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Rheumatoid Arthritis by Anne Kazanas

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Rheumatoid arthritis or (RA) is a chronic inflammatory autoimmune disorder.  It affects and causes damage to many different joints including the joints of the hands and feet, ankles, elbows, hips, and shoulders.  RA also causes damage to cartilage, tendons, and ligaments.  Over time it can affect organs and internal systems.  There is no cure for rheumatoid arthritis.

Rheumatoid arthritis occurs when the immune system attacks a thin membrane that lines the joints called synovium.  When this happens, fluid builds up in the joints which causes pain and systemic inflammation.  This results in bone erosion, joint deformity, fever, fatigue, loss of appetite, possibly anemia, and commonly disability.  Signs and symptoms of this disease vary in severity among patients. Some people develop rheumatoid nodules which are lumps of tissue formed under the skin mostly over bony areas such as fingers and elbows.  Most patients experience intermittent bouts of flares that cause intense disease activity and some patients experience periods of remission when their swelling and pain lessens or even disappear for long periods of time.

Approximately 1.3 million people in the United States have RA.  Women are more likely to develop rheumatoid arthritis than men are. 70 percent of people with RA are women.  The common age of onset is between the ages of 30 and 60 but can occur as early as the teens. This disease occurs in all ethnic groups all around the world. There are factors that increase a person’s risk of rheumatoid arthritis.  Smoking cigarettes can increase the risk of RA in some people.  Also, a family history of RA can increase a person’s risk of the disease.   The complications of rheumatoid arthritis include osteoporosis, carpel tunnel syndrome, heart problems, and lung disease.

RA can be difficult to diagnose in the early stages since its symptoms are similar to other diseases. Diagnosing rheumatoid arthritis includes a physical examination by a physician to look for RA features such as swelling, warmth, limited motion, and overall stiffness in joints. Also, the presence of nodules is an indication of the disease. Blood tests that are used to indicate rheumatoid arthritis include an elevated red blood cell sedimentation rate, RA factor, and anti-cyclic citrullinated antibodies.  X-rays are done to determine if there is bone and joint cartilage loss. Treatment for rheumatoid arthritis includes medication.

Medications used for RA that reduce inflammation include nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.  Disease-modifying antirheumatic drugs can slow the progression of rheumatoid arthritis and can prevent permanent damage of the joints and other tissues.   Immunosuppressant drugs are used to control the immune system.  TNF-alpha inhibitors drugs help reduce pain, and swelling and aid stiff joints.  Examples of name-brand medications that are used of this type include Enbrel and Humira. If medications fail to prevent or slow joint pain then surgery may be needed to repair the damaged joints, restore joint mobility, reduce pain, and correct deformities caused by the disease.  Rheumatoid arthritis surgery includes total joint replacement, tendon repair, and joint fusions.  Medications and surgeries both carry benefits and risks.

Managing rheumatoid arthritis includes engaging in regular moderate physical activity to decrease fatigue and strengthen the muscles around the joints. Swimming, walking, and are good forms of exercise that put minimal stress on the joints.   Occupational and physical therapy can be helpful in RA management.   OT and PT professionals can instruct patients as to how to protect the joints.  There are assisting devices available for patients to aid them in gripping and grabbing. Diet plays a part in managing RA also.  Eating a balanced healthy diet with foods such as strawberries, olives, and fish, can help reduce RA inflammation. Controlling stress is also beneficial in managing rheumatoid arthritis.   Learning and practicing relaxation techniques can reduce stress and control pain.

Early detection of rheumatoid arthritis can slow disease progression and lower the chances of joint damage.


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