Rheumatoid Arthritis is an chronic inflammatory disease that causes pain,swelling,stiffness and loss of function in the joints.It has several special features that make it different from other types of arthritis.

RA occurs in a symmetrical pattern.If one knee or hand is involved the other one is usually, also affected. The disease often affects the wrist and finger joints closest to the hand.It can also affect other parts of the body beside the joints.

In addition people with the disease may have fatigue,and a general sense of not feeling well (malise).RA often mimics other rheumatic diseases and at the early stages,the full symptoms may not appear till later on in the course of the disease. RA affects patients in different forms and manner.

For some people the disease is mild,and non-erosive that lasts only a few months or a year or two and goes away without causing any major damage. There are periods in which the patient may feel better with little or no symptoms of the disease  called remissions.

Still others,have moderate-severe-erosive disease that is active most of the time that lasts for many years (life-time) and it can lead to serious disability and damage.  

Rheumatoid Arthritis will profoundly change your life. Most people do not think about our health,until it is threatened. Hardly any one thinks about joint disease until pain,stiffness and loss of function affects us.A disease such as RA,which affects the whole system will limit quality of life.

It can be difficult to diagnose R.A. in its early stages.R.F.(rheumatoid factor) is not always conclusive in the early stages since some people who do not have R.A.have a slight R.F.in the blood stream although 80% of R.A. patients do have positive R.F.

E.S.R. or "sed" is useful but not conclusive in the early stages-checks inflammation rate.

Anti-nuclear antibody testing-positive results, without underlying disease present-usually helps in determining if inflammatory disease is involved-it's not conclusive.

Synovial fluid assessment can be taken and to assist the clinician's knowledge  of the amount of inflammation present in a joint.

X-rays should be taken at the start and later compared,but in the early stages of disease it may not be helpful.

RA can not be diagnosed by one test alone,a number of tests are done and the total results are analyzed for a formal diagnosis. A person may look "normal",yet have severe RA. This misconception of the disease is one of the major factors contributing to the "myths"of RA.   

There are three major forms of R.A., mild, moderate and severe.A important factor is to have the disease determined as to its severity and type. An excellent analogy is the weather conditions,Windy, Storm,and Hurricane, with respect to prognosis.

Medication,treatment and exercise capability of the patient will be different for each case. Most of the damage is done in the early stages, estimated at 2 years after onset of disease. Once damage is done it is not reversible.  

Mild R.A.(30% of patients have the mild form)characterized by symmetrical joint inflammation(both left and right sides)pain,swelling and stiffness,which usually occurs first thing in the morning. Joint function may be slightly decreased.

The only extra-articular feature is painful inflammation of the tendons(tendonitis) R.F. is usually negative or slightly positive in most patients diagnosed with mild R.A. The arthritis remains mild throughout its course.

Some patients have a very short course,but in others it may recur or be constantly present for years.Deformity may or not be present.

Medication: NSAIDs(non-steriodal anti-inflammatory drugs in the aspirin family.DMARDs (disease modifying drugs)may,or may not be prescribed. 

Moderate R.A.-30%-40% have the moderate type. They have much more pain,swelling,stiffness, more joints affected,and loss of everyday function then those patients with the mild form.

Hands,wrists,elbows,knees and feet are usually all involved. Often moderate R.A.is accompanied by early loss of movement and morning stiffness that can last for 1 to 3 hours or more.

Tendonitis nodules(bumps over pressure points develop). Some may develop internal organ disorder,R.F.increases 2 to 3 times normal.

 Medication: NSAIDs and DMARDs. The use of DMARDs  was once used mainly in severe cases only,at the onset of disease.Since damage to joints is not reversible,DMARD therapy is encouraged at the early stages of the disease process.    

Severe R.A.:10% of RA patients have the severe form,severe means severe,function is severely affected. Deformity usually occurs within the first few months. Sufferers of this type feel tired,very weak,and ill. Severe RA is often accompanied by extra-articular features,besides joint damage. Connective tissue may be involved.

Inflammation may develop subcutaneous nodules. The internal organs may become involved in the on-going process of the disease. Lungs, rib cage muscles, jaw joints,eyes,and swelling of blood vessels may also occur(vasculitis).

Often R.F. is strongly positive.Without a aggressive DMARDs therapy-disability,and a possible shortened life span. Extra-articular features are usually involved.(EAFs are not limited to one class)

10 to 15% of all RA patients have the type of arthritis characterized by stiffness. This type of RA leads to abnormal tightness rather then swelling in the small joints of the hands, wrist,shoulders,and occasionally the feet and knees.

The stiffness is marked,EAFs are rare in this type of arthritis. Loss of function is the major problem caused by this stiffness.

Physician monitoring of therapy through appropriate laboratory tests will eliminate most of the serious side effects caused by some RA medications.

RA occurs in all races and ethnic groups.The disease often begins in prime middle age and young adulthood but children may have it. Like some other forms of arthritis,RA occurs more frequently in women then men.

From an economic standpoint,the medical and surgical treatment for RA and the wages lost because of disability caused by the disease add up to billions of dollars annually.

Daily joint pain is an inevitable consequence of the disease and most patients also experience some degree of depression,anxiety and feelings of helplesness.

Often,RA can interfere with a person's ability to carry out normal daily activities,limit job opportunities or disrupt the joys,quality of life and hinder responsibilities of family life.

Diagnosing and treating RA is a team effort between the patient and several types of health care professionals--family physician and rheumatologist. As treatment progresses, other professionals may help.

These other professionals may include nurses, specifically trained in RA, physical or occupational therapists,orthopedic surgeons, psychologists and social workers,as the need arises.

Combinations of treatments are employed and at different times,