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What is Rheumatoid Arthritis ?Rheumatoid Arthritis is an autoimmune disease that causes chronic inflammation of the joints. It can also cause inflammation of the tissue around the joints, as well as other organs in the body. Autoimmune diseases are illnesses which occur when the body tissues are mistakenly attacked by its own immune system. The immune system is a complex organization of cells and antibodies designed normally to "seek & destroy" invaders of the body, particularly infections. Patients with these diseases have antibodies in their blood which target their own body tissues, where they can be associated with inflammation. As the illness can affect other organs of the body, it is referred to as a systemic illness and is sometimes called rheumatoid disease.
A joint is where two bones meet to allow movement of body parts. Arthritis means joint inflammation. the joint inflammation of rheumatoid arthritis causes swelling, pain, stiffness and redness in the joints. The inflammation of rheumatoid disease can also occur in tissues around the joints, such as the tendons, ligaments and muscles. In some patients with rheumatoid arthritis, chronic inflammation leads to the destruction of the cartilage, bone and ligaments causing deformity of the joints. Damage to the joints can occur early in the disease and be progressive. Moreover, studies have shown that the progressive damage to the joints does not necessarily correlate with the degree of pain, stiffness or swelling present in the joints. The disease is 3 times more common in women than men. It afflicts people of all races equally. The disease can begin at any age, but most often starts after age forty and before sixty. In some families, multiple members can be affected, suggesting a genetic basis for the disorder. Causes of rheumatoid arthritisUnknownInfectious disease such as virus, bacteria and fungi have long be suspected, none has been proven as the cause. Genetically Inherited Regardless of the exact trigger--results in an immune system that is geared up to promote inflammation in the joints and other tissues of the body. Immune cells called lymphocytes are activated and chemical messengers are expressed in the inflamed areas. Environmental Factors SymptomsThe symptoms of rheumatoid arthritis come and go, depending on the degree of tissue inflammation. When body tissues are inflamed, the disease is active. When tissue inflammation subsides, the disease becomes inactive (in remission). Remissions can occur spontaneously or with treatment, and can last weeks, months, years. During remissions, symptoms of the disease disappear and patients generally feel well. However, when the disease becomes active (relapse)--symptoms return and that is known as a flare. The course varies from patient to patient and periods of flares and remissions are typical.
When rheumatoid arthritis is active, symptoms can include fatigue, lack of appetite, low grade fever, muscle and joint aches and stiffness. Muscle and joint stiffness are usually in the morning and after periods of inactivity. During flares, joints frequently become red, swollen, painful and tender due to the lining tissue of the joint(synovium) becoming inflamed, resulting in the production of excessive joint fluid(synovial fluid) and the lining tissue of the joint also thickens with inflammation(synovitis).In rheumatoid arthritis, multiple joints are usually inflamed in a symmetrical pattern (both sides of the body affected). The small joints of both hands and wrists are often involved. Simple tasks of daily living, such as turning door knobs and opening jars can become difficult during flares. The small joints of the feet are also commonly involved. The arthritis can mimic the joint inflammation caused by other forms of arthritis such as gout or joint infection. Chronic inflammation can cause damage to body tissues, cartilage and bone--to a loss of cartilage and erosion and weakness of the bones, as well as the muscles, resulting in joint deformity, destruction and loss of function. Since rheumatoid arthritis 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 to these areas and is referred to as Sjogren's syndrome. Rheumatoid inflammation of the lung lining(pleuritis) causes chest pain with deep breathing or coughing. The lung tissue itself can also become inflamed and sometimes nodules of inflammation develop within the lungs. Inflammation around the heart(pericarditis) can cause a chest pain that typically changes in intensity when lying down or leaning forward. The rheumatoid disease can reduce the number of red blood cells and white blood cells. Decreased white cells can be associated with an enlarged spleen(referred to as Felty's syndrome) and can increase the risk of infections.
Rheumatoid nodules can occur around the elbows and fingers, where there is frequent pressure. Even though these nodules do not cause symptoms, occasionally they can become infected. A rare, serious complication, usually with long standing rheumatoid disease, is blood vessel inflammation(vasculitis). It can impair blood supply to tissues and lead to tissue death. Often visible as tiny black areas around the nail beds or as leg ulcers. TreatmentThere is no known cure for rheumatoid arthritis. The goal of treatment 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 damage to joints as seen on X-rays and prevent disability. Optimal treatment for the disease involves a combination of medications, rest, joint protection and patient (and family) education. Treatment is customized according to many factors, such as disease activity, types of joints involved, general health, age and patient occupation. Treatment is most successful when there is close cooperation between the doctor, patient and family members.
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While rheumatoid arthritis is a chronic illness, meaning it can last for years, patients may experience long periods without symptoms. Typically, rheumatoid arthritis is a progressive illness that has the potential to cause joint destruction and functional disability.
