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Rheumatoid arthritis

AGE  Most common over the age of 40GENDER  Three times more common in females
LIFESTYLE  Not a significant factorGENETICS  May run in some families

Rheumatoid arthritis is a chronic disorder that can cause the joints to become painful, swollen, stiff, and deformed.

Rheumatoid arthritis
© Jupiter

In rheumatoid arthritis, the affected joints become stiff and swollen as a result of inflammation of the synovial membrane, which encloses each joint. If the inflammation persists, it may damage both the ends of the bones and the cartilage that covers them. Tendons and ligaments, which support the joints, may also become worn and slack, and deformity of the joints occurs.

In most cases, rheumatoid arthritis affects several joints. The disorder usually appears first in the small joints of the hands and feet but may develop in any joint. It usually tends to appear in similar areas on both sides of the body. Tissues in other parts of the body, such as the eyes, the lungs, the membranous sac around the heart, and blood vessels, may also be affected by the inflammation.

Rheumatoid arthritis is a chronic disease and usually recurs in episodes lasting for several weeks or months with relatively symptom-free periods in between. The disorder affects about 1 in 100 people and is three times more common in women than in men. A similar but distinct arthritic disorder can develop in children (see Juvenile chronic arthritis).

Rheumatoid arthritis is an autoimmune disorder in which the body produces antibodies that attack the synovial membrane and, in some cases, other body tissues. A genetic factor may be involved since the condition is common in some families.

What are the symptoms of rheumatoid arthritis?

Rheumatoid arthritis usually develops slowly, although sometimes the onset of the inflammation can be abrupt. General symptoms associated with the condition may include tiredness, poor appetite, and loss of weight. Specific symptoms may include:

  • Painful, swollen joints that are stiff on waking in the morning.
  • Painless, small bumps (nodules) on areas of pressure, such as the elbows.

Since the condition can be both painful and debilitating, depression is common in people with rheumatoid arthritis. In women, the symptoms of rheumatoid arthritis may improve during pregnancy but may then flare up again after the baby is born.

Are there complications?

Over time, thinning of the bones (see Osteoporosis) and a greater susceptibility to fractures may develop in people with rheumatoid arthritis. This results partly from the disease itself and partly from reduced mobility.

The general symptoms of rheumatoid arthritis are partly due to anaemia, caused by a failure of the bone marrow to manufacture enough new red blood cells. Bursitis may develop, in which one or more of the fluid-filled sacs around a joint become inflamed. Swelling that compresses the median nerve in the wrist may lead to a tingling feeling and pain in the fingers (see Carpal tunnel syndrome). Spasm or narrowing of the walls of the arteries that supply the fingers and toes results in Raynaud's phenomenon, in which the digits become pale and painful on exposure to cold.

A less common complication is when the spleen and the lymph nodes enlarge (see Lymphadenopathy). Inflammation may affect the membranous sac that surrounds the heart (see Pericarditis) and also the lungs (see Fibrosing alveolitis). In some cases, there may be inflammation of the white of the eye (see Scleritis), or the eyes may become very dry (see Sjögren's syndrome).

How is rheumatoid arthritis diagnosed?

The diagnosis is usually based on your medical history and a physical examination. Your doctor may arrange for blood tests to check for the presence of an antibody known as rheumatoid factor, which is usually associated with rheumatoid arthritis. You may also have blood tests to measure the severity of the inflammation. X-rays of the affected joints may be taken to assess the degree of damage.

What is the treatment?

There is no cure for rheumatoid arthritis. The aim of treatment is to control symptoms and reduce further joint damage by slowing the progression of the disease. Various types of drug are available; your doctor's recommendation will depend on the severity and progression of the disease, and your age and general health.

If your symptoms are usually mild, your doctor may prescribe a nonsteroidal anti-inflammatory drug. If they are severe, he or she may prescribe drugs that slow the progression of the disease (see Antirheumatic drugs). These drugs may have to be taken for several months before the full benefits are felt. An antirheumatic such as sulfasalazine or hydroxychloroquine may be given first. If symptoms persist, the doctor may prescribe a drug such as gold, penicillamine, methotrexate, or ciclosporin. These drugs can sometimes cause serious side effects, such as kidney damage and blood disorders, so the doctor will closely monitor your condition.

Your doctor may advise you to use a splint or brace to support a particularly painful joint and to slow down the development of deformities. Gentle, regular exercise may help to keep your joints flexible and prevent supporting muscles from weakening. physiotherapy may be given to improve joint mobility and help increase muscle strength. Hydrotherapy and heat or ice treatments may provide pain relief.

An intensely painful joint may be eased if your doctor injects it with a corticosteroid drug (see Locally acting corticosteroids). If a joint is severely damaged, surgery to replace the damaged joint with an artificial one (see Joint replacement) or to fuse the joint may be suggested.

What is the prognosis?

Many people with rheumatoid arthritis are able to lead a normal life (see Living with arthritis), but lifelong drug treatment may be needed to control the symptoms. About 1 in 10 people becomes severely disabled as repeated attacks destroy the joints. To monitor progression of the disease and your response to treatment, regular blood tests will be needed. Sometimes, the attacks gradually cease, and the disease is said to have burned itself out, but some permanent disability may remain.

Posted 09.09.2010

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