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" Rheumatoid Arthritis "

I have been diagnosed with Rheumatoid Arthritis.
I would like to share with You some of the things I have found out about RA.

" What is Rheumatoid Arthritis ( RA ) "

Rheumatoid arthritis is a form of arthritis that leads to inflammation in the lining of the joints( "arthr-" means joint and " itis " means inflammation ). Rheumatoid arthritis can affect many different joints in the body and is chronic, meaning that it lasts a lifetime. Over time, RA can damage various parts of the joint, such as catilage , bone, tendons, and ligaments.

" Who gets RA ? "

Anyone can be diagnosed with RA, including children and the elderly. However, most people develop RA during their young to middle adult years. Women are diagnosed with RA approximately three times more often than a man. Over 2 million people in the United States have RA.

" The Major Symptoms of Rheumatoid Arthritis "

The most common initial signs of rheumatoid arthritis (RA) are:

                  • Fatigue
                  • Loss of appetite
                  • Fever
                  • Muscle pain
                  • Joint pain

Weight loss may also accompany these initial symptoms, although it is less common. Additionally, some people experience the formation of rheumatoid nodules, which are firm lumps underneath the skin that form close to the joints (especially around the hands and elbows).

As the condition progresses, joints become warm, swollen, and tender and can eventually grow deformed. RA tends to affect joints symmetrically, which means you are likely to experience pain on both sides of the body at once – in both your hands or both your feet, for example.

" Causes of Rheumatoid Arthritis "

The exact cause of rheumatoid arthritis is unknown. Many doctors believe that a virus or a bacterium may prompt rheumatoid arthritis to develop in those people who have a genetic predisposition to it. Seven out of ten people who have rheumatoid arthritis have an inherited chemical marker on their cells leading doctors to believe that there is a correlation.

Some experts think rheumatoid arthritis is an autoimmune disease, meaning that the body tissue is the victim of an immune response against itself. The body creates antibodies that actually attack the joints causing the swelling and redness. Excess fluid will flow into the joint space making joint motion painful.

Severe stress may also play a role. In some cases, rheumatoid arthritis will first appear after a person has experienced a life-changing event like a divorce, loss of a job, death of a loved one or a severe injury.

" Treatment of Rheumatoid Arthritis "

If your doctor suspects that you have rheumatoid arthritis, he or she will order a series of diagnostic tests after performing a physical examination. One test he or she may order looks for an ntibody called rheumatoid factor. Approximately 85 percent of people with rheumatoid arthritis have this antibody.

Once a diagnosis is made, you can start a series of treatments designed to help you continue to live your life. Advances in treatment have been made so that few people with rheumatoid arthritis end up bed ridden.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are used to reduce pain and swelling in the short term. Disease modifying drugs (DMARDs) may also be used if you don’t respond to NSAID treatment. These slow acting drugs are designed to help slow the progression of rheumatoid arthritis. Over the long term, biologic response modifiers may be used. These drugs are either injected or given intravenously. Corticosteroid medications, like Prednisone, may also be used to help you during flareups.

Exercise is one of the best things you can do for your arthritis. It will increase your strength and give you endurance. Stretching will help your joints retain or gain flexibility. Exercise not only helps your body but also will improve your state of mind. Remember that there are many ways to exercise. Speak to your doctor before starting an exercise program.

In some cases, surgery may be necessary. Surgery, such as joint replacement, is considered when you and your doctor have concluded that previous treatments for pain and mobility have been unsuccessful and your quality of life is suffering. In addition to joint replacement surgery, other types of surgery include the reconstruction or fusion of a joint and the removal of diseased tissue from the joint (synovectomy).

Tens of millions of Americans experience the nagging pains and physical limitations of arthritis. There are more than 100 forms of arthritis. Rheumatoid arthritis is among the most debilitating of them all, causing joints to ache and throb and eventually become deformed. Sometimes these symptoms make even the simplest things — such as opening a jar or taking a walk — difficult to manage.

Unlike osteoarthritis, which results from wear and tear on the joints, rheumatoid arthritis is an inflammatory condition. The exact cause of it is unknown. But it’s believed to be caused by the body’s immune system attacking the synovium — the tissue that lines the joints.

Rheumatoid arthritis affects about 2.1 million Americans. It’s three times more common in women than in men and generally strikes between the ages of 20 and 50. But rheumatoid arthritis also can affect very young children and adults older than age 50.

