What is rheumatoid (room-a-toid) arthritis? The body’s immune system attacks healthy joints. This causes inflammation in the lining of the joints. It can also affect other parts of the body, such as the eyes, lungs or heart. The inflammation can be painful. It can lead to permanent damage if the disease is not treated and controlled.
Joint damage can occur even in cases where the pain is not severe. It can happen even in the early stages of the disease. For many people with RA, damage has shown up on X-rays of the hands and feet within two years of the onset of the disease. But it may be too late to fix by the time X-rays discover the problem. One study found that damage got worse more quickly during the first two years, and 75 per cent of all damage happened in the first five years.
Severe damage can lead to permanent joint deformity and disability. It can cause so much pain and swelling that you may have difficulty walking. You may have trouble using your hands for routine activities, such as dressing and cooking.
How common is rheumatoid arthritis? While it more commonly appears between the ages of 25 and 50, RA can affect people of all ages from toddlers to seniors.
What are the warning signs of rheumatoid arthritis? RA may start gradually or with a sudden, severe attack with flu-like symptoms. It's important to remember that RA symptoms vary from person to person. In some people the disease will be mild with periods of activity or joint inflammation (flare-ups) and inactivity (remissions). In other cases the disease will be continuously active and appear to get worse, or progress, over time.
You may feel weak and tired, you may have a fever or lose weight, but joint pain will be the main problem. If any warning sign lasts more than two weeks, see your doctor. If your doctor believes that you have RA, it is important to see a rheumatologist right away, to begin treatment.
Joints Affected One important way to distinguish RA from other forms of arthritis is by the pattern of joint involvement. For example, RA affects the wrist and many of the hand joints but usually not the joints that are closest to the fingernails.
Osteoarthritis, in contrast , affects those joints closest to the fingernails more often than other areas of the hand. In RA, the joints tend to be involved in a symmetrical pattern. That is, if the knuckles on the right hand are inflamed, the knuckles on the left hand are likely to be inflamed as well.
Other joints commonly affected by RA include the elbows, shoulders, neck, jaw, feet, ankles, knees, and hips. Other than the neck, the spine usually is not directly affected by RA.
Non-joint Involvement Along with painful, inflamed joints, RA can cause inflammation in other body tissues and organs. In 20% of cases, lumps called rheumatoid nodules develop under the skin, often over bony areas. These occur most often around the elbow but can be found elsewhere on the body and even in internal organs.
Occasionally, people with RA will develop inflammation of the membranes that surround the heart and lung or inflammation of the lung tissue itself. Inflammation of tear glands and salivary glands (called sicca syndrome) results in dry eyes and dry mouth. Rarely, RA causes inflammation of the blood vessels (vasculitis), which affects the skin, nerves and other organs.
What causes rheumatoid arthritis? No one knows for sure what causes RA, although scientists are well on their way to understanding the events that lead to abnormal responses of the body's immune system. We know the disease is not necessarily passed on from generation to generation, but the gene that influences the tendency to have RA is more common in the families of people who have RA. Not everyone who inherits this gene will develop the disease.
Canadian scientists are trying to learn why the immune system attacks healthy body tissues. They are also trying to find medicines to help prevent the joint swelling that happens in RA. In fact, The Arthritis Society funds many leading-edge research projects that bring vital new insights and lead to new and better treatments for RA.
For example, at the University of Sherbrooke, The Arthritis Society is funding a study to define markers in the blood that will tell us who will have the mild or serious form of rheumatoid arthritis. At the University of Western Ontario, a study we are funding is looking at a new, very important protein marker for RA. This study will help us understand how our immune system begins to attack joints.
Along with the control of the disease, we must also learn how to regenerate and repair joint tissue, as is the case with two studies we are funding at the Universities of Calgary and Laval. One is learning how genes control the growth of our bones and the other is building frameworks for cells to grow along and repair damaged tissue in our joints.
What can you do about rheumatoid arthritis? RA can have a serious impact on a person’s life and well-being, especially if it is not diagnosed and treated early. Establishing the correct diagnosis early is very important because the sooner appropriate treatment is started the better the chance of avoiding disability or deformity.
Your doctor may be able to diagnose RA based on your medical history and a physical examination. Usually he or she will order certain tests to help confirm the diagnosis, to determine how much joint damage exists, or to distinguish RA from other types of arthritis. These tests may include blood tests (erythrocyte sedimentation rate, RA factor, etc.), X-rays or joint fluid tests. If you are diagnosed with RA, speak to your doctor about referring you to a rheumatologist (an arthritis specialist).
There is no cure for RA, but when you are diagnosed early and start the right treatment, you can take control of your disease and avoid severe damage to your joints. Most people with RA can lead active and productive lives with the help of the right medication, surgery (in some cases), exercise, rest and joint protection techniques.