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Rheumatoid Arthritis is a disease tht causes chronic inflammation of the joints and may affect many tissues and organs. It can also produce diffuse inflammation in the lungs, pericardium, pleura, sclera, and nodular lesions under the skin. The exact cause of rheumatoid arthritis is unknown, but it is autoimmunity is known to play a pivotal role in its progression.
Rheumatoid Arthritis typically infects the joints, where two bones meet to allow movement of body parts. The affected areas become swollen, warm, painful and stiff in the morning upon waking or following extended inactivity.
Sometimes this can lead to the destruction of the cartilage, bone, and ligaments, causing deformity of the joints. Damage can occur early in the disease and can be progressive. Studies have shown that the progressive damage to the joints does not necessarily correlate with the degree of pain, stiffness, or swelling present in the joints.
This disease afflicts people of all races equally and is a fairly common, afflicting approximately 1.3 million in the United States alone. It is three times more likely to afflict women than men and can begin at any age, but most often, it starts after the age of forty and before sixty. A genetic basis has been suggested because multiple members of the same family can be affected.
When Rheumatoid Arthritis is clinically suspected, immunological studies are required to test for the presence of rheumatoid factor, which is a specific antibody to RA. A negative result does not necessarily rule out rheumatoid arthritis and about 15% of patients get negative results while still having the disease.
Unfortunately, this test is not as specific as it could be, so a new serological test has been developed that tests for the presence of anti-citrullinated protein antibodies. While this test is about as accurate as the Rheumatoid Factor test, a positive result is extremely rare if Rheumatoid Arthritis is not present.
The American College of Rheumatology defined the following criteria for a rheumatoid arthritis diagnosis:
- Morning stiffness of more than one hour most mornings for at least six weeks.
- Arthritis and soft-tissue swelling of more than three of fourteen joints or joint groups for at least six weeks.
- Arthritis in the hand joints for at least six weeks.
- Symmetric arthritis for at least six weeks.
- Subcutaneous nodules in specific places
- Rheumatoid Factor at a level above the 95th percentile
- Radiological changes suggestive of joint erosion.
There is no known cure for rheumatoid arthritis. The goal of the treatment, so far, is to reduce the joint inflammation and pain, maximize joint function and prevent joint deformity and destruction. Early medical intervention has been shown to be extremely helpful in improving the outcome. Some optimal treatments for the disease involve a combination of medications, joint-strengthening exercises, joint protection, patient education and rest.
There are two types of drugs associated with the treatment of Rheumatoid Arthritis: First-Line Drugs and Slow-Acting Drugs. First-Line drugs, such as aspirin and cortisone (corticosteroids), are used to help reduce pain and inflammation. The Slow-Acting drugs, such as gold, hydroxychloroquine and methotrexate, promote disease remission and prevent progressive joint destruction, but are not anti-inflammatory agents.
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