This overview is a sample of the type of information available to you at Griffin Hospital's Community Health Resource Center. It is not intended to replace your physician's instructions in the management of your health problems, but to better inform you about a particular illness and alert you to the availability of other materials. If you have a question about any piece of information presented in theses fact sheets, please call your physician, or stop by the Community Health Resource Center at your convenience.

 RHEUMATOID ARTHRITIS

Rheumatoid arthritis is an inflammatory disease, and one of the most common forms of arthritis. Rheumatoid arthritis results in redness, pain, heat and swelling in the joints and their adjoining muscles.

A healthy joint (where two bones meet) is normally surrounded by a thin layer of tissue (synovium) which helps protect the joint and keeps it smooth and lubricated. Cartilage is a firm rubbery substance protecting the ends of bones from rubbing against each other as they move.

In rheumatoid arthritis the synovium becomes rough and swollen. This leads to inflammation of other portions of the affected joint, which can damage the cartilage and cause the joints to become deformed. The joints most often affected by rheumatoid arthritis are in your hands and feet, mainly at the knuckles or toe joints. Joints in the wrists, knees, ankles, and neck may also be affected.

WHAT CAUSES RHEUMATOID ARTHRITIS?

No one knows what causes rheumatoid arthritis. It is believed that the body's immune system (the system that usually protects you from infection) turns against itself and attacks healthy tissues.

While some people feel that rheumatoid arthritis is made worse by physical or emotional stress, there is no proof that illness or mental strain can cause an episode of rheumatoid arthritis.

WHO GETS RHEUMATOID ARTHRITIS?

It is estimated that 5-7 million people in the United States have rheumatoid arthritis. It is three times more common in women than in men. Rheumatoid arthritis can begin at any age, but most commonly occurs between the ages of 20 and 60. It is known that rheumatoid arthritis can be inherited, and like many chronic conditions (one that is long-lasting) it may flare up and then go away for no apparent reason.

WHAT ARE THE SYMPTOMS OF RHEUMATOID ARTHRITIS

Symptoms vary and can come or go quickly and without warning. You may experience tiredness or stiffness, especially in the mornings or after you've been sitting for a long period of time. Soreness throughout your body, a change of appetite, and a loss of weight are likely to occur. The inflammation from rheumatoid arthritis causes your joints to be swollen red and painful to move. Both sides of your body are usually affected with similar joint pain. A low-grade fever may accompany your symptoms.

You may have a condition in which your blood is low in red blood cells. This condition (known as anemia) is common in chronic diseases such as rheumatoid arthritis, but the development of it is not understood. The anemia causes you to feel weak and look very pale.

Small blood vessels may become inflamed and cause rheumatoid nodules, which are about the size of a pea. These are little lumps that grow under your skin and are commonly located near the elbows. They may come and go during the course of your illness.

DIAGNOSING RHEUMATOID ARTHRITIS

Different physical clues, along with laboratory tests, are used by your doctor in reaching a diagnosis of rheumatoid arthritis. A complete medical history is taken, along with a physical exam, x-rays, blood and urine tests.

In taking your medical history, your doctor will ask if you have been experiencing pain and swelling in two or three joints for at least six weeks. Occasionally this may be the only clue to make a firm diagnosis.

During the physical exam your doctor will check your joints carefully by looking, touching, and listening for any signs of abnormality in the joints. The doctor will look for signs of pain, reduced movement or loss of strength.

Lab and x-ray tests also help in confirming the diagnosis. A sample of blood will be drawn from which several blood tests are performed. These include a complete blood count (CBC), which will let the doctor know if you have anemia, and a white blood count (WBC), which measures the cells that fight off infection. The white blood cells are increased when rheumatoid arthritis is present. An increased erythrocyte sedimentation rate (ESR) will indicate inflammation due to rheumatoid arthritis. Although the ESR test may not necessarily help in the diagnosis, it can be used to help determine how severe your rheumatoid arthritis may be.

Another common blood test is called the rheumatoid factor (RF). Most people with rheumatoid arthritis have high amounts of RF in their blood, however, you maybe negative for this in the early stages of your disease.

X-rays are taken to see if any deformity has already occurred in the joints. On occasion, the doctor may remove some fluid from your joint using a special syringe. This is called joint aspiration (arthrocentesis) and is used to determine the extent of the inflammation.

TREATMENT OF RHEUMATOID ARTHRITIS

The goal of your treatment is to relieve the pain, reduce the inflammation, maintain as much strength and movement as possible, and prevent deformity of your joints. This includes a program of physical therapy, medications, emotional support and information on how to remain active with this condition.

Physical Therapy : A physical therapist will work with you and your doctor to develop a safe exercise program that will strengthen your muscles and increase the use of your joints. It is important to remain active and to balance your activity with daily rest periods. It is helpful to have at least 10-12 hours of sleep each night. When you are able to move the joints affected by rheumatoid arthritis, rotate them gently to prevent them from getting stiff. The physical therapist will show you how.

Drug therapy: In the initial months of your treatment, different drugs maybe prescribed to see which one is best for you and your condition. Treatment by medication involves anti-inflammatory drugs which reduce the inflammation caused by rheumatoid arthritis. Commonly used drugs are aspirin and ibuprofen, which are available over the counter and help to relieve pain as well as the inflammation. Follow the advice of your physician before taking any medication. If the rheumatoid arthritis is severe, drugs such as hydroxycholoroquine, penicillamine, gold salts, or corticosteroids maybe used. With your help, your doctor will be able to decide which of the medications is best suited for you.

Heat therapy: You may find swimming in a heated pool soothing for your stiff joints. The use of hot baths, heat lamps, heating pads, or whirlpool treatments may also help. Ask your doctor or nurse for more information concerning this.

Additional therapies: A firm mattress and lightweight covers may also help you sleep without putting pressure on your joints. Painful joints may require the use of splints to rest and support the joint. You would still want to exercise the joints, however, and should consider wearing the splints at night for protection as well as for the support.

Diet therapy: It is important to eat a normal, well-balanced diet. If you are overweight, weight reduction may help relieve some of the pressure on certain joints such as knees and ankles.

Surgical therapy: On occasion surgery maybe needed, especially if the joint is badly inflamed or severely damaged.

COPING

It is not uncommon for people with rheumatoid arthritis to feel frustration, anger or sadness in learning to live with a chronic illness. By understanding rheumatoid arthritis you will be better able to assist in your own care and feel more active and independent.

Family members may also be affected by your illness, and may feel helpless and frustrated when you are in pain. You may find it helpful to talk to a friend, a family member, fellow patient or professional on how to cope with your illness. You may wish to go to family counseling for assistance in developing coping skills for yourself and your family. Patient support groups may also be helpful by talking to others living with this condition.

Many people with rheumatoid arthritis find that with good medical treatment and exercise they can lead active and independent lives.

Please note that this information is intended to give you a general overview of the topic. It is not intended to replace advice or instruction of a health professional. We recommend that you consult your physician, nurse, or qualified health professional regarding the information in this publication. © 1994 Planetree, Inc. Reproduction of this material in any form is limited to license agreement.

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