ArthritisTQ

What is Rheumatoid Arthritis?                            

(RA) or Rheumatoid arthritis belongs to the autoimmune disease group of conditions that triggers chronic pain and inflammation from the body joints. Rheumatoid arthritis also causes inflammation from the tissue around the joints, plus other organs in the body. Autoimmune diseases are illnesses that occur once the body’s tissues are mistakenly attacked by their very own immune system. The immune system contains a complex organization of cells and antibodies designed normally to “seek and destroy” invaders from the body, particularly infections. Patients with autoimmune diseases have antibodies within their blood that target their own body tissues, where they can be associated with inflammation. Because it can impact multiple other organs from the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease. While rheumatoid arthritis symptoms is a chronic illness, meaning it may last for years, patients may experience long stretches without symptoms. However, rheumatoid arthritis is typically a progressive illness which has the potential to cause joint destruction and functional disability.

Known Causes. The cause of rheumatoid arthritis is unknown. Despite the fact that infectious agents such as viruses, bacteria, and fungi have always been suspected, none has been proven as the cause. The cause of rheumatoid arthritis is a very active area of worldwide research. It’s believed that the tendency to build up rheumatoid arthritis may be genetically inherited. It’s also suspected that certain infections or factors in the environment might trigger the activation of the immune system in susceptible individuals. This misdirected immune system then attacks the body’s own tissues. This leads to inflammation in the connection and sometimes in various organs of the body, such as the lungs or eyes.
Regardless of the exact trigger, the result is an immune system that is geared up to promote inflammation within the couplings and occasionally other tissues of the body. Immune cells, called lymphocytes, are activated and chemical messengers (cytokines, such as tumor necrosis factor/TNF, interleukin-1/IL-1, and interleukin-6/IL-6) are expressed in the inflamed areas.
Environmental factors also seem to play some role in causing rheumatoid arthritis. For example, scientists have reported that smoking cigarettes increases the risk of developing rheumatoid arthritis symptoms.

Symptoms, Signs and Warnings. The the signs of rheumatoid arthritis come and go, depending on the level of tissue inflammation. When body tissues are inflamed, the condition is active. When tissue inflammation subsides, the condition is inactive (in remission). Remissions can occur spontaneously or with treatment and can last weeks, months, or years. During remissions, the signs of the disease disappear, and people generally feel well. Once the disease becomes active again (relapse), symptoms return. The return of disease activity and symptoms is called a flare. The course of rheumatoid arthritis varies among individuals, and periods of flares and remissions are typical.

When the disease is active, symptoms can include fatigue, loss of energy, lack of appetite, low-grade fever, muscle and joint aches, and stiffness. Muscle and joint stiffness are often most notable in the morning and after periods of inactivity. Arthritis is common during disease flares. Also during flares, joints frequently become red, swollen, painful, and tender. This occurs because the lining tissue of the joint (synovium) becomes inflamed, inducing the production of excessive joint fluid (synovial fluid). The synovium also thickens with inflammation (synovitis).

In rheumatoid arthritis, multiple joints are usually inflamed in a symmetrical pattern (both sides from the body affected). The small joints of both the hands and wrists are often involved. Simple tasks of daily living, such as turning door knobs and opening jars, may become difficult during flares. The small joints of the feet are also commonly involved. Occasionally, just one joint is inflamed. When only one joint is involved, the arthritis can mimic the joint inflammation brought on by other forms of arthritis, for example gout or joint infection. Chronic inflammation can cause damage to body tissues, including cartilage and bone. This leads to a loss of cartilage and erosion and weakness from the bones as well as the muscles, resulting in joint deformity, destruction, and loss of function. Rarely, rheumatoid arthritis can even affect the joint that is accountable for the tightening of our vocal cords to alter the tone of our voice, the cricoarytenoid joint. If this joint is inflamed, it may cause hoarseness of the voice.

