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Rheumatoid Arthritis Facts:


Rheumatoid arthritis (RA) is a chronic,delibilitating disease that causes pain stiffness,swelling and loss of function in the joints. Along with painful joints. RA can cause inflammation in other body tissues and organs in some patients. Occasionally people with RA develop inflammation of the membrane that surrounds the heart,and lungs or inflammation of the lung itself. Inflammation of tear glands and salivary glands result in dry eyes and dry mouth. Sometimes RA causes inflammation of the blood vessels,which affects the skin,nerves and other organs. These effects are referred to as extra-articular features of RA. EAF's are more associated with some moderate and severe rheumatoid arthritis patients,but they can occur in all types.

The most common EAF in RA is tenosynovitis. Tenosynovitis is inflamtion of the tendon sheath. Tendons,similr to joints,are often covered with a sheath-like membrane (the synovium). The synovium becomes inflamed and swollen in RA patients. Tenosynovitis occurs most frequently in the hands,but can also occur in wrists,elbows,shoulders,around the knees,and in the feet. Tenosynovitis is typical of RA and helps distinguish it from other types of arthritis,where extra-articular features,usually,are absent.

In patients with moderate or severe types of RA,firm non-tender nodules develop under the skin,particularily in areas subject to pressure such as elbows,feet,or buttocks. These nodules are a hallmark of RA. This may indicate that the more moderate or severe type of RA is present. In such cases,aggressive theapy is indicated. Nodules rarely occur with arthritic diseases other than RA.

The heart may become involved in RA. Inflammation occur most commonly in the pericardium. The pericardium is a sac-like structure that surrounds the heart. The inflammation causes pain and occasionally an increase in fluid,which can compress the heart and impair function. This type of inflammation (pericarditis) can be detected by a simple,ultrasound test Only rarely does RA cause nodules or scarring within the heart walls,arteries,or on the valves of the heart.

With RA,inflammation of the lungs is common. The most common site of inflammation is in the pleurae,which lie between the lungs and the chest cavity. When the lungs are involved,most patients experience pain,particularily when breathing in or breathing out. In other patients,the pleural space,which separates the chest wall and lungs,fills with fluid. Occasionally RA patients develop nodules within the lung tissues,but usually,these do not cause symptoms. Unfortunately,on an x-ray film these tiny nodules may appear to be tiny lung tumors,and usualy,a biopsy or other test must be done to rule out cancer. Occasionally inflammation occurs throughout the lungs. This condition of diffuse inflammation is called fibrosis and leads to lung scarring. Symptoms are shortness of breath and cough. Breathing tests help to confirm a diagnosis of fibrosis.

RA can affect the nervous system. The most common cause arises from compression of nerves. This occurs most frequently in the hands,and is called carpel tunnel syndrome. The carpel tunnel is a narrow shallow tunnel in the wrists through which all of the important nerves,tendons,and blood supply to the hand passes. Inflammation within this narrow tunnel,caused by arthritis or other conditions,create pressure on one of the nerves passing through it,which leads to irritation. Pressure on the nerve results in numbness in the palm of the hand and the second,third,and fourth fingers. Generaly,the numbness in the hands is worst at night. RA can also affect nerves in other parts of the body. If RA causes damage to the joints in the neck,it can lead to bone shifts and compression of the spinal cord or the nerves that exit it. The result is numbness in the legs and arms.

In rare cases,RA can be so wide-spread that it causes inflammation within the lining of the blood vessels. Blood vessel inflammation is called vasculitis. Damage to the blood vessels or their closure can lead to damage in the organs that the blood vessels feed. Vasculitis is serious because it could damage organs such as the kidneys or heart.

RA can affect the eyes,either directly by inflammation,or indirectly by damaging the tear ducts. If the tear ducs are damaged their secreations decrease,and the patient will experience dry eyes,particularily at night. Inflammation of the cornea can cuse distorted vision and sometimes damage the eye.

