Three times as many women as men have rheumatoid arthritis (RA). It is an inflammatory disease where your own immune system overreacts and causes swelling and destruction in your joints. If you have RA in one knee or wrist, you'll likely have it in the other. You might have chronic pain and stiffness, infrequent flare-ups, or practically no symptoms at all. Nobody knows exactly what causes RA, and there is no known cure. However, treatment and lifestyle adjustments can help.
What Goes Wrong?
For some unknown reason, with RA, your joints are attacked by your own immune system. White blood cells that normally protect you against disease, travel to your joints and cause a reaction with a substance in the joints called synovial fluid. This causes swelling and redness around the joint. Then, synovial cells grow and divide abnormally. Eventually they invade and destroy the cartilage and bone within the joint. When this affects the ligaments, tendons, and muscles, the joint can become non-functional, and the damage cannot be undone.
This process typically starts in middle age, but can start much earlier.
What Are the Symptoms?
Symptoms vary widely and are often vague and general. They can include any of the following.
- Tender, warm, swollen joints
- Symmetrical pain – the same joints on opposite sides of the body are affected
- Joint inflammation, most often in the wrist and finger joints closest to the hand
- Fatigue, occasional fever, general malaise
- Pain and stiffness lasting 30 minutes or more in the morning or after resting
- Swelling and pain lasting many years
- Pain and swelling in the neck, shoulders, elbows, hips, knees, ankles, or feet
- Nodules (rheumatoid nodules) under the skin
Early diagnosis is important. See your doctor when you first notice symptoms.
What Are Your Treatment Options?
RA can be difficult to diagnose in its early stages because symptoms can be so general and can vary from person to person. Your doctor will typically use some or all of the following diagnostic tools.
- Medical history: When did the symptoms begin, what exactly are the symptoms, what makes your condition better or worse, how limited is your movement and activity?
- Physical examination: Your joints, skin, reflexes, and muscle strength are checked.
- Laboratory tests: A blood test will search for the presence of an antibody called the rheumatoid factor – common in most who have RA. Other tests will look for anemia and a white blood cell level.
- X rays: If there is extensive joint destruction, X-rays can usually detect it.
Once a diagnosis has been made, you and your medical care team will map out a plan of action. Treatment plans vary, but will usually include measures to:
- Relieve pain
- Reduce inflammation
- Slow down or stop joint damage and destruction
- Improve your well-being and ability to function
You can take steps to improve your own RA management skills:
- Eat a healthful diet
- Manage your weight
- Learn to relax and manage stressful situations
- Be physically active
- Rest to help reduce inflammation
- Use splints or braces to support damaged joints
Medical Options
- Aspirin and other NSAIDs can reduce swelling and relieve pain temporarily. NSAIDs can cause stomach irritation when used over time.
- A class of medications called disease-modifying antirheumatic drugs (DMARDs) can be prescribed to slow the course of the disease. Not everyone can tolerate DMARDs
- Biologic response modifiers (BRMs), also called biologic agents, are a new class of drugs created by living cells. Four BRMs have been approved by the U.S. Food and Drug Administration to treat rheumatoid arthritis in adults: etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), and anakinra (Kineret).These drugs target specific pathways of the immune system that are involved in joint inflammation and damage in RA. Some people report relief after the first injection or infusion of a biologic agent. For others, relief can take weeks. If relief doesn't happen quickly, a short-term course of oral corticosteroids might help. If one or a few joints remain acutely inflamed, the injection of a corticosteroid into the affected joint(s) can provide relief while you wait for the full effects of the biologic medicine.
- NSAIDs. Although these drugs can start to take the edge off pain in 30 minutes or so, getting full effects takes about two weeks of continual use. In some cases, doctors may prescribe oral corticosteroid medications to relieve inflammation while you wait for NSAIDs to work. You can help the wait by using cold compresses on hot joints, soothing sore joints in a warm tub or exercising or massaging painful joints gently. Taking NSAIDs consistently – even when your pain is under control –can help eliminate waits for relief. NSAIDs should be taken for long periods only under a doctor's supervision.
- Analgesics. Pain-relieving drugs can take from 30 minutes to two hours to provide full benefits. Take your first dose prior to a painful procedure or take it at regular intervals for as long as your doctor advises, because it is easier to keep pain at bay than to stop it once it starts. Ask your doctor about taking an NSAID in addition to an analgesic or practice techniques, such as relaxation exercise, hot and cold applications or massage.
- Gout medications. Drugs, such as allopurinol (Lopurin, Zyloprim) and probenecid (Benemid), that lower blood levels of uric acid (the culprit behind gout) can take from several months to a year to get gout under control. To control the pain and inflammation of acute attacks, your doctor might prescribe quicker acting anti-inflammatories, including corticosteroids, colchicine or injections of adrenocorticotropic hormone (ACTH), a hormone that helps your body produce its own inflammation-fighting steroids.
- Corticosteroids. Because corticosteroids work so quickly and efficiently to control inflammation, doctors often prescribe them while waiting for other drugs to work. But when inflammation-related damage is imminent, even oral corticosteroids might not work quickly enough. In those cases, doctors might choose to infuse high doses of the intravenous corticosteroid methylprednisolone, which might start working immediately.
- Surgery can repair or replace damaged joints. This is a serious consideration and should be determined by you and your doctor after careful and thorough study of your condition and the likelihood of success.
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