There’s no cure for rheumatoid arthritis. But with proper treatment, a strategy for joint protection and changes in lifestyle, you can live a long, productive life with the condition.

" Rheumatoid arthritis Signs and symptoms "

" The signs and symptoms of rheumatoid arthritis may come and go over time. They include:"

Pain and swelling in the smaller joints of your hands and feet
Generalized aching or stiffness of the joints and muscles, especially after sleep or after periods of rest
Loss of motion of the affected joints
Loss of strength in muscles attached to the affected joints
Fatigue, which can be severe during a flare-up
Low-grade fever

Deformity of the joints as time goes on Rheumatoid arthritis usually causes problems in many joints at the same time. Joints in the wrists, hands, feet and ankles are the ones most often affected. The disease can also involve your elbows, shoulders, hips, knees, neck and jaw. It generally affects both sides of the body at the same time. The knuckles of both hands might be one example.

Small lumps, called rheumatoid nodules, may form under the skin of your elbow, your hands, the back of your scalp, over your knee or on your feet and heels. These nodules can range in size — appearing as small as a pea to as large as a walnut. Usually these lumps aren’t painful.

In contrast to osteoarthritis, which affects only your bones and joints, rheumatoid arthritis can cause inflammation of tear glands, salivary glands, the lining of your heart and lungs, the lungs themselves and, in rare cases, your blood vessels.

Although rheumatoid arthritis is often a chronic disease, it tends to vary in severity and may even come and go. Periods of increased disease activity — called flare-ups or flares — alternate with periods of relative remission, during which the swelling, pain, difficulty in sleeping and weakness fade or disappear.

The flexibility of your joints may be limited by swelling or deformity. But even if you have a severe form of rheumatoid arthritis, you’ll probably retain flexibility in many joints.

" Rheumatoid arthritis Complications "

Rheumatoid arthritis causes stiffness and pain and may also cause fatigue. It can lead to difficulty with everyday tasks such as turning a doorknob or holding a pen. Dealing with the pain and unpredictability of rheumatoid arthritis can also cause depression.

In the past, people with rheumatoid arthritis may have ended up confined to a wheelchair because damage to joints made it difficult or impossible to walk. That’s not as likely today because of better treatments and self-care methods.

A chronic inflammatory disease that primarily affects the joints and surrounding tissues, but can also affect other organ systems.

" Alternative Names "

RA Causes, incidence, and risk factors

The cause of rheumatoid arthritis (RA) is unknown, however the condition involves an attack on the body by its own immune cells (auto-immune disease). Different cases may have different causes. Infectious, genetic, and hormonal factors may play a role.

The disease can occur at any age, but the peak incidence of disease onset is between the ages of 25 and 55. The disease is more common in older people. Women are affected 2.5 times more often than men. Approximately 1-2% of the total population is affected. The course and the severity of the illness can vary considerably.

The onset of the disease is usually gradual, with fatigue, morning stiffness (lasting more than one hour), diffuse muscular aches, loss of appetite, and weakness. Eventually, joint pain appears, with warmth, swelling, tenderness, and stiffness of the joint after inactivity.

Joint involvement in RA usually affects both sides of the body equally -- the arthritis is therefore referred to as symmetrical. Wrists, fingers, knees, feet, and ankles are the most commonly affected joints. Severe disease is associated with larger joints that contain more synovium (joint lining).

When the synovium becomes inflamed, it secretes more fluid and the joint becomes swollen. Later, the cartilage becomes rough and pitted. The underlying bone eventually becomes affected. Joint destruction begins 1-2 years after the appearance of the disease.

Characteristic deformities result from cartilage destruction, bone erosions, and tendon inflammation and rupture. A life-threatening joint complication can occur when the cervical spine becomes unstable as a result of RA.

Other features of the disease that do not involve the joints may occur. Rheumatoid nodules are painless, hard, round or oval masses that appear under the skin, usually on pressure points, such as the elbow or Achilles tendon. These are present in about 20% of cases and tend to reflect more severe disease.

On occasion, they appear in the eye where they sometimes cause inflammation. If they occur in the lungs, inflammation of the lining of the lung (pleurisy) may occur, causing shortness of breath.

