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Rheumatoid Arthritis

more about Rheumatoid Arthritis

An example of rheumatoid arthritis is joint inflammation or RA.  The text below refers to RA.

  • Rheumatoid Arthritis (RA) describes a chronic (long term), gradual inflammation (i.e., swelling, stiffness, pain, irritation, and destruction) of the articular joints (knees, hands, elbows, etc.).
  • Structures such as the skin (e.g., rheumatoid nodules), heart (e.g., Pericarditis), arteries (arteritis or vasculitis), nerves (Neuropathy), eye (e.g., scleritis), lungs (e.g., Pleurisy) spleen (splenomegaly), blood (e.g., anemia), and others may also be affected.

  • Fatigue
  • Weakness
  • Low grade fever
  • Often starts by attacking smaller joints and then bigger ones
  • Joint pain
  • Joint stiffness
  • Morning stiffness lasting more than an hour
  • Joint swelling
  • Joints commonly involved:
    1. Wrist
    2. Metacarpophalangeal joints (large hand joints at base of fingers)
    3. Proximal interphalangeal joints of the fingers (closer to wrist)
    4. Elbows
    5. Shoulders
    6. Ankles
    7. Knees
  • Deformity of joints are common after years of RA
  • Decreased range of motion
  • Joint destruction occurs within first few years of RA
  • Other:
    1. Hard non-painful nodules under the skin, often back of the ankle, or elbows
    2. Shortness of breath
    3. Chest pain upon breathing
    4. Muscle weakness
    5. Muscle wasting (atrophy)
    6. Vomiting blood or black tarry stools (peptic or stomach ulcers)
    7. Skin rash or bluish fingertips (vasculitis/Raynaud's phenomenon)
    8. Dry eyes, itchy eyes (from scleritis)
    9. Numbness or tingling of the skin
    10. Depression
    11. Disability

  • Unknown
  • Risk factors and causes are being actively researched.
  • Autoimmune etiology-the process involves a gradual attack (inflammation) on the synovium (the sac lining the inside of joints) and destruction of the cartilage (acts as a cushion like Shock absorbent) by the cells (white blood cells) and protective Proteins (antibodies) of the immune system (body's natural defenses), as if they were foreign to the body.

  • A rheumatologist (doctor of joints) may be consulted.
  • History of symptoms, family, illnesses, surgeries, habits, medications, allergies, diet
  • Medical exam:
    1. General exam may reveal reduction in weight, nodules, muscle wasting, dry eyes, joint swelling and stiffness, warm (skin reddened) joints, fluids in the lungs, enlarged spleen, and evidence of all systems affected.
    2. Ulnar deviation (wrist deviates towards ulnar bone, away from the body), swan neck, or boutonniere deformities of the finger joints describe some of the changes.
    3. Several joints may be affected at the same time (symmetrical).
  • Tests:
    1. Blood samples may show anemia on a CBC (Complete blood count), elevated ESR (evidence of inflammation), presence of antibodies such as RF (positive in 60-80% of RA patients) and ANA (positive in 20-30% of RA patients).
    2. Blood is also sent for liver, kidney, and overall body function.
    3. If there is swelling or excess joint fluid it may be removed and analyzed for its contents (protein, glucose, and white blood cell count).
    4. X-Rays show narrowing of the spaces between joints, and bone and cartilage erosions; it may be helpful for follow up.
    5. MRI and CAT scans are useful in providing a more detailed picture of the joints, especially if the spine is affected.
    6. Appropriate tests may be needed if other organ systems are affected.
    7. Food allergy testing may be helpful.
    8. Antibody tests for E .coli or mycoplasma bacteria may help.

  • Females > males
  • Age -- starts at 30 and increases with age
  • Females are affected in their 20s.
  • Infections with E .coli and mycoplasma bacteria may be a risk.
  • Genetic:
    1. Family history
    2. Presence of a gene responsible for specific cell surface Proteins (antigens) known as HLA-DR4.
    3. Presence of abnormal (mutated) Gene P53.
    4. Hormone deficiency -- corticotropin releasing hormone deficiency
    5. Native Americans
  • Possible risks:
    1. Smoking
    2. Coffee
    3. Blood transfusion
    4. Obesity
    5. Hay Fever sufferers may have lower risk
    6. Nutritional factors
    7. Bowel impermeability and bacterial overgrowth
    8. Food allergies -- corn, wheat, milk or dairy, beef, tomatoes, peppers (except black), potatoes, and egg plant

  • If elderly, be aware of increased risk of medication side effects.
  • Let your doctor know if you are pregnant, have Bleeding Disorders, or stomach/digestive problems.
  • Diet changes may help -- find out if you are allergic to any foods and eliminate them.
  • Supplements - Omega 3 fatty acids, vitamins and minerals (C, E, Selenium, Manganese, Zinc), Querecetin, and other chemicals may help.
  • Herbs - Turmeric and ginseng (Korean and Siberian) and others are helpful.
  • Exercise in water, walking, stretching
  • Weight loss if obese
  • Fluids -- water use plenty (>8 glasses per day) unless contraindicated
  • Medications:

- Tylenol good for pain

  • Anti-inflammatory agents -- decrease immune system attack:

  1. Aspirin and NSAIDs (Ibuprofen, Naproxen, etc.) are first line for RA therapy
  2. Corticosteroids such as oral (pills) Prednisone or injections of these drugs into the joint (no more than 3 times a year) are also used.
  3. Newer agents such as Celebrex or Vioxx (Cox enzyme inhibitors) are highly effective in reducing the inflammation and pain.
  4. Stomach ulcers or bleeding are serious side effects of NSAIDs and newer Cox inhibitors.
  5. Gold salts, Methotrexate, azathioprine, sulfasalazine, and penicillamine are reserved for severe cases of RA and have serious side effects.
  6. Minocycline antibiotics are helpful in cases with antibodies to bacteria.
  7. Sometimes all the above are combined for best results.
  8. Physical therapy and surgery for damaged joints may be needed.

  • Do not despair. Find a combination that works for you and check with your doctor about ongoing research in RA therapy. Contact your local Arthritis Foundation in the United States.

more about Rheumatoid Arthritis

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