In 2007 about 1.5 million people in the United States had rheumatoid arthritis. It usually starts in the middle ages, between 25 to 55 years old. Incidence increases with age and women are more likely to get it than men.
As with other autoimmune diseases, the exact cause of rheumatoid arthritis is unknown. Genetic factor, infection, and hormones may play a role in the development of this condition. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis causes inflammation on the synovium (the lining of your joints), causing damage to the cartilage that eventually result in bone erosion and joint deformity.
What are the symptoms?
Rheumatoid arthritis begins gradually, affecting small joints of the hands and feet at first, causing minor joint pain and stiffness that are accompanied by fatigue or low grade fever. Over time, symptoms often spread to the knees, ankles, elbows, hips and shoulders. Severity varies and symptoms may come and go. Periods of when the disease gets worse (flare-up), alternate with periods when the pain and swelling gets better (remission).
Joint symptoms may include:
- Joint pain that oftentimes affects the same joint on both sides of the body, accompanied with warmth and swelling.
- Morning stiffness that usually lasts for more than 1 hour.
- Deformity of joints and the surrounding structure with limited range of motion
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| small joints of the hands and feet are usually affected first |
- Fatigue
- Low grade fever
- Weight loss
- Anemia
- Chest pain or shortness of breath
- Dry eyes and mouth
- Buring sensation and itchiness in both eyes
- Lumps under the skin, called rheumatic nodules.
What are the tests to support the diagnosis?
The two lab tests that often came up with abnormal results are rheumatoid factor test and Anti-CCP antibody test. Complete blood count any show anemia. C-reactive protein and erythrocyte sedimentatio rate may be elevated, a sign of chronic inflammation. Your physician may also preform joint imaging like x-ray, ultrasound, or MRI and synovial fluid analysis.
What are the complications?
Rheumatoid arthritis can affect almost every part of the body. Complications may include:
- Lung damage and scarring causing shortness of breath
- Inflammation of the heart muscle and the outer lining of the heart can progress to heart failure
- Hardening of the arteries which in turn leads to nerve, skin, and brain problems
- Spinal injury if the neck joints are affected
- Osteoporosis
What are the treatment options?
A treatment plan usually includes medications, physical therapy, exercise, and even surgery. Early and aggressive treatment can delay joint destruction, but the drugs can have significant side effects especially because they will be used for life-long.
The most important drugs that are used to treat rheumatoid arthritis are the disease modifying antireheumatic drugs (DMARDs) like methotrexate, leflunomide, and chloroquine. Anti-inflammatory drugs like aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids are used to reduce inflammation and joint pain. Biologic agents like rituximab, infliximab, etanercept, and tocilizumab may be used when the other drugs failed to give improvements. They work by suppressing the immune system and thus carry risks of infection.