Anemia may occur due to failure of the bone marrow to produce enough new red cells to make up for the lost ones. Iron supplements will not usually help this condition because iron utilization in the body becomes impaired. Other blood abnormalities can also be found, for example, platelet counts that are either too high or too low.

Rheumatoid vasculitis (inflammation of the blood vessels) is a serious complication of RA and can be life-threatening. It can lead to skin ulcerations (and subsequent infections), bleeding stomach ulcers (which can lead to massive hemorrhage), and neuropathies (nerve problems causing pain, numbness or tingling).

Vasculitis may also affect the brain, nerves, and heart causing strokes, sensory neuropathies (numbness and tingling), heart attacks, or heart failure.

Heart complications of RA commonly affect the outer lining of the heart. When inflamed, the condition is referred to as pericarditis. Inflammation of heart muscle, called myocarditis, can also develop. Both of these conditions can lead to congestive heart failure characterized by shortness of breath and fluid accumulation in the lung.

Lung involvement is frequent in RA. Fibrosis of the lung tissue leads to shortness of breath and has been reported to occur in 20% of patients with RA. Inflammation of the lining of the lung, called pleuritis, can also lead to fluid accumulation. Pulmonary nodules, similar to rheumatoid nodules, can also develop.

Eye complications include inflammation of various parts of the eye. These must be screened for in RA patients.

" Signs and tests "

Joint X-rays
A rheumatoid factor test is positive in about 75% of people with symptoms . The erythrocyte sedimentation rate is elevated A CBC may show low hematocrit (anemia) or abnormal platelet counts A C-reactive protein (may be a positive indication for patients with no detectable rheumatoid factor) A synovial fluid analysis

" Treatment "

RA usually requires lifelong treatment, including various medications, physical therapy, education, and possibly surgery aimed at relieving the signs and symptoms of the disease.


For the past 10 years, studies have shown that early, aggressive treatment for RA can delay the onset of joint destruction. In addition to rest, strengthening exercises, and anti-inflammatory agents, the current standard of care is to initiate aggressive therapy with disease-modifying anti-rheumatic drugs (DMARDs) once the diagnosis is confirmed.

Anti-inflammatory agents used to treat RA traditionally included aspirin and non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (Motrin, Advil), fenoprofen, indomethacin, naproxen (Naprosyn), and others.

These are widely used medications that are effective in relieving pain and inflammation associated with RA. However, side effects associated with frequent use of many of these medications include life-threatening gastrointestinal bleeding.

Similar drugs, called Cox-2 inhibitors, are now a mainstay of anti-inflammatory therapy because the risk of gastrointestinal bleeding is significantly reduced with these drugs. Currently, there are two available -- rofecoxib (Vioxx) and celecoxib (Celebrex).

As mentioned, DMARDs alter the course of the disease. Included in this group are gold compounds, which can be injectible (Myochrysine and Solganal) or oral (auranofin/Ridaura). Methotrexate (Rheumatrex) is the most commonly used DMARD for rheumatoid arthritis with good proven effectiveness.

Antimalarial medications, such as Hydroxychloroquine (Plaquenil), as well as Sulfasalazine (Azulfidine), are also beneficial, usually in conjunction with Methotrexate.

The benefits from these medications may take weeks or months to be apparent. Because they are associated with toxic side effects, frequent monitoring of blood tests while on these medications is imperative.

In the last few years, new and exciting medications have been introduced. A promising medication that is fast becoming a first-line agent for the aggressive treatment of RA is called etanercept (Enbrel). Enbrel acts by inhibiting an inflammatory protein, called tumor necrosis factor (TNF).

Other new medications include infliximab (Remicade) that also blocks TNF and leflunomide (Arava), which blocks the growth of new cells. Anakinra is an even newer therapy that blocks the action of another inflammatory protein, interleukin-1. Anakinra and Etanercept are injectable medications, whereas Infliximab is given intravenously every 2 months.

Drugs that suppress the immune system, like azathioprine (Imuran) and cyclophosphamide (Cytoxan), may be used in people who have failed other therapies. These medications, which are associated with toxic side effects, are reserved for severe cases of RA.

Corticosteroids have been used to reduce inflammation in RA for greater than 40 years. However, because of potential long-term side effects, corticosteroid use is limited to short courses and low doses where possible.

