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What is rheumatoid
arthritis?
Rheumatoid arthritis
(rue-ma-TOYD arth-write-tis) is an autoimmune
disease, mainly characterized by inflammation of
the lining, or synovium, of the joints.
Rheumatoid arthritis can also cause inflammation
of the tissue around the joints, as well as
other organs in the body. Autoimmune diseases
are illnesses that occur when the body tissues
are mistakenly attacked by its own immune
system. The immune system is a complex
organization of cells and antibodies designed
normally to "seek and destroy" invaders of the
body, particularly infections. Patients with
autoimmune diseases have antibodies in their
blood that target their own body tissues, where
they can be associated with inflammation.
Because it can affect multiple other organs of
the body, rheumatoid arthritis is referred to as
a systemic illness and is sometimes called
rheumatoid disease.More women than men get
rheumatoid arthritis. It often starts between
ages 25 and 55.
Rheumatoid arthritis
(RA) progresses in three stages. The first
stage is the swelling of the synovial lining,
causing pain, warmth, stiffness, redness and
swelling around the joint. Second is the rapid
division and growth of cells, or pannus, which
causes the synovium to thicken. In the third
stage, the inflamed cells release enzymes that
may digest bone and cartilage, often causing the
involved joint to lose its shape and alignment,
more pain, and loss of movement. While
rheumatoid arthritis is a chronic illness,
meaning it can last for years, patients may
experience long periods without symptoms.
Typically, however, rheumatoid arthritis is a
progressive illness that has the potential to
cause joint destruction and functional
disability.

A joint is where two
bones meet to allow movement of body parts.
Arthritis means joint inflammation. The joint
inflammation of rheumatoid arthritis causes
swelling, pain, stiffness, and redness in the
joints. The inflammation of rheumatoid disease
can also occur in tissues around the joints,
such as the tendons, ligaments, and
muscles.
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.
Rheumatoid arthritis
is a common rheumatic disease, affecting more
than two million people in the United States.
The disease is three times more common in women
as in men. It afflicts people of all races
equally. The disease can begin at any age, but
most often starts after age forty and before
sixty. In some families, multiple members can be
affected, suggesting a genetic basis for the
disorder.
Rheumatoid
arthritis most often affects the smaller joints,
such as those of the hands and/or feet, wrists,
elbows, knees, and/or ankles. The symptoms often
lead to significant discomfort and
disability.
- Many
people with rheumatoid arthritis have difficulty
carrying out normal activities of daily living,
such as standing, walking, dressing, washing,
using the toilet, preparing food, and carrying
out household chores.
- The
symptoms of rheumatoid arthritis interfere with
work for many people. As many as half of those
with rheumatoid arthritis are no longer able to
work 10-20 years after their condition is
diagnosed.
- On
average, life expectancy is somewhat shorter for
people with rheumatoid arthritis than for the
general population. This does not mean that
everyone with rheumatoid arthritis has a
shortened life span. Rheumatoid arthritis itself
is not a fatal disease.
However, it can be associated
with many complications and treatment-related
side effects that can contribute to premature
death.
Although rheumatoid arthritis most often
affects the joints, it is a disease of the
entire body. It can affect many organs and body
systems besides the joints. This is what is
meant by systematic disease.
- Musculoskeletal structures: Damage to
muscles surrounding joints may cause atrophy
(shrinking and weakening). This is most common
in the hands. Atrophy also may result from not
using a muscle, usually because of pain or
swelling. Damage to bones and tendons can cause
deformities, especially of the hands and feet.
Osteoporosis and carpal tunnel syndrome
are other common complications of rheumatoid
arthritis.
- Skin: Many people with rheumatoid
arthritis form small nodules on or near the
joint that are visible under the skin. These
rheumatoid nodules are most noticeable under the
skin on the bony areas that stick out when a
joint is flexed. Dark purplish areas on the skin
(purpura) are caused by bleeding into the skin
from blood vessels damaged by rheumatoid
arthritis. This damage to the blood vessels is
called vasculitis, and these vasculitic
lesions also may cause skin ulcers.
- Heart: Collection of fluid around the
heart from inflammation is not uncommon in
rheumatoid arthritis. This usually causes only
mild symptoms, if any, but it can be very
severe. Rheumatoid arthritis related
inflammation can affect the heart muscle, the
heart valves, or the blood vessels of the heart
(coronary arteries).
- Lungs: Rheumatoid arthritis' effects on
the lungs may take several forms. Fluid may
collect around one or both lungs, or tissues may
become stiff or overgrown. Any of these effects
can have a negative effect on
breathing.
- Digestive tract: The digestive tract is
usually not affected directly by rheumatoid
arthritis. Dry mouth, related to
gren syndrome, is the most common
symptom of gastrointestinal involvement.
Digestive complications are much more likely to
be caused by medications used to treat the
condition, such as gastritis (stomach
inflammation) or stomach ulcer associated with
NSAID therapy. Any part of the digestive tract
may become inflamed if the patient develops
vasculitis, but this is uncommon. If the liver
is involved (10%), it may become enlarged and
cause discomfort in the abdomen.
- Kidneys: The kidneys are not
usually affected directly by rheumatoid
arthritis. Kidney problems in rheumatoid
arthritis are much more likely to be caused by
medications used to treat the
condition.
