Approximately 15 % of cases will be come on suddenly,over a matter of days. Although not all the joints that will eventually
cause trouble will be involved in this first attack,there may be two dozen,which is typical. They will include the MCPs and
MTPs. Similar joints on both right and left sides will be involved. Morning stiffness and fatigue will be prominant.
About 75 % of the time the scenery is less spectacular. A wrist becomes swollen and for some time it's the only problem.
Or a patient develops marked tenderness under the balls of both feet (MTP joints),particularily when first getting out of
bed. Gradually,over several weeks to several months,more and more joints show up. Fatigue and morning stiffness also come
into play. It may take a year or so before the pictire is clear enough for definite diagnosis.
In 10 % of cases,-A single joint such as the knee,wrist or shoulder,suddenly becomes very painful,swollen and warm. Often
the pain is so severe that the joint can't be used. Two or three days later,it's back to normal. After a month or so another
attack strikes,usually in another joint. With time,the attacks becomes more frequent. Gradually they are less and less severe
but more and more frequent,and instead of clearing up,the pain starts to persist. One day, perhaps after a year more
it becomes obvious that the problem is RA. This pattern is called palindromic rheumatism,and while it doesn't always
turn out to be RA,it most often does.
Palindromic rheumatism may clear up as mysteriously as it comes on,may continue indefinitely,or may evolve into very
active rheumatoid arthritis, requiring aggressive action.
Very rarely,RA first appears in an extra-articular (EAFs-non-joint) site,with joint symptoms appearing months later.
When it does,it usualy takes the form of chest complications,and the patient is usually male.
The inflammation associated with RA also occurs outside the joints. Extra-articular features are more common in patients
with moderate and severe disease,but they can occur in mild cases too. Since RA can cause EAF's,it can be viewed as a disease
that affects the whole body and not just the joints. the most common EAf in RA is tendonitis or tenosynovitis. Tenosynovitis
is inflammation of the tendon sheath.
Rheumatoid nodules (usually over pressure points may appear,it is associated with the moderate-severe type of RA.but
it not limited to type. The heart may become involved in RA. (Pericardium-pericarditis-detected with simple ultra sound tests)
Lungs-inflammation of lungs is comon. The nervous sstem can be affected-the most common is carpel tunnel syndrome (CTS). RA
can also affect nerves in other parts of the body. In rare cases,RA can be so wide-spread that it causes withinin the linings
of blood vessels. Eyes can be affected. These features are discussed in other section of my sites in more detail.
"There are mild,moderate and severe types of RA (type is more in reference to severity of disease). The effects,medication,day-to-day
living and prognosis will be individually different in each case.
Being diagnosed with RA is one thing,but living individually is another thing."
Thirty percent of patients have the mild type of RA. Thirty to forty percent have the moderate form. Approximately
ten percent will have the severe manifestations of RA to confront. Severe means severe. Ten to fifteen percent of all
patients have the type of arthritis characterized by stiffness. This type leads to abnormal tightness than to swelling in
the small joints f the hands,wrist,shoulders,and occassionallythe knees and feet The stiffness is marked In this type the
joints may look normal,but the patient may find it difficult to hold a glass of water in their hands.Loss of function is the
major problem caused by this stiffness.
The need of a rheumatologist is clearly,required for a successful conclusion. Due to the medical training
system currently taught,family doctor are given less than 1 % of rheumatology training at medical school. They have a option
to take this limited option in rheumatology and many family physicians and internists choose not to take this available option.
Rheumatologists are trained in feeling the normally microscopic synovial membrane lining (which becomes thick
in RA) they are trained in "bone count" (number of tender joints). Family doctors and most internists are not trained at medical
school in this,and other necessary procedures required in rheumatology. The number of rheumatic diseases makes it impossible
for a general practice or internist to follow,in depth.. It is a matter of common sense and factual.
Experience and knowledge is provided by a rheumatologist. The family doctor is invaluable,they take care
of our general health,and a good doctor,will refer the patient to a specialist.
People have to take repossession of their lives. One of the simplest isn't always easy,but it's effective.
Relax,pain,causes stress and tension,and not just psychological tension. Taking a relaxation training session teaches you
to enter a more relax physical state that lowers blood pressure,respiratory rate,and adrenalin flow.
You'll be taught to lie down and find a comfortable breathing rhythm. Close your eyes,focus on your body's
different muscle groups,starting with your calf muscles. Slowly relax your muscles,moving progressively up your body to your
neck and shoulders. As the muscles relax,there's a cocomitant release of the body's natural opiates (endorphins),pain relieving
hormone's that are related to synthenic opiates like morphine.
Endorphins can be released by any number of stimuli,including laughter. A good belly laugh relaxes stomach
muscles,and that may be one reason why it works,releasing muscle tension is a relief fron an unconscious source of pain and
discomfort. The heart speeds up,blood pressure rises and,when respiration accelerates,there's an increase in oxygen exchange.
A good belly laugh when watching a TV sitcom not only exercises your diaphragm and abdomen,but the muscles of your face and
shoulders and sometimes even the muscles of your legs and arms.
By the time your laughter subsides at the commercial break,you've had a short aerobic workout. After an
exhausting "laugh-out",don't underestimate the value of rest,energy conservation,and sleep.