Living with Rheumatoid Arthritis

Rheumatoid arthritis, or RA, is an inflammatory disease that causes pain, swelling, and stiffness of the joints. It is estimated that about 2.1 million adults in the United States suffer from RA, with women three times more likely to be affected than men. It impacts all races and ethnic groups and, although it often begins in middle age, children and young adults can develop the disorder as well. In severe cases, over time, RA can lead to serious joint damage.

The cause of rheumatoid arthritis is unknown, but heredity may play a part, along with environmental and/or hormonal factors. The severity of RA may vary greatly from person to person. In some cases, it may last only a few months; in others, it can last for many years.

Because damage to the bones is believed to begin within the first year or two after someone develops RA, it is important to diagnose the condition as early as possible. With current treatment strategies – including medications, physical therapy, and a balance of rest and exercise – many people with RA can lead active and productive lives.

How RA develops and progresses

A normal joint (the place where two bones connect) is surrounded by a “capsule” that protects and supports it . Cartilage covers and cushions the ends of the two bones.. The capsule is lined with a kind of tissue called “synovium,” which produces a clear fluid that keeps the cartilage and bones lubricated and nourished inside the joint capsule.

When someone has rheumatoid arthritis, their immune system, for unknown reasons, attacks their own cells inside the joint capsule. White blood cells travel to the synovium and cause an immune reaction or “inflammation,” resulting in warmth, redness, swelling, and pain – the typical symptoms of RA. The cells of the synovium begin to grow and divide abnormally, causing it to thicken and swell. Chronic inflammation if left unchecked, will destroy the cartilage and bone within the joint. Eventually, the surrounding muscles, ligament, and tendons that support and stabilize the joint become weak and unable to work normally, resulting in the pain and deformities that can occur with rheumatoid arthritis.

Symptoms of rheumatoid arthritis

RA occurs most commonly in the joints of hands, wrists, elbows, shoulders, hips, knees, and feet. Because RA is a systemic disease, it generally occurs in a symmetrical pattern, meaning that if one hand or knee is affected, the one on the other side is also. Symptoms typically include: joint pain and stiffness, particularly in the morning; red, warm, swollen joints; and mild fever and fatigue.

RA can affect other areas of the body besides the joints. Many people with RA may also develop anemia, a decrease in the normal number of red blood cells, and less commonly heart and lung problems. RA is also a “chronic” disease, usually characterized by periods of flare-ups and remissions (times when symptoms subside). Flare-ups will vary in length and may last for weeks.

How is RA diagnosed?

Rheumatoid arthritis can be difficult to diagnose in its early stages, because symptoms vary from person to person and may be similar to those of other types of arthritis and joint conditions.

Your doctor will thoroughly review your medical history and your family`s medical history and will perform a physical exam. X-rays or blood tests may be taken to help confirm the diagnosis and measure the extent of the disease. While there is no single blood test that can positively confirm or exclude the diagnosis of RA, the presence of an antibody called “rheumatoid factor” is common in many people who have the disorder.

Treating RA with medication

Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen and ibuprofen, are effective medications commonly used to help control the pain, swelling, and inflammation of RA. Newer prescription anti-inflammatory medications called “COX-2 inhibitors,” may cause less gastrointestinal upset than NSAIDs or aspirin, so you may want to discuss these with your doctor.

Then there are disease-modifying antirheumatic drug (DMARD) medications that may actually alter the course of the disease itself, slowing or preventing the destruction of joints and cartilage. These include gold compounds, taken orally or by injection; antimalarials, such as hydroxychloroquine; penicillamine; and sulfasalazine. Exactly how these medicines help is not fully understood.

Other DMARDs which act to suppress the auto-immune response that sets RA in motion include methotrexate, azathioprine, cyclosporine, and cyclophosphamide. Two new drugs in this category, leflunomide and etanercept, were recently approved for the treatment of RA as well. Corticosteroids, such as prednisone, also are commonly prescribed to suppress the auto-immune response, as well as to reduce inflammation and pain.

Sometimes combinations of some of these medications are needed to control the pain and inflammation of RA and hopefully to slow or stop progression of the disease. As with the use of all medications, side effects may occur. Be sure to tell your doctor immediately about any reactions or side effects you experience.

Other important types of therapy

In addition to medication, your doctor may recommend a course of physical or occupational therapy for you. A physical therapist can work with you to help you restore use of affected joints. An occupational therapist can teach you how to deal with everyday problems and manage everyday tasks.

Self-management programs and support groups can help you become better informed and participate in your own care. A good example is the self-help course offered by the National Arthritis Foundation. Check with your doctor about programs in your area.

Living with RA

In summary, you can relieve the symptoms of rheumatoid arthritis and help prevent permanent joint damage by following these guidelines:

• Stick to the medication regimen and treatment schedule prescribed by your doctor.

• Rest your joints when they become warm, swollen, or painful.

• Learn how you can best keep the affected joints mobile.

• Maintain a balance of rest and exercise.

• Try to keep a positive outlook. It will make it easier for you to cope.

• Follow any other recommendations made by your doctor for controlling your arthritis.

Supported as an educational service by Novartis Pharmaceuticals Corporation. This information is not intended for use as medical advice. You should discuss this information with your doctor.

Avaraham Henoch, MD
564 West 160th Street
New York, NY 10032
Phone: (212) 740-6400