses are significantly lower and the risks of side effects tend to be considerably less than when prescribed in higher doses for cancer treatment.

People who haven't responded to the DMARDs may consider another new treatment called apheresis with Prosorba.

Apheresis is a treatment that removes antibodies from the blood. A special catheter, like that used for hemodialysis, is placed in a large vein, and blood travels out of the body, into a special machine containing the Prosorba column, and then circulates back to the body. When the blood passes through the Prosorba column, antibodies are retained in the column and removed from the blood.

The treatments take about two hours each. For rheumatoid arthritis, the treatments are performed once a week for 12 weeks.

Research studies have shown that some patients with rheumatoid arthritis improve after Prosorba treatments. Possible complications include anemia, infection, clotting of the vein or the catheter, and low blood pressure.

Why is rest and exercise important?

A balance of rest and exercise is important in treating rheumatoid arthritis. During flare-ups (worsening of joint inflammation), it is best to rest the joints that are inflamed. This may be accomplished by the temporary use of a cane or joint splints.

When joint inflammation is decreased, guided exercise programs are necessary to maintain flexibility of the joints and to strengthen the muscles that surround the joints. Range-of-motion exercises should be done regularly to maintain joint mobility.

When is surgery necessary?

When joint damage from the arthritis has become severe or pain is not controlled with medications, surgery is an option to restore function to a damaged joint.

Can rheumatoid arthritis be cured?

Although there is not yet a cure for rheumatoid arthritis, early, aggressive treatment has been shown to help prevent disability. There are many different methods available for decreasing the pain and inflammation. Research is in progress to determine the cause of rheumatoid arthritis and the best treatment for it.

Source: http://www.medscape.com/viewarticle/490242