Rheumatoid Arthritis - Symptoms and Treatment

Rheumatoid arthritis is a chronic, systemic, symmetrical inflammatory disease. It primarily attacks peripheral joints and surrounding muscles, tendons, ligaments, and blood vessels. Spontaneous remissions and unpredictable exacerbations mark the course of this potentially crippling disease. A similar condition, psoriatic arthritis, has the same arthritic component along with psoriasis of the skin and nails.

Rheumatoid arthritis occurs worldwide. Rheumatoid arthritis is two to three times more common in women than in men and generally strikes between the ages of 20 and 50. But rheumatoid arthritis can also affect young children and adults older than age 50.

Causes

The exact cause of rheumatoid arthritis is not known. Rheumatoid arthritis is an autoimmune disorder, which means the body's immune system attacks its own healthy cells and tissues. The response of the body causes inflammation in and around the joints, which then may lead to a destruction of the skeletal system. Rheumatoid arthritis also may have devastating effects to other organs, such as the heart and lungs. Researchers believe certain factors, including heredity, may contribute to the onset of the disease.

Rheumatoid arthritis affects more women than men (75 percent of persons with rheumatoid arthritis are women). The disease most often occurs between the ages of 20 and 45.

Symptoms

Some of the most common symptoms of rheumatoid arthritis are:

• Joint swelling. Especially in the small joints of the hands and feet.
• Joint tenderness, stiffness, and pain. Especially in the morning.

Diagnostic tests

Diagnosis of rheumatoid arthritis may be difficult in the early stages, because symptoms may be very subtle and go undetected on x-rays or blood tests. In addition to a complete medical history and physical examination, diagnostic procedures for rheumatoid arthritis may include the following:

• x-ray
• joint aspiration
• biopsy (of nodules tissue)
• blood tests

Treatment

Treatment requires a multidisciplinary health care team to reduce the patient's pain and inflammation, preserve functional capacity, resolve pathologic processes, and bring about improvement.

Salicylates, particularly aspirin, are the mainstay of therapy because they decrease inflammation and relieve joint pain. The patient may also receive other nonsteroidal anti-inflammatory drugs (such as indomethacin, fenoprofen, and ibuprofen), antimalarials (hydroxychloroquine), gold salts, penicillamine, and corticosteroids (prednisone), although corticosteroid therapy can cause osteoporosis. Other therapeutic drugs include such immunosuppressants as cyclophosphamide, methotrexate, and azathioprine, which are used in the early stages of the disease.

Supportive measures include increased sleep ( 8 to 10 hours every night), frequent rest periods between daily activities, and splinting to rest inflamed joints (although, like corticosteroid therapy, immobilization can cause osteoporosis).

A physical therapy program that includes range-of-motion exercises and carefully individualized therapeutic exercises forestalls the loss of joint function; application of heat relaxes muscles and relieves pain. Moist heat (hot soaks, paraffin baths, whirlpools) usually works best for patients with chronic disease. Ice packs help during acute episodes.

Early intervention, under the guidance of an occupational therapist, with splinting and joint protection devices can delay the progression of joint deformities. A well-balanced diet and weight control along with the use of adaptive devices and ambulatory support (such as a cane, crutches, and a walker) are beneficial.

Useful surgical procedures include metatarsal head and distal ulnar resectional arthroplasty and insertion of a Silastic prosthesis between the metacarpophalangeal and proximal interphalangeal joints. Arthrodesis ( joint fusion) can bring about stability and relieve pain but at the price of decreased joint mobility. Synovectomy (removal of destructive, proliferating synovium, usually in the wrists, fingers, and knees) can halt or delay the course of the disease. Osteotomy (the cutting of bone or excision of a wedge of bone) can realign joint surfaces and redistribute stresses. Tendons that rupture spontaneously require surgical repair. Tendon transfers can prevent deformities or relieve contractures. The patient may need joint reconsruction or total joint arthroplasty in advanced disease.

Prevention

There is no known way to prevent rheumatoid arthritis, although progression of the disease usually can be stopped or slowed by early, aggressive treatment.

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