Rheumatoid arthritis (RA) is a common rheumatic disease, affecting approximately 1.3 million people in the United States, according to current census data. 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 it most often starts after 40 years of age and before 60 years of age. In some families, multiple members can be affected, suggesting a genetic basis for the disorder. It is not easy living with RA, but there are medications and tips in regards to caring for the disease. This type of arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks the joints producing an inflammatory synovitis that often progresses to destruction of the articular cartilage and ankylosis of the joints. Rheumatoid arthritis can also produce diffuse inflammation in the lungs, pericardium, pleura, and sclera, and also nodular lesions, most common in subcutaneous tissue under the skin. Although the cause of rheumatoid arthritis is unknown, autoimmunity plays a pivotal role in its chronicity and progression.
The disease usually begins gradually with symptoms of fatigue, loss of appetite, morning stiffness (lasting more than 1 hour), widespread muscle aches and weakness. Eventually, joint pain appears. When the joint is not used for a while, it can become warm, tender and stiff. When the lining of the joint becomes inflamed, it gives off more fluid and the joint becomes swollen. Joint pain is often felt on both sides of the body, and may affect the fingers, wrists, elbows, shoulders, hips, knees, ankles, toes and neck. Additional symptoms include anemia due to failure of the bone marrow to produce enough new red blood cells, eye burning, itching and discharge, hand and feet deformities, limited range of motion, low-grade fever, lung inflammation (pleurisy), nodules under the skin (usually a sign of more severe disease), numbness or tingling, paleness, skin redness or inflammation and swollen glands. It is extremely important for early diagnosis, as joint destruction may occur within 1-2 years after the appearance of the disease. RA usually requires lifelong treatment, including medications, physical therapy, exercise, education, and possibly surgery. Early, aggressive treatment for RA can delay joint destruction.
Range-of-motion exercises and individualized exercise programs prescribed by a physical therapist can delay the loss of joint function. Joint protection techniques, heat and cold treatments, and splints or orthotic devices to support and align joints may be very helpful. Sometimes therapists will use special machines to apply deep heat or electrical stimulation to reduce pain and improve joint mobility. Occupational therapists can construct splints for the hand and wrist, and teach how to best protect and use joints when they are affected by arthritis. They also show people how to better cope with day-to-day tasks at work and at home, despite limitations caused by RA. Frequent rest periods between activities, as well as 8 to 10 hours of sleep per night, are recommended.
There are several main categories of drugs used to treat rheumatoid arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat the symptoms of rheumatoid arthritis – they do not prevent the damage caused by rheumatoid arthritis from progressing and thus should not be considered the primary treatment. NSAIDs can reduce the swelling in affected joints and relieve pain. Aspirin is no longer used to treat rheumatoid arthritis because effective doses are often toxic. Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, hydroxychloroquine and sulfasalazine slow the progression of rheumatoid arthritis and sometimes can improve the course of the disease, although most take weeks or months to have an effect. These drugs are usually added promptly after the diagnosis of rheumatoid arthritis is made. Even if pain is decreased with NSAIDs, a doctor will likely prescribe a DMARD because the disease progresses even if symptoms are absent or mild. Corticosteroids, such as prednisone, are the most dramatically effective drugs for reducing inflammation anywhere in the body. Although corticosteroids are effective for short-term use, they may become less effective over time, and rheumatoid arthritis is usually active for years.
Recently there has been great progress on studies and treatments for rheumatoid arthritis. People are bonding together to share their experiences and talk about what works for them. Award winning Deborah Norville is now hosting a new, online talk show, , for people living with rheumatoid arthritis. The show focuses exclusively on addressing topics of overall health and well-being for people living with the disease. It provides expert advice and practical information through an engaging and accessible web-based format that includes caring for the disorder at home and at work. Visitors to the site can view the entire show online and listen to real-life stories from people living with rheumatoid arthritis. The project is sponsored by Centocor Ortho Biotech, Inc. This program will further raise awareness about a chronic disease that affects more than one million Americans, the majority of whom are women.