Rheumatoid Arthritis
What Is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is a chronic disease that causes pain, stiffness, swelling and loss of function in the joints and inflammation in other body organs.
Cause
While the cause of RA remains unknown, rapidly advancing research is discovering the bodily reactions that lead to arthritis and joint damage. Recent studies show that certain people inherit a tendency to develop RA.
Diagnosis
RA can be difficult to diagnose early because it may begin gradually with subtle symptoms. Blood tests and X-rays may be normal initially. The disease varies among individuals with respect to symptoms, joints affected and the nature of other organs involved, such as the eyes, lungs or skin. Other types of arthritis may mimic RA. Skill and experience are essential to reach a precise diagnosis and to arrive at the most appropriate treatment.
The diagnostic criteria established by the American College of Rheumatology include prolonged morning stiffness in the joints, characteristic nodules under the skin, joint erosions apparent on X-ray tests, and blood tests of an antibody known as rheumatoid factor.
Health Impact
- RA affects more than two million Americans.
- Direct and indirect costs of RA reached $65 billion in 1992.
- More than 75 percent of RA patients are women.
- Peak onset is between age 20 and 45.
- Osteoporosis is common in patients with RA.
Treatment
Therapy for patients with RA has improved dramatically over the last 25 years, offering most patients good to excellent relief of symptoms and the ability to continue to function at or near normal levels. There is no cure for RA; therefore, the goal of treatment is to minimize patients’ symptoms.
Successful management of RA requires early diagnosis and aggressive treatment before functional impairment and irreversible joint damage has occurred. Nonsteroidal anti-inflammatory drugs such as ibuprofen may be used first, but all RA patients with persistent swelling in the joints are candidates for treatment with disease-modifying drugs. These drugs include methotrexate, hydroxychloroquine, sulfasalzine, corticosteroids, intramuscular and oral gold, d-penicillamine, minocycline, azathioprine, cyclosporine, leflunomide, and etanercept.
Optimal treatment requires comprehensive coordinated care, patient education and the expertise of a number of providers, including rheumatologists, primary care physicians, nurses, occupational and physical therapists, physiatrists and orthopedic surgeons. With the tremendous success of total joint replacement surgery (especially for the hip and knee) many patients with advanced disease have continued to be active and mobile.