Rheumatoid Arthritis

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Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention | Organizations

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Definition

Rheumatoid arthritis (RA) is an autoimmune disease that causes pain, swelling, stiffness, and loss of function in the joints. RA usually affects the same joint on both sides of the body. It occurs most frequently in the:

• Fingers
• Wrists
• Elbows
• Shoulders
• Jaw
• Hips
• Knees
• Toes

Causes

Rheumatoid arthritis is likely to be caused by a combination of genetic and environmental factors that trigger an abnormal immune response. Possible causes include:

• Genetic factors - Certain genes that play a role in the immune system are associated with the development of RA.
• Defects in the immune system, which cause on-going inflammation
• Environmental factors - An infectious agent, such as a virus or bacterium, may increase susceptibility to RA.
• Other factors - Some evidence suggests that hormonal factors may promote the development of RA in combination with genetic factors and environmental exposure.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

• Family members with rheumatoid arthritis
• Sex: Female
• Ethnic background: Pima Indians
• Major, persistent depression
• Heavy or long-term smoking

Symptoms

When RA first begins, symptoms may include:

• Joint pain and stiffness that is:
  • Symmetrical
  • Most prominent in the morning
  • Lasts for at least half an hour
• Red, warm or swollen joints
• Joint deformity
• Mild fever, tiredness
• Small lumps or nodules under the skin

As RA progresses, it may cause complications with the:

• Heart
• Lungs
• Eyes
• Skin
• Liver
• Kidneys
• Blood
• Nervous system

Diagnosis

There is no single test for RA. The doctor will ask about your symptoms and medical history. Physical exam will include an examination of your joints, skin, reflexes, and muscle strength.

Tests may include:

• Rheumatoid factor (RF)
• Erythrocyte sedimentation rate (ESR)
• C-reactive protein (CRP) - an indicator of active inflammation
• White blood cell count
• X-rays of affected joints (especially dual energy x-ray absorptiometry)

Treatment

There is no treatment to cure RA. The goals of treatment are to:

• Relieve pain
• Reduce inflammation
• Slow down joint damage
• Improve functional ability

Treatments include:

Medications

Medications include:

• Anti-inflammatory medications:
  • Non-buffered aspirin
  • Acetaminophen (Tylenol)
  • Nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and naproxen (Advil, Aleve)
  • Cox-2 inhibitors - celecoxib (Celebrex) and rofecoxib (Vioxx)
  • Steroid drugs (prednisone)
• Disease-modifying antirheumatic drugs (DMARDS) - to slow the course of the disease:
  • Methotrexate (Rheumatrex)
  • Hydroxycholoquinone (Plaquenil)
  • Sulfasalazine (Azulfidine)
  • Leflunomide (Arava), cyclosporine (Neoral)
  • Penicillamine (Cuprimine)
  • Gold (Ridaura). Gold can also be given as an injection.
• Immunosuppressive drugs (only used when other drugs are ineffective):
  • Azathioprine (Imuran)
  • Cyclophosphamide (Cytoxan)
  • Chlorambucil (Leukeran)
• Biologic response modifiers - drugs that interfere with the autoimmune response associated with RA.
  • Etanercept (Enbrel)
  • Infliximab (Remicade)

Steroids

When less potent pain relievers are ineffective, corticosteroid injections to the inflamed joint may be given. Because cortisone injections can be harmful to the tissue and bones, they are reserved for patients with more pronounced symptoms.

Rest and Exercise

Rest helps reduce active joint inflammation and pain, and fight fatigue. Exercise is important for maintaining muscle strength and flexibility, as well as preserving joint mobility.

Joint Care

Splints applied to painful joints may help reduce pain and swelling. Devices that assist in activities of daily living can also reduce stress on joints, such as:

• Zipper extenders
• Long-handled shoehorns
• Specially designed kitchen tools

Stress Reduction

Stress reduction can ease the difficulties of living with a chronic, painful disease. Exercise programs, support groups, and open communication with health care providers can all help to reduce stress.

Surgery

Several types of surgery can help alleviate severe joint damage. Arthroscopic surgery can clean out the bone and cartilage fragments that cause the pain and inflammation. Joint replacement and tendon reconstruction are other surgical alternatives.

Lifestyle Measures

The following measures may relieve stiffness and weakness and reduce inflammation:

• Maintain a balance between rest and exercise.
• Attempt mild strength training.
• Aerobic exercise (walking, swimming, dancing).
• Avoid heavy impact exercise.
• Stop smoking.
• Control weight.
• Physical therapy.

Prevention

There are no guidelines for preventing rheumatoid arthritis.

Organizations

American College of Rheumatology
http://www.rheumatology.org

The Arthritis Foundation
http://www.arthritis.org/

SOURCES:

National Institute of Arthritis and Musculoskeletal and Skin Disorders

"Rational use of new and existing disease-modifying agents in rheumatoid arthritis."

Annals of Internal Medicine, 2001.

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Last reviewed June 2001 by Medical Review Board