A B C D E F G H I J K L M N O P R S T U V W

RHEUMATOID ARTHRITIS

What is Rheumatoid Arthritis ?

Rheumatoid arthritis is a common disorder. The main feature is inflammation of joints (arthritis). A joint is made up of two bone-ends each of which is covered with a layer of cartilage. This is surrounded by a cover, called the joint capsule. The capsule has a lining (synovium) which produces a small amount of fluid to help oil the surfaces and feed the cartilage. The inflammation starts in the synovium which becomes thickened, hot and swollen. It produces a large amount of fluid into the joint, which expands. This makes the joint very stiff, swollen and painful to move. The skin over the joint looks red and feels hot and tender to touch. All these changes are reversible when the inflammation settles. However, if it continues for many months or years, it can damage the cartilage and bone underneath. The joints then become deformed and function poorly. The severity tends to wax and wane. A flare-up of symptoms can be set off by a mild illness, stress or injury. The inflammation may affect the blood, making you feel tired, ill and lose weight. Inflammation can cause lumps on tendons under the skin. Occasionally it can affect other tissues, such as lungs and eyes.

How does Rheumatoid Arthritis occur ?

The cause of rheumatoid arthritis is not known. Something triggers the body's defence system so that it acts against its own tissues, resulting in inflammation. This is called an auto-immune disease. Although the actual trigger factor is unknown, the mechanism by which it acts in well understood.

Why does Rheumatoid Arthritis occur ?

It affects 1 in every 50 people, and is more common in women. The condition tends to affect people in their 30s and 40s, although it can start at any age. It is not infectious, and it runs in families. Those who have a gene called HLA DR4 appear to be more susceptible. What it is that makes those people more vulnerable is not known. Nor is it known why it starts at a certain age in different individuals. It sometimes starts after a blood transfusion, pregnancy or any illness.

Treatment Involved for Rheumatoid Arthritis

Treatment involves helping the actual symptoms of arthritis as well as trying to control the disease which causes the symptoms. REST is important. You may be given splints so that the joints rest in the correct position. PHYSIOTHERAPY provides various treatments to the inflamed joints, which will help relieve pain. Physiotherapists will also explain an exercise routine for you to follow, and may advise hydrotherapy. This will keep all the muscles strong, especially those which surround an inflamed joint: weak muscles do not provide proper support for a joint. OCCUPATIONAL THERAPY will help to adapt your daily life to any restrictions imposed by painful joints. They will also show you how to protect them from overstrain (joint protection). SYMPTOM RELIEF is provided by drugs (non-steroidal anti-inflammatory drugs) and pain killers. There are over 40 different types. They are usually taken as tablets or suppositories. They can be taken for a long time with no risk of addiction. If one type does not suit an individual, another can always be tried.

DISEASE-MODIFYING DRUGS are given to control the auto-immune disease process which causes the inflammation, and thus causes joint damage to progress. There are many different drugs which are chosen for individual patients, according to their disease. They may take a few weeks to work, but in some people the disease will come under control very rapidly and even disappear. All these drugs have to be used with care because of occasional side-effects. They need careful monitoring with blood tests at regular intervals. The mildest drug is hydroxychloroquine, which is particularly useful for early cases. It has the advantage of not requiring detailed monitoring, as long as it is taken in low dose, for no more than seven years. The main disease-modifying drug now used is methotrexate, and this induces a remission in a high percentage of patients. Folic acid is usually given after the weekly methotrexate dose. This reduces the risk of bone marrow effects such as anemia which is otherwise an occasional side effect. Other drugs such as penicillamine and gold are still considered effective in some cases. However, the risk of side-effects is greater than with methotrexate or hydroxychloroquine. They are therefore used less often. An injection of steroids (cortisone-like drugs) into a joint may have a marked anti-inflammatory effect, with short-term relief of pain, swelling and stiffness. They are used sparingly and infrequently. Steroids given by mouth suppress the disease very effectively. The dose is kept as low as possible to minimize side-effects. They should not be stopped except under medical supervision. New and potentially exciting therapies are becoming available. These work specifically on the immune system cells (T-cells and B-cells) and the chemical messages that they send out to cause the arthritis. One such drug is called anti-TNF-alpha, given either as a subcutaneous injection (Etanercept) or intravenously (Infliximab). Both drugs can provide impressive benefits in about 70% of patients, but must be continued longterm. They are expensive and therefore restricted. Also their long-term (5 year) safety profile is not yet clear. It has yet to be shown that dietary factors are important. It might be worth discussing the role of complementary therapies with the doctor.

During Treatment fo Rheumatoid Arthritis

The disease is often severe for a few months and then gradually settles. The outcome is good in most people. About one in three people will recover completely in a few years. Only a very small number will end up severely disabled. The final outcome in an individual patient is, however, difficult to predict at the start. NSAIDs can be taken for long periods of time. However, they may cause indigestion, swollen ankles or rash. They cannot be taken by people with peptic ulcers, as they may delay ulcer healing. Disease-modifying drugs need strict supervision by the hospital specialist with regular monthly blood tests. You must let your doctor know about any untoward side-effects. Steroids may cause high blood pressure, a round face and fat abdomen, as well as bruising and swollen ankles. If taken in sufficient dose for long periods, they cause thinning of bones and fractures. Your doctor may prescibe addiitonal tablets (called bisphosphonates) to reduce the extent of the bone thinning. If given too often into the same joint, steroids may actually increase the damage in it. Most drugs should not be taken during pregnancy, which must be planned and carefully discussed with your physician. It is useful to know that during pregnancy, the pain and stiffness of rheumatoid arthritis are often reduced.

After Treatment for Rheumatoid Arthritis

If you have a severe form of the disorder, you may need minor surgery to release tendons or nerves which have become trapped by the inflammation, or to improve joint function. Sometimes hips and knees are badly damaged and need joint replacement surgery.

If Rheumatoid Arthritis is Left Untreated

Without treatment, you would have a greater chance of being seriously disabled in the long term, and more pain.

Effects on Family of Rheumatoid Arthritis

They will need to provide you with support with what is quite a long drawn out disorder. Particularly during a flare-up, reliable help should be provided for you to help reduce stress.