Rheumatoid Arthritis
Swollen Inflamed Joints: Symptoms And Treatment

Rheumatoid Arthritis Guide

Contents

• What Is Rheumatoid Arthritis?
• What It Does To The Body
• What Are The Symptoms?
• What Causes It?
• How Is It Diagnosed?
• How Does The Disease Progress?
• How Is It Treated?
• Special Considerations For Women
• Long-Term Dangers

Articles In This Section

Symptoms
Diagnosis
Treatment
Medications
Biologic Drugs
Alternative Arthritis Treatments
Risk Factors
Hip Arthritis
Hand Arthritis
Knee Arthritis
Shoulder Arthritis

Related Articles

Arthritis Guide
Bones and Joint Problems
Back Problems

Terminology: Rheumatoid Arthritis is also known as rheumatism.

What Is Rheumatoid Arthritis?

Rheumatoid arthritis is an inflammatory disease that typically affects the smaller joints in your hands and feet. It attacks the lining of the joints causing them to become tender and swollen. Eventually this inflammation damages the joint bones and surrounding muscles leading to crippling deformity. Rheumatism is a progressive disease, which means it worsens over time. Although it can strike at any age, it typically starts between the ages of 20 and 50. Rheumatoid arthritis is also a systemic disease. This means it can affect multiple organs and tissues of the body, causing inflammation of the heart, lungs and kidney muscles. Recent research indicates a significant increase in the risk of heart attack in patients with the disease. Rheumatoid arthritis affects 3 times as many women as men. There is currently no cure, but the sooner it is diagnosed and treated, the better the chance of slowing the progression of the condition.

What It Does To The Body

Rheumatoid arthritis (RA) is the most common form of synovitis. Synovitis is an inflammation of the synovial membrane - soft tissue that line the joints. The synovial membrane produces a lubricant called synovial fluid which helps bones to glide over each other when we move. With RA, the body's immune system mistakes the cells of the synovial membrane as foreign invaders. It mounts an attack against the membranes, causing the tissue to thicken and swell. The joint appears red, swollen and puffy to touch. Increased blood flow to the battle zone makes it feel warm. The cells of the membrane also release enzymes which increases pain. If the process continues for years, as it often does, these enzymes gradually digest nearby bone and cartilage until they become misshapen or shift out of place becoming immobile.

What Are The Symptoms?

Although symptoms of rheumatoid arthritis can vary in severity and may come and go over time, persistent joint pain that lasts 6 weeks or longer is usually a typical sign of RA. Other typical symptoms include:

• Inflamed joints, that are painful, swollen and warm to touch.
• Wrists and knuckles commonly affected, but can spread to knees, ankles, feet, hips, shoulders, elbows and the jaw.
• Joints are particularly stiff first thing in the morning for about an hour.
• RA that starts in old age (after 60) is more likely to cause stiffness of the shoulder.
• Low grade fever, general feeling of unwellness and tiredness.
• Mild anemia.
• 25-35 percent of patients develop small lumps under the skin called rheumatoid nodules. These lumps are not usually painful.

Other conditions associated with rheumatoid arthritis:

• Sjogren syndrome: Another autoimmune disorder which attacks the exocrine glands (such as the tear or salvia glands).
• Carpal tunnel syndrome: Pain and numbness in the hand.
• Raynaud’s phenomenon: Hands turn blue or red in cold temperatures.

What Causes It?

Scientists still don't know what causes RA, but it is believed to be the result of a faulty immune response. The immune system illogically makes antibodies to attack healthy tissues in the body. Read, about the risk factors for rheumatoid arthritis.

How Is It Diagnosed?

An early diagnosis of rheumatoid arthritis can be challenging because symptoms like fever, weakness, and muscle soreness could be symptoms of many other conditions: such as lupus, scleroderma, fibromyalgia, polymyositis and rheumatic fever (rheumatic fever sometimes develops after strep throat and can cause arthritis symptoms). A physical examination, including possibly X-rays will be performed. Blood tests will also be carried out. These may include:

Rheumatoid factor (RF): The presence of this protein indicates a likelihood of RA being present. However, it can also be present in 5 to 10 percent of healthy women. It is also frequently absent in elderly-onset RA (considered where the disease first appears after the age of 60). Still, it is present in 80 percent of those with RA.
Anti-citrullinated protein antibody (ACPA): Newer test, considered even more accurate than RF.
Erythrocyte sedimentation rate (ESR, or sed rate): Often elevated in those with RA.
C-reactive protein: Also indicates the risk of heart disease in the patient.

How Does The Disease Progress?

There are 3 possible ways the disease can progress:

Monocyclic: A single brief episode which ends after a few months and leads to no disability.
Polycyclic: Patient experiences flare ups, separated by periods of complete remission with little or no disability between flare ups.
Progressive: RA is chronic (ongoing) and constant lasting several years or for life. This is the most common course of the disease.

How Is It Treated?

There is no cure for the condition so patients need to learn how to live with it. Rheumatoid arthritis medications, physical and occupational therapy, lifestyle adjustments and in severe cases surgery may be required. No single drug or therapy works with all patients, or even with the same patient all of the time. A treatment plan should be put together by a rheumatologist (doctor specializing in RA) in consultation with the patient. See, treatment for rheumatoid arthritis for more details.

Special Considerations For Women

• RA has no effect on menstrual cycles or fertility.
• Pregnancy often brings complete remission of symptoms. But may flare up again within 6 to 9 months of childbirth.
• Delivery may be difficult if the spine or hips are deformed.
• Babies born to mother with RA experience no adverse effects.
• Oral contraceptive pills should only be used with caution as RA can cause circulatory system problems.
• IUD devices should not be used as they can cause heavier periods and women with RA are prone to anemia.

Long-Term Dangers

RA accounts for about 22 percent of all deaths related to arthritis. About 40 percent of deaths due to RA have a cardiovascular cause, including heart attack and stroke. Among patients with RA, the presence of rheumatoid factor and/or anti-citrullinated protein antibody (ACPA) are potential markers for premature death. The following is a list of 4 conditions that are associated with premature death in people with RA:

Cardiovascular disease (CVD): Particularly ischemic heart attack. It is not clear if CVD increases the risk of RA or if RA increases the risk of CVD. What is known is that patients with RA have greater risk of atherosclerosis (hardening of the arteries) and silent heart attacks.
Infections: Primarily tuberculosis (TB), accounts for 1 in 4 death in people with RA. It may be that a faulty immune system makes patients more prone to infection, or it could be something to do with the drugs RA patients take to suppress their immune system (immunosuppresion).
Cancers: An increased risk of lymphoproliferative cancers (such as leukemia and multiple myeloma) has been reported in people with RA. The cause is unknown.
Mental health conditions: The high rate of anxiety and depression in patient with RA is well documented. See, effects of depression.

Related Questions

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Related Articles on Rheumatism

For more on aches and pains, see the following:

Arthritis Equipment: Handy tools for making life easier.
Hospital Departments Explained: Know your way around.

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