RA can be difficult to diagnose at onset of disease because it may develop suddenly or begin gradually with subtle symptoms which progressively worsens. Blood tests and X-rays may be initially normal. The disease varies among individuals with respect to symptoms,joints affected, and the nature of other organs involved. Other types of arthritis often mimac RA. There are mild,moderate and severe types of RA. Thirty percent of patients have mid RA Joint function is only slightly decreased. In most patients diagnosed with mild RA,the disease remains mild throughout its course. In some patients,in this group,the disease may have a very short course,but in others,it may recur intermittenly or be constantly present for years with the mild form of RA,damage or deformity is uncommon. The only extra-articular feature is painful inflammation of the tendons (tendonitis).

Skill,often-patience and experience are essential to reach a accurate diagnosis and to arrive at the appropiate treatment. The majority of patients will have to take some form of therapy or medications for the rest of their lives

RA is an inflammatory disease of the synovium,or lining of the joint. The normally thin synovium membrane tissue which is microscopic in nature becomes thick and inflamed and can be felt by a rheumatologist. The synovium becomes inflamed and filled with destructive white blood cells (macrophages,cytokines,etc.,forms the pannus) and debris attacking cartilage and bone. Inflammation most often affects joints of the hands,knees and foot. The disease tends to be symmetrical or polyarticular (occurring equally on left and right sides of the body) this symmetry helps distinguish RA from other types of arthritis.

Rheumatoid arthritis is characterized by the signs of inflammation: pain,swelling,heat,and stiffness. Pain is caused by inflamed cells and chemicals that affect the nerve endings In RA,pain is felt in the joint or with joint movement. Swelling is caused by thickening of the synovial membrane and sometimes by increased fluid or debris within the joint. Increased blood-flow to the inflamed joint results in heat and redness. Stiffness commonly called "morning stiffness",occurs in almost all inflamed joints after a period of disuse. To regain mobility inflamed joints must be loosened up by applying heat or doing exercise.

RA is an autoimmune disease ,the immune system is a complex organization of cells and antibodies designed to "seek and destroy" invaders of the body,particularily bacteria and infections, normally. Patients with autoimmune diseases have antibodies in their blood which target their own tissues,where they can be associated with inflammation. It is a chronic disease that can last for a short period with no outward damage in the case of mild RA.

About 10% of RA patients have a form of RA characterized by marked stiffness which usually leads to abnormal tightness rather then swelling in the small joints of the hands,wrist,shoulders and occasionally,the knees and foot. The joints may look normal. Some of these patients will have difficulty raising their arms above their heads within a matter of weeks. Mobility and day-to-day function will be severely affected in many or these patients. With the exception of inflammation of the tendons. EAF's are rare in this type of RA. If left untreated,loss of function caused by this stiffness can be pronounced and irreversible.

All patients with RA may feel unwell but patients with moderate (30 to 35%} and severe (10 to 15%) are most affected. Like EAF's, the severity of these symptoms help to separate RA from other forms of arthritis Because it can affect mutiple joints and other organs of the body,RA is referred to as a systemic disease.

RA effects will vary with the individual patient,and type of medications will help one patient and do nothing for another. The number and severity of inflamed joints,whether the inflammation is symmetrical gives the doctor of what type of arthritis is present. The presence or absence of EAF's also gives the doctor a hint on the severity of disease present. If deformity or erosive daamage have occurred (not all patients have erosive patterns) are other clues for the type of therapy to be followed.

Some RA patients will have a negative rheumatoid factor (R.F. in the blood) A antinuclear antibody test (ANA) will indicate the presence of inflammation but it is used more for the diagnosis of lupus (patients have different type of ANA). RA cannot be detected by one test or by the physical appearance,usually,a number of tests is done and the whole "Big Picture" is analyzed. E.S.R. or "sed rate" is one of the most often used blood test to check the inflammation rate present but other diseases may also indicate a higher then normal rate. Blood tests are helpful in the diagnosis of RA but the person's medical history examination is equally important. Communication between physician and patient is essential.

Arthritis can be classified either inflammatory or non-inflammatory. Inflammatory arthritis features inflammatory white blood cells in the joint fluid. Forms of inflammatory arthritis include RA,lupus arthritis,psoriatic arthritis,ankylosing spondylitis, and many others. Forms of non-inflammatory arthritis include arthritis of tyroid disease,arthritis after injury and usually osteoarthritis (in some OA patients there are reported signs of inflammatory criteria present in some patients) and many others.