- Blood vessels: Vasculitic lesions can
occur in any organ but are most common in the
skin, where they appear as purpura or skin
ulcers.
- Blood: Anemia or low blood
is a common complication of rheumatoid
arthritis. Anemia means that you have an
abnormally low number of red blood cells and
that these cells are low in hemoglobin, the substance that
carries oxygen through the body. (Anemia has
many different causes and is by no means unique
to rheumatoid arthritis.)
- Nervous system: The deformity and damage
to joints in rheumatoid arthritis often leads to
entrapment of nerves. Carpal tunnel
syndrome is one example of this. Entrapment can
damage nerves and may lead to serious
consequences.
- Eyes: The eyes commonly become dry and/or
inflamed in rheumatoid arthritis.
Like many autoimmune diseases, rheumatoid
arthritis typically waxes and wanes. Most people
with rheumatoid arthritis experience periods in
which their symptoms worsen (flares or active
disease) separated by periods in which the
symptoms improve. With successful treatment,
symptoms may even go away completely (remission,
or inactive disease).
About 2.1 million people in the United
States are believed to have rheumatoid
arthritis.
- About 1.5 million of these are women.
Women are 2-3 times more likely to develop
rheumatoid arthritis than men.
- Rheumatoid arthritis affects all ages,
races, and social and ethnic groups.
- It
is most likely to strike people aged 35-50
years, but it can occur in children, teenagers,
and elderly people. (A similar disease affecting
young people is known as juvenile
rheumatoid arthritis.)
- Worldwide, about 1% of people are
believed to have rheumatoid arthritis, but the
rate varies among different groups of people.
For example, rheumatoid arthritis affects
about 5-6% of some Native American groups, while
the rate is very low in some Caribbean peoples
of African descent.
- The
rate is about 2-3% in people who have a close
relative with rheumatoid arthritis, such as a
parent, brother or sister, or
child.
Although there is no cure for rheumatoid
arthritis, the disease can be controlled in most
people. Early, aggressive therapy to stop or
slow down inflammation in the joints can prevent
or reduce symptoms, prevent or reduce joint
destruction and deformity, and prevent or lessen
disability and other
complications
What
causes rheumatoid arthritis?
The
cause of rheumatoid arthritis is unknown. Even
though infectious agents such as viruses,
bacteria, and fungi have long been suspected,
none has been proven as the cause. The cause of
rheumatoid arthritis is a very active area of
worldwide research. Some scientists believe that
the tendency to develop rheumatoid arthritis may
be genetically inherited. It is suspected that
certain infections or factors in the environment
might trigger the immune system to attack the
body's own tissues, resulting in inflammation in
various organs of the body such as the lungs or
eyes. Many factors are involved in the abnormal
activity of the immune system that characterizes
rheumatoid arthritis. These factors include
genetics (heredity), hormones (explaining why
the disease is more common in women than men),
and possibly infection by a bacterium or
virus.
Regardless of the exact trigger, the
result is an immune system that is geared up to
promote inflammation in the joints and
occasionally other tissues of the body. Immune
cells, called lymphocytes, are activated and
chemical messengers (cytokines, such as tumor
necrosis factor/TNF and interleukin-1/IL-1) are
expressed in the inflamed areas.
Environmental factors also seem to play
some role in causing rheumatoid arthritis.
Recently, scientists have reported that
smoking tobacco increases the risk
of developing rheumatoid arthritis.
Rheumatoid Arthritis Symptoms
Although rheumatoid
arthritis can have many different symptoms,
joints are always affected. Rheumatoid arthritis
almost always affects the joints of the hands
(such as the knuckle joints), wrists, elbows,
knees, ankles, and/or feet. The larger joints,
such as the shoulders, hips, and jaw may be
affected. The vertebrae of the neck are
sometimes involved in people who have had the
disease for many years. Usually at least 2 or 3
different joints are involved on both sides of
the body, often in a symmetrical (mirror image)
pattern. The usual joint symptoms include the
following:
- Stiffness: The joint does not move as
well as it once did. Its range of motion (the
extent to which the appendage of the joint, such
as the arm, leg, or finger, can move in
different directions) may be reduced. Typically,
stiffness is most noticeable in the morning and
improves later in the day.
- Inflammation: Redness, tenderness, and
warmth are the hallmarks of inflammation.
- Swelling: The area around the affected
joint is swollen and puffy.
- Nodules: These are hard bumps that appear
on or near the joint. They often are found near
the elbows. They are most noticeable on the part
of the joint that juts out when the joint is
flexed.
- Pain: Pain in rheumatoid arthritis has
several sources. Pain can come from inflammation
or swelling of the joint and surrounding tissues
or from working the joint too hard. The
intensity of the pain varies by the
individual.
These symptoms may keep you from being
able to carry out your normal activities.
General symptoms include the following:
- Malaise (blah feeling)
- Fever
- Fatigue
- Loss
of appetite
- Weight loss
- Myalgias (muscle aches)
- Weakness or loss of
energy
The
symptoms usually come on very gradually,
although in a small number of people they come
on very suddenly. In some cases, the general
symptoms come before the joint symptoms, and you
may think you have the flu or a similar
illness.
The
following suggest that rheumatoid arthritis is
in remission:
- Morning stiffness lasting less than 15
minutes
- No
fatigue
- No
joint pain
- No
joint tenderness or pain with motion
- No
soft tissue
swelling
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