Since rheumatoid arthritis symptoms is a systemic disease, its inflammation can affect organs and areas of the body other than the joints. Inflammation of the glands of the eyes and mouth can cause dryness of those areas and is referred to as Sjogren’s syndrome. Rheumatoid inflammation of the lung lining (pleuritis) causes chest pain with deep breathing, shortness of breath, or coughing. The lung tissue itself can also become inflamed, scarred, and often nodules of inflammation (rheumatoid nodules) develop within the lungs. Inflammation of the tissue (pericardium) surrounding the heart, called pericarditis, can cause a heart problems that typically changes in intensity when prone or leaning forward. The rheumatoid disease can help to eliminate the number of red blood cells (anemia) and white blood cells. Decreased white cells can be associated with an enlarged spleen (known as Felty’s syndrome) and can increase the risk of infections.

Firm lumps underneath the skin (rheumatoid nodules) can occur around the elbows and fingers high is frequent pressure. Even though these nodules usually do not cause symptoms, occasionally they are able to become infected. Nerves may become pinched in the wrists to cause carpal tunnel syndrome. A rare, serious complication, usually with long-standing rheumatoid disease, is blood vessel inflammation (vasculitis). Vasculitis can impair blood supply to tissues and result in tissue death (necrosis). This is usually initially visible as tiny black areas around the nail beds or as leg ulcers.

What your healthcare provider may say.

There is no known cure for rheumatoid arthritis symptoms. To date, the goal of treatment in rheumatoid arthritis is to reduce joint inflammation and pain, maximize joint function, and prevent joint destruction and deformity. Early medical intervention has been shown to be important in improving outcomes. Aggressive management can improve function, stop harm to joints as monitored on X-rays, and stop work disability. Optimal treatment for the disease involves a combination of medications, rest, joint-strengthening exercises, joint protection, and patient (and family) education. Treatment is customized according to many factors for example disease activity, types of joints involved, general health, age, and patient occupation. Treatment methods are most successful when there is close cooperation between the doctor, patient, and family members.
Two classes of medications are used in treating rheumatoid arthritis: fast-acting “first-line drugs” and slow-acting “second-line drugs” (also referred to as disease-modifying antirheumatic drugs or DMARDs). The first-line drugs, for example aspirin and cortisone (corticosteroids), are used to reduce pain and inflammation. The slow-acting second-line drugs, for example gold, methotrexate, and hydroxychloroquine (Plaquenil), promote disease remission and prevent progressive joint destruction, but they’re not anti-inflammatory agents.

The degree of destructiveness of rheumatoid arthritis symptoms varies among affected individuals. Those with uncommon, less destructive forms of the disease or disease that has quieted after years of activity (“burned out” rheumatoid arthritis) could be managed with rest and pain and anti-inflammatory medications alone. In general, however, function is improved and disability and joint destruction are minimized when the condition is treated earlier with second-line drugs (disease-modifying antirheumatic drugs), even within months of the diagnosis. Most people require more aggressive second-line drugs, for example methotrexate, in addition to anti-inflammatory agents. Sometimes these second-line medicine is used in combination. In some cases with severe joint deformity, surgery might be necessary.

Diagnosis

The first step in the diagnosis of rheumatoid arthritis is a meeting between your doctor and the patient. The doctor reviews the history of symptoms, examines the joints for inflammation and deformity, the skin for rheumatoid nodules, and other parts of the body for inflammation. Certain blood and X-ray tests are often obtained. The diagnosis will be based about the pattern of symptoms, the distribution from the inflamed joints, and the blood and X-ray findings. Several visits might be necessary before the doctor could be certain of the diagnosis. A doctor with special training in arthritis and related diseases is known as rheumatologist.

