Rheumatoid Arthritis or (RA) is an autoimmune disease that attacks the joints and connective tissue. The result is inflammation that produces permanent damage in the joints. Rheumatoid arthritis is a chronic syndrome that tends to be progressive and destructive as compared to Osteoarthritis or (OA), which is more of an age related disease caused by “wear and tear” of the joints. In contrast to (OA), rheumatoid arthritis is characterized by inflammation mostly of the joints, but is a general body disease. The type of joint that is chronically affected is the synovial joint. The bones that are at a synovial joint are covered by articular cartilage; which reduces friction and absorbs shock. The space between the articulating bones is called the synovial cavity, which is surrounded by an articular capsule. The outer layer of the capsule is called the fibrous capsule and consists of dense irregular connective tissue.
The inner layer of the capsule is lined with the synovial membrane, which is composed of areolar connective tissue with elastic fibers and may also contain adipose tissue. In a healthy joint the synovial membrane produces synovial fluid. The fluid not only reduces friction and lubricates the joint, but it also supplies nutrients and removes debris, wastes, and microbes.Rheumatoid arthritis affects twice as many women as it does men.
It can develop in child hood, but in most cases it develops between the ages of twenty-five and fifty. Rheumatoid arthritis itself may not be inherited, but what can be inherited are the genes that may make someone more likely to develop the disease including those genes that control the immune system.Normally the immune system protects your body against foreign proteins like bacteria, fungi, or viruses and it does this by attacking them and producing antibodies. In Rheumatoid arthritis the immune system loses it’s ability to tell the difference between these antigens and the bodies normal cells. The body begins to attack the normal cells by using its plasma cells to produce antibodies called serum rheumatoid factors (RF). The chemical messengers called cytokines control the inflammatory process. One of the key cytokines is called Tumor Necrosis Factor or TNF; which is part of the normal inflammatory process.
People with rheumatoid arthritis have been found to have much more TNF than normal. Too much TNF excites the immune system or drive it to produce more inflammation, especially in the joints.A person’s general feeling of wellness is affected. One may become easily tired, fatigued, and wake up stiff in the morning. Everyday chores may become more and more difficult. It is important to treat and diagnose rheumatoid arthritis as soon as possible. The joint damage of rheumatoid arthritis is not just progressive, but is hidden.
The amount of joint damage increases quickly. The synovial membrane thickens and accumulates synovial fluid, which can cause pain and tenderness in the peripheral joints. The membrane then produces an abnormal granulation tissue called pannus. The pannus adheres to the articular cartilage and erodes it away and also causes distortion. In fact 93% of people with rheumatoid arthritis show major erosion within two years. In severe cases of rheumatoid arthritis the cartilage is completely worn away and the bone ends ossify. The joint fuses together and becomes completely immovable.People who have rheumatic diseases should see a rheumatologist in order to determine the precise form of arthritis and the stage of the disease.
General physical examination is necessary, beyond that there is a specific rheumatic disease exam that include blood tests, x-rays, and a complete exam of the joints. Blood tests are helpful to confirm diagnosis because they can check for factors that are typical of other chronic diseases as well as specific for rheumatoid arthritis (e.g. Rheumatoid Factor). The synovial fluid, which is abnormal during inflammation, is aspirated from a joint. It is examined microscopically as well as for volume and appearance.
An x-ray is taken to see how far and at what rate the disease is progressing. These diagnostic tests can diagnose rheumatoid arthritis as well as other disease present that may be affecting the joint. The criteria for clinical diagnosis of rheumatoid arthritis has been developed by The American College of Rhuematology in a helpful guide:TABLE 50-1. REVISED CRITERIA FOR CLASSIFICATION OF RHEUMATOID ARTHRITIS (1987)The concern for this disease is to attack it early and prevent damage. There are various techniques to prevent or at least slow down the progressive damage in the joints. As many as 75% of patients improve symptomatically with conservative treatment during the first year of disease however, >=10% are severely disabled despite full treatment.
The medication used for rheumatoid arthritis is divided into two classes. The fast acting anti-inflammatory drugs which gives relief of symptoms and the disease modifying anti-rheumatic drugs (DMARS) to gradually slow the progression of the disease. Often a combination of both medicines is used. The fast acting anti-inflammatory drugs may be eventually stopped if things go well and the patient is kept on maintenance of disease modifying drugs, which keep the disease suppressed. Fast acting drugs such as non-steroidal anti-inflammatory drugs and salicyates (NSAIDs). Slow acting-drugs are: Gold compounds, Hydroxychloroquine, Sulfasalazine, and Penicillamine.
Combinations of the slow acting have been found to be more effective. Carticosteriods are the best for a short term anti-inflammatory, but with continued use the benefits wear off. Cytotoxic or immunosuppressive drugs can also be used for more severe cases of rheumatoid arthritis, but the side-effects can be terrible.
One could develop liver disease, pneumonitis, bone marrow suppression, and with long term use even malignancy. Treatment also consists of rest and a nutritious diet. Some supplements such as fish or plant oils can be taken to partially relief some of Cavezza 7the symptoms because they can decrease the production of prostaglandins. Exercise and physiotherapy can restore muscle mass and help preserve the range of motion. This is recommended after the inflammation subsides. Another alternative if or when drugs fail is arthroscopic or surgical synovectomy, which temporarily relieves inflammation. Prosthetic replacement of joints is possible, but this greatly reduces the functionality.
Rheumatoid arthritis affects everyone differently. In most patients, joint symptoms develop gradually over several years. In some people, rheumatoid arthritis may progress rapidly. Other people may have rheumatoid arthritis for a limited period of time and then enter a period of remission.
More than two million people in the United States alone have rheumatoid arthritis and with research and development of new drugs and gene therapy there may be a clearer picture of a patients future and quality of life.