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