The distribution of joint inflammation is important to the doctor in making a diagnosis. In rheumatoid arthritis, the small joints of the hands, wrists, feet, and knees are usually inflamed in a symmetrical distribution (affecting both sides of the body). When just one or two joints are inflamed, diagnosing of rheumatoid arthritis becomes more difficult. A doctor may then perform other tests to exclude arthritis due to infection or gout. The detection of rheumatoid nodules (described above), most often around the elbows and fingers, can suggest the diagnosis.
Abnormal antibodies can be found in the blood of people with rheumatoid arthritis. An antibody called “rheumatoid factor” are available in 80% of patients. Citrulline antibody (also referred to as anticitrulline antibody, anticyclic citrullinated peptide antibody, and anti-CCP) exists in most people with rheumatoid arthritis. It is important in the diagnosis of rheumatoid arthritis when looking for cases of unexplained joint inflammation. A test for citrulline antibodies is most useful when you are looking for the cause of previously undiagnosed inflammatory arthritis when the traditional blood test for rheumatoid arthritis, rheumatoid factor, is not present. Citrulline antibodies have been felt to represent the sooner stages of rheumatoid arthritis in this setting. Another antibody called the “antinuclear antibody” (ANA) can also be frequently found in people with rheumatoid arthritis.

A blood test called the sedimentation rate (sed rate) is a measure of how fast red blood cells fall to the bottom of a test tube. The sed minute rates are used as a crude way of measuring the inflammation of the joints. The sed rate is usually faster during disease flares and slower during remissions. Another blood test that is used to measure the degree of inflammation contained in the body is the C-reactive protein. Blood testing may also reveal anemia, since anemia is common in rheumatoid arthritis, particularly because of the chronic inflammation.
The rheumatoid factor, ANA, sed rate, and C-reactive protein tests may also be abnormal in other systemic autoimmune and inflammatory conditions. Therefore, abnormalities during these blood tests alone are not sufficient for a firm proper diagnosis of rheumatoid arthritis.
Joint X-rays may be normal or only show swelling of soft tissues at the start of the disease. As the disease progresses, X-rays can show bony erosions typical of rheumatoid arthritis in the joints. Joint X-rays can also be helpful in monitoring the advancement of disease and joint damage with time. Bone scanning, a radioactive procedure, can also be used to demonstrate the inflamed joints. MRI scanning may also be used to demonstrate joint damage.

The American College of Rheumatology is promoting a system for classifying rheumatoid arthritis that’s primarily based upon the X-ray appearance of the joints. This system helps doctors classify the severity of your rheumatoid arthritis.

I
• no damage seen on X-rays, however, there may be signs of bone thinning

II
• on X-ray, evidence of bone thinning around a joint with or without slight bone damage
• slight cartilage damage possible
• joint mobility may be limited; no joint deformities observed
• atrophy of adjacent muscle
• abnormalities of soft tissue around joint possible

III
• on X-ray, proof of cartilage and bone damage and bone thinning round the joint
• joint deformity without permanent stiffening or fixation from the joint
• extensive muscle atrophy
• abnormalities of soft tissue around joint

IV
• on X-ray, evidence of cartilage and bone damage and osteoporosis around joint
• joint deformity with permanent fixation from the joint (referred to as ankylosis)
• extensive muscle atrophy
• abnormalities of soft tissue around joint

Rheumatologists also classify the functional status of people with rheumatoid arthritis symptoms as follows:

• Class I: completely in a position to perform usual activities of daily living

• Class II: able to perform usual self-care and work activities but limited in activities outside of work (such as playing sports, household chores)

• Class III: in a position to perform usual self-care activities but limited in work along with other activities

• Class IV: limited in ability to perform usual self-care, work, and other activities

The doctor may elect to do an office procedure called arthrocentesis. Within this procedure, a sterile needle and syringe are used to drain joint fluid from the joint for study within the laboratory. Analysis of the joint fluid within the laboratory can help to exclude other causes of arthritis, such as infection and gout. Arthrocentesis can also be helpful in relieving joint swelling and pain. Occasionally, cortisone medications are injected to the joint during the arthrocentesis in order to rapidly relieve joint inflammation and further reduce symptoms.

What is Arthritis