After making a diagnosis,the physician will decide on the severity of RA the patient has, and determine its course. Active or progressive RA must always be treated to stop the progression. To treat early RA (within 3 months) is always preferable,but treatment of all progressive RA,at anytime,is important. When physicians use the term "late" or "already damaged",the implication is that nothing can be done. Nothing could be further from the truth, Rheumatiod arthritis should always be treated,but the earlier,the easier to treat.

After the diagnosis,the physician will prescribe some form of treatment,usually a combination of drugs and supportive therapy. The treatment will take several weeks or months (depending upon medication) before the effects are felt,in many cases. Sometimes therapy will have to be changed or altered At which point,many follow-up and monitoring appointments will be the order of the day. The patient must communicate with the medical team,educate themselves on every aspect of the disease because of the individual charachteristics this disease will display.

Many patients are seen only occasionally,over a period of weeks and months,while trying different drugs. If after an appropriate period of time,the disease does not show signs of control the patient must be referred to a rheumatologist. Some patients will have difficulty more-so then others. This is usually poor for prognosis. The major problem is delay! Delays caused by poor diagnosis,long waiting lists,too short office visits and inappropiate treatment,which further means "the window of opportunity" to control,moderate or severe disease is missed Any type of RA requires appropriate treatment. Persistence and self-education are needed to ensure the patient get prompt and appropiate treatment. The patient must take a major role in therapy management. Moving from disease onset to control.

Management of rheumatoid arthritis involves-the onset of disease-the family physician-the rheumatologist-the institution of disease modifying drugs (DMARDs) ,non-steriodal anti-inflammatory drugs (NSAIDs) and steriodal (corticosteriods) drugs at appropriate periods of disease activity . The patient and doctor must recognize when the therapy is working and when it is not.

There will be periods of time when the patient "feels good" and times when the patient "feels worse". There will likely be times that a patient with RA "feels cured" It is important to understand that the patients who have a complete remission is not common,therefore it is essential that the patient does not stop the treatment regimen established by knowledgeable health care providers. At times,the symptoms will remit and in some cases,the periods may be longer than others. Disability is higher with with 50% being unable to continue employment. Surgery was looked upon as a last resort,but that is changing,with improved surgical techniques.

Research and development is progressing at a speed unforseen in the past and future development of cheaper medication that can be assessable to all patients is the goal of research scientists.

Formal diagnosis of RA require that the case meet at least four of the seven criterias:

Several Patterns have been described:


Links:...Socks Toxicity And Drugs In RA....Tripod Rheumatoid Arthritis Essentials.....Sock's Rheumatoid Arthritis Links....Inflammatory Arthritis.....Socks Rheumatoid Arthritis Page 1


Have a consultation with a Rheumatologist-There is no "Quick-Fix."---Some sites have been deleted--The Tripod sites will be updated when I have the time--"Sock's Rheumatoid Arthritis Links and Inflammatory Arthriitis are the latest updated Tripod site---This is a "Free-Site". I have no control of advertisement"*All my sites.--I have written many articles over the years.*Disregard any reference to "Vioxx" which was taken off the market by the FDA a few years ago. The NSAID had proven to have negative adverse heart problems to many patients--rise in blood pressure. Don't waste your time,money or health on "cures". See a rheumatologist to treat your disease. There are differences in each RA patient's prognosis,effects and form.---SOCK'S TOXICITY AND DRUGS IN RA--SOCK'S RHEUMATOID ARTHRITIS PAGE 1--IVILLAGE.COM--SOCK'S RHEUMATOID ARTHRITIS LINKS--TRIPOD--ANGELFIRE LINKS--NETSCAPE WEBPAGE--GEOCITIES--AOL LINKS--RHEUMATOID ESSENTIALS--TRIPOD COM--GOVERNMENT MISMANAGEMENT AND HISTORY DURING WORLD WAR II IN CANADA--ABOUT A MINORITY GROUP IN CANADA--EVENTS THAT EVOLVED--UN JUSTIFIED HYSTERIA--WHICH SHOULD NOT HAVE OCCURRED IN A JUST AND DEMOCRATIC SOCIETY--TO CITIZENS BORN AND EDUCATED IN THEIR OWN COUNTRY