Side effects may include bruising, psychosis, thinning of the bones (osteoporosis), cataracts, weight gain, susceptibility to infections, diabetes, and high blood pressure. A number of medications can be administered in conjunction with steroids to minimize resultant osteoporosis.

Consult a health care provider before long-term use of any medication, including over-the-counter medications.


Occasionally, surgery is indicated for severely affected joints. The most successful surgeries are those on the knees and hips. Usually, the first surgical treatment is removal of the synovium (synovectomy).

A later alternative is total joint replacement with a joint prosthesis. Surgeries can be expected to relieve joint pain, correct deformities, and modestly improve joint function. In extreme cases, total knee or hip replacement can mean the difference between being totally dependent on others and having an independent life at home.


Range of motion exercises and individualized exercise programs prescribed by a physical therapist can delay the loss of joint function.

Joint protection techniques, heat and cold treatments, and splints or orthotic devices to support and align joints may be very helpful.

Frequent rest periods between activities, as well as 8 to 10 hours of sleep per night are recommended.


Prosorba column is a device approved by the FDA in 1999 for treatment of moderate to severe RA in adult patients with long-standing disease (who have not responded to DMARD's).

It works by removing inflammatory antibodies from the blood by a process called apheresis. The blood is removed through a small catheter and then passed through a column (the size of a coffee mug) that is coated with a substance called protein A.

Protein A binds with the antibodies and removes them from the blood. The blood is then given back. The procedure takes 2-3 hours, and must be done once a week for 12 weeks.

Studies have reported that one third to one half of the people who receive this treatment may slow down, or even stop the RA from worsening. Reported side effects include anemia, fatique, fever, low blood pressure, and nausea. Some people have developed an infection from the catheter. Often there is a flare-up of joint pain for several days after the treatment.

Sometimes therapists will use special machines to apply deep heat or electrical stimulation to reduce pain and improve joint mobility.

Occupational therapists can construct splints for your hand and wrist, and teach you how to best protect and use your joints when they are affected by arthritis. They also show people how to better cope with day-to-day tasks at work and at home, despite limitations caused by RA.


Depending on the medications being taken, regular blood or urine tests should be done to monitor both progress and negative side effects.

" Support Groups "

The stress of illness can often be helped by joining a support group in which members share common experiences and problems. Look for arthritis - support group on the net..

" Expectations (prognosis) "

Frequently, the disease can be controlled with a combination of treatments. Treatment may vary depending on the severity of the symptoms. Surgery may be needed, if medications fail.

The course of the disease varies between individuals. People with rheumatoid factor and/or subcutaneous nodules seem to have a more severe course of disease. People who develop RA at younger ages also have a more rapidly progressive course.

Remission is most likely to occur in the first year and the probability decreases as time progresses. By 10 to 15 years from diagnosis, about 20% of people will have had remission.

Between 50 - 70% will remain capable of full-time employment. After 15 to 20 years, only 10% of patients are severely disabled, and unable to perform simple activities of daily living (washing, toileting, dressing, eating).

However, the average life expectancy may be shortened by 3 to 7 years with this disease, and patients with severe forms of RA may die 10-15 years earlier than expected.

As treatment for rheumatoid arthritis improves, the occurrence of severe disability and life threatening complications appears to be decreasing, so these figures may be overly pessimistic.

" Prevention "

Rheumatoid arthritis has no known prevention. However, it is often possible to prevent further damage of the joints with proper early treatment

" Death More Prevalent in RA Patients "

Patients with rheumatoid arthritis (RA) have a shortened life expectancy because of an increased risk to lung and hematopoi-etic malignancies, circulatory disorders, and cerebrovascular causes, according to the results of a 20-year study. Researchers in England and Scotland conducted a large population-based cohort study to determine specific mortality incidence in >40,000 people with RA and other rheumatic conditions. The participants were followed for 20 years following their initial hospital admission.

The results showed that RA patients had the greatest number of deaths, and those with systemic sclerosis had the highest risk of death. Death was more prevalent in the first 5 years after hospitalization. For RA patients, the greatest risk was seen in diseases associated with the musculoskeletal system and connective tissues—a 60-fold increased risk in men and a 28-fold increase in women.

I know this is long and I have repeated myself but it is importation to Me.. If You think You have RA, Go today to Your Doctor..All it takes is a blood test to find out if You have RA.

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