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Rheumatoid arthritis

Rheumatoid arthritis (RA) is a disorder in which the immune system mistakenly attacks the body's tissues. The condition affects the lining of the joints, causing pain, swelling, stiffness and loss of function.

In addition to joint problems, rheumatoid arthritis can also cause fevers and fatigue.

The joints RA most commonly affects are:
  • Fingers
  • Wrists
  • Elbows
  • Shoulders
  • Jaw
  • Hips
  • Knees
  • Toes

Causes

The cause of RA isn't known, but there are several factors that may contribute to its development:

  • Genetics. Certain genes that play a role in the immune system are associated with the development of RA.
  • Immune system weakness. Defects in the immune system can cause ongoing inflammation of the joints.
  • Environment. Certain infectious agents, such as certain viruses or bacteria, may increase susceptibility to RA.
  • Hormones. Evidence suggests that hormonal factors may promote the development of RA. 

Risk factors

Certain factors make patients more likely to develop RA, including:

  • Family history. If a member of your family has RA, you have an increased risk.
  • Sex. Women are more likely to develop RA.
  • Age. RA can occur at any age, but strikes most commonly between the ages of 40 and 60.
  • Ethnic background. Pima Indians are at increased risk, although anyone of any ethnicity can develop RA.
  • Smoking. Heavy or long-term smoking increases your risk. Quitting smoking can reduce your risk.

If you have any of these risk factors, be sure to discuss them with your physician.

Symptoms

In the earliest stages of RA, symptoms may include joint pain that is:

  • Symmetrical (on both sides of the body)
  • Most prominent in the morning
  • Lasts for at least 30 minutes.

Affected joints may also be warm, tender and swollen. Fatigue, fever and unexplained weight loss can also be signs of a problem.

As the disease progresses, it can cause complications with the:
  • Heart
  • Lungs
  • Eyes
  • Skin
  • Liver
  • Kidneys
  • Blood
  • Nervous system
  • Blood vessels

Rheumatoid arthritis also is linked to early cardiovascular disease and death.

Diagnosis

In order to make an accurate diagnosis of RA, your physician will review your symptoms and medical history. In a physical exam, your joints will be checked for redness, swelling or warmth. Your muscle strength and reflexes also will be checked.

Other conditions with symptoms similar to RA, such as lupus and gout, need to be ruled out.

To further aid your physician in making a diagnosis, certain tests may be ordered, including:

  • Blood tests to determine whether you have an autoimmune disease and the extent of any RA.
  • Imaging tests, such as X-rays, to determine the existence and severity of RA. X-rays can also be used to measure the progression of the condition.

Treatment

Although there is no cure for RA, therapies to relieve the symptoms have improved greatly. Treatment goals are:

  • Relieving pain
  • Reducing inflammation
  • Delaying joint damage
  • Improving day-to-day functioning

Relief is accomplished through a combination of medications, therapies and lifestyle adjustments.

Medications

There are a wide variety of medications that can help treat the pain and inflammation of RA. In some cases, medicine may be used in combination. Drugs that may be prescribed include:

  • Disease-modifying anti-rheumatic drugs (DMARDs). DMARDs are used early in the course of RA to slow its progression and prevent long-term damage. Examples of DMARDs include methotrexate (Rheumatrex), hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), leflunomide (Arava), cyclosporine (Neoral), penicillamine (Cuprimine), gold (Ridaura) and minocycline (Minocin).
  • Immunosuppressive drugs. Immunosuppressive drugs are given when other DMARDs are ineffective. Such drugs include: azathioprine (Imuran), cyclophosphamide (Cytoxan) and chlorambucil (Leukeran).
  • Over-the-counter medication. OTC medications that may provide relief include acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen and naproxen.
  • Biologic response modifiers. This type of drug interferes with the autoimmune response. The class includes TNF-inhibitors, such as etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), golimumab (Simponi), certolizumab (Cimzia).

Steroids

Low-dose corticosteroids, such as prednisone, are often prescribed first. When other drugs begin to take effect, the use of steroids may be tapered off to avoid long-term use. Corticosteroid injections to painful joints may also be used when needed.

Rest and physical activity

Rest reduces joint inflammation, pain and helps fight fatigue. Gentle exercise is important for maintaining muscle strength, as well as flexibility and joint mobility. However, it is important to avoid exercising injured or inflamed joints.

Joint care

There are additional ways you can get pain relieve when suffering from a flare-up of RA:

  • Pain and swelling can be relieved by applying splints to the joints.
  • Applying heat can help ease pain and relieve tension.
  • Applying cold can dull painful sensations and reduce muscle spasms.

Assist devices can help avoid placing stress on painful joints. For example, using a grabbing tool may be easier that using inflamed fingers to pick up items.

Joint replacement

If conservative treatments don't alleviate pain and discomfort, surgery may be an option. In total joint replacement, the damaged joint surfaces are replaced with plastic and metal devises, called prostheses.

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