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Rheumatoid Arthritis

  • Chris Woolston, M.S.
  • Posted March 11, 2013

What is rheumatoid arthritis?

On the surface, rheumatoid arthritis (RA) looks like a close relative of osteoarthritis, a condition all too familiar to many older people. Both conditions make joints stiff and sore, but that's where the similarity ends. Its cause and its destructiveness put rheumatoid arthritis in a class by itself.

What's the difference?

Unlike osteoarthritis -- a condition brought on partly by decades of wear-and-tear in the joints -- rheumatoid arthritis arises from a glitch in the immune system. For unknown reasons, the white blood cells that normally fend off germs suddenly attack healthy tissues, especially the lining of the joints, or cartilage. The joint swells during the assault, and the surrounding bones, ligaments, and muscles slowly erode. While the cause of RA remains elusive, many researchers believe it is due to a combination of genetic and environmental factors.

Unlike osteoarthritis, rheumatoid arthritis can be a crippling condition that only gets worse with time. Left untreated, the disease almost always attacks at least five joints, and sometimes many more. In time, the deformed joints may become difficult or impossible to move.

Rheumatoid arthritis usually strikes people between the ages of 30 and 50, and people in their mid- to late fifties are especially vulnerable. Rheumatoid arthritis is three times more common in women than in men.

What are the symptoms of rheumatoid arthritis?

Rheumatoid arthritis usually starts out as a minor complaint. A person may feel slight pain or stiffness in a single joint, probably a knuckle, wrist, shoulder, knee, or ankle. The symptoms may come and go, but as months pass, the pain and stiffness gradually gets worse and spreads to other joints.

Affected joints are often swollen and may also be warm to the touch. The symptoms of rheumatoid arthritis are usually symmetrical: If one ankle is sore and swollen, the other probably is too. Patients tend to feel extremely stiff on awakening, with some flexibility returning one to several hours later.

In some cases, early-stage rheumatoid arthritis does not affect the joints at all. Patients can feel lethargic or depressed for weeks or months before pain and stiffness sets in. Many lose all energy several hours after waking up. Some also have a low-grade fever in the range of 99 to 100 degrees.

Rheumatoid arthritis takes many different courses, and it's impossible to predict how it will progress in any particular patient. For a lucky few (less than 10 percent), the condition vanishes completely within six months. Others suffer explosive attacks of pain followed by long periods of relief. For most people, the symptoms fade in and out from day to day and hour to hour, but steadily worsen over the long term.

As the disease progresses, joints can become permanently deformed. The damage is often most visible in the hands, where wrist and finger joints can be swollen and lumpy.

In many cases, the joints look worse than they feel. Even a person with badly deformed fingers may be proficient at typing and needlework. As time goes on, however, some patients lose mobility in their joints. The severity of the disease varies from person to person, however, and you may be able to maintain flexibility through a combination of medication and mild exercise and stretching.

How is rheumatoid arthritis diagnosed?

A doctor checks for rheumatoid arthritis by asking about symptoms and feeling the joints. Blood tests can also detect a certain abnormal antibody called rheumatoid factor, which is carried by 70 to 90 percent of all rheumatoid arthritis patients but is rarely seen in those without the disease. (The latter is not a good screening tool, however, since you can have a positive screen without developing the disease.)

How is rheumatoid arthritis treated?

If your arthritis is in its early stages, you're in luck: A class of drugs can slow down and even prevent the destruction of your joints. In time, experts believe these drugs, known as disease modifying anti-rheumatic drugs (DMARDs), could make long-term disabilities from rheumatoid arthritis a thing of the past.

DMARDS fall into one of two categories: "nonbiologic" or "biologic." The main differences between them have to do with how pharmaceutical companies manufacture them and how doctors administer them to patients.

Nonbiologic DMARDs are usually started within months of the first signs of arthritis. For this reason, you should see a doctor as soon as you notice symptoms. He or she may start you on large doses of one or a combination of different ones. Either way, you'll be giving yourself a good chance to slow the disease and limit joint damage.

Your doctor may also prescribe a nonbiologic DMARD in combination with a biologic DMARD. TNF-alpha inhibitors are the most commonly used biologic DMARDs. TNF-alpha (tumor necrosis factor-alpha) is a cell protein that inflames the joints of people who have rheumatoid arthritis. TNF-alpha inhibitors block this protein, reduce the pain and stiffness that come with swollen joints, and help to prevent the long-term, crippling effect that rheumatoid arthritis has on the joints.

If your disease is already advanced, you still can take some steps to ease your symptoms and, with luck, retain your mobility. Of course, these steps can also help people in the early stages of the disease.

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) can greatly reduce the pain and swelling of rheumatoid arthritis. Unfortunately, these drugs are not without risk. In June 2005, the US Food and Drug Administration requested that warning labels be added to all NSAIDs -- both prescription and over-the-counter versions -- advising users of the increased risk of gastrointestinal bleeding and heart problems. In April 2009, the FDA issued a rule requiring manufacturers of over-the-counter NSAIDs to prominently display NSAID on the label and to include a warning about the risk of gastrointestinal bleeding. Your doctor can help you decide whether the benefits outweigh the risks in your case, or whether another pain relief option would be better.

Medications are important, but you need to do your part to stay healthy. On days when your symptoms are mild, stretching, weightlifting, and moderate aerobic exercises can all help improve mobility and diminish pain. When pain flares up, however, you should rest your joints as much as possible to prevent any further damage.

It's also important to watch your weight. Shedding any extra pounds will help relieve the strain on your joints and can speed your recovery.

Your doctor or an occupational therapist can give you other tips for managing your rheumatoid arthritis. For instance, you may need to walk with a cane to protect an arthritic knee, and you may need to wear a splint at night.

Further Resources

The Arthritis Foundation provides information on many forms of arthritis and can help you find a support group.

800/283-7800

http://www.arthritis.org

The Arthritis Helpbook, by Kate Lorig, RN, PhD, and James Fries, MD, is full of tips for managing arthritis and fibromyalgia. Perseus, 1995.

References

Arthritis. Johns Hopkins White Paper. 2011.

Food and Drug Administration. FDA requires additional labeling for over-the-counter pain relievers and fever reducers to help consumers use products safely. April 28, 2009.

Arthritis Foundation. Who Gets It? http://www.arthritis.org/conditions/diseasecenter/RA/ra_who.asp

Mayo Clinic. Rheumatoid Arthritis: Causes. June 2008. http://www.mayoclinic.com/health/rheumatoid-arthritis/DS00020/DSECTION=causes

Johns Hopkins Arthritis Center. Anti-TNF therapy for the Treatment of Rheumatoid Arthritis. http://www.hopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/tnf.html

Saag KG et al. American College of Rheumatology 2008 Recommendations for the Use of Nonbiologic and Biologic Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis. Arthritis & Rheumatism (Arthritis Care & Research). Volume 59, Number 6, pp 762-784. June 15, 2008. http://www.rheumatology.org/publications/guidelines/recommendations.pdf

Mayo Clinic. Rheumatoid Arthritis: Treatments and Drugs. September 18, 2008.

AARP. Biologics in Perspective: Expanded Clinical Options amid Greater Cost Scrutiny. June 2007. http://www.aarp.org/research/health/drugs/fs136_biologics.html

Kavanaugh, Arthur. Rheumatoid Arthritis in the Elderly: Is it a Different Disease? American Journal of Medicine. 1997 December: Vol. 103(6A)40-45.

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