Of the many different forms of arthritis, rheumatoid arthritis (RA) is probably thought to be one of the worst, because the joints swell, and become deformed-making it difficult to walk or perform some of the simplest tasks. RA is different from osteoarthritis (OA), in that OA is caused by wear and tear on the joints. RA is caused by inflammation, and is believed to be an autoimmune disease, in which the immune system attacks the synovial tissue that lines the joints. It is not fully known what causes the immune system to attack the joints.
Rheumatoid arthritis is more common in women, than in men. It manifests between the ages of 20 and 50; however RA can strike young children and seniors over 50 also. RA is not curable; however, by making lifestyle changes and following your doctor's treatment plan most people live long productive lives. It is believed that the inflammatory process may be triggered by an infection. Certain genes may be sensitive to the bacteria or viruses. If the gene becomes sensitive to the organisms, the immune system may then be activated to attack the synovial membranes. Since women are more at risk to develop RA, it is believed the hormone, estrogen is a factor. In women, the symptoms get worse as she gets older, but then after the age of 80, her symptoms begin to be less severe. Smoking also seems to be a factor; it seems that the symptoms in people who smoke regularly are more severe than in those who don't.
The signs and symptoms of RA are: low grade fever; painful joints; swelling-leading to deformed joints; pain and stiffness of muscles; immobility of joints; fatigue and generalized malaise. When RA first begins, you may experience pain and swelling of the hands, wrists and knees. As RA continues to spread throughout the body, you may experience pain and stiffness in the jaw, neck, shoulders and hips. RA seems to affect both sides of the body equally, where in OA, the arthritis symptoms are felt where wear and tear are the worst. RA causes small lumps (nodules) to form at pressure points under the skin of your hands, feet, elbows and Achilles tendons. These nodules can also form in the lungs, scalp and on the knee. RA nodules vary in size from 0.25 cm to 2.5 cm, but they usually do not cause any pain or discomfort.
Rheumatoid Arthritis does not only affect joints, as osteoarthritis does. RA causes inflammation to the salivary and tear glands, the linings to the heart and lungs, and also the blood vessels. It is a chronic progressive disease that varies in severity. The signs and symptoms become much more severe during flare-ups. The patient may have periods of remission followed by increased inflammatory action, called flares. The deformity of the joints caused by synovial swelling may limit flexibility and movement of the joints.
If you haven't been diagnosed with RA and you have painful joints on both sides of your body, or if you are being treated and have side effects to your medications, see your doctor for an evaluation. The side effects of medications that treat RA can be quite bothersome with drowsiness, constipation, nausea, abdominal pain, and black tarry stools. Your doctor may order tests, and scans to diagnose or rule out the presence of RA. A blood test, called an ESR-also known as sed rate-measures the sedimentation rate of erythrocytes (red blood cells), which is an indicator of RA. Patients with RA tend to have elevated ESRs and people with OA tend to have normal ESRs.
The medications most commonly used to treat RA are NSAIDs, such as Advil, Anaprox, Aleve and others; and another group of meds called COX-2 inhibitors. Which is another class of NSAIDs that is easier on the stomach-one such medication is Celebrex. COX-2 inhibitors have to be given with caution, even though they are easier on the stomach, they can in some patients cause high blood pressure, which can lead to stroke and heart attacks. The COX-2 inhibitor, Viox, had adverse side effects related to strokes and heart attacks and was taken off the market.
Medications for short term, such as corticosteroids, may be used. However, corticosteroids become less effective when used over a long period of time. There are serious side effects associated with steroids-leading to bone thinning, weight gain, round face, and the onset of diabetes. It is believed that Rheumatoid arthritis patients may be at a higher risk to develop osteoporosis and heart disease, which may be attributed to the use of corticosteroids to treat RA. The inflammatory process of RA in the cardiovascular system may also play a role in the development of heart disease.
To limit bone damage in patients with RA, physicians prescribe disease modifying antirhumatic drugs (DMARDs) such as Plaquenil, Ridaura and Rhematrex. It may take several weeks for improvement to be noticeable. There are other drugs that work to suppress the immune system. Due to serious side effects-higher rate of infections of the respiratory system-they are used with extreme caution.
Surgery is an option for people suffering with joint pain, in the form of joint replacement. Once the arthritic joint is removed the pain will be relieved, when healing has taken place. Another option to patients with severe pain is a treatment in which the blood is cleansed of the antibodies that causes the inflammation of RA. This treatment is called the Prosorba column treatment. This treatment is not recommended for people with high blood pressure, heart or clotting problems.
If you are trying to maintain care at home, follow your doctor's plan of care, exercise regularly, eat healthy and control your weight. Apply heat when necessary to ease pain, and apply cold packs for the flare-ups. It helps to practice relaxation techniques to control pain and discomfort. The mind controls the body; try to keep a positive outlook. Changing your attitude to be more positive changes how you relate to pain. Pain is always worse when we cry or get upset. Use whatever assistive devices you need to take stress off your joints. If you believe a cane or walker will help you, ask your doctor to prescribe the items you need. Your insurance may help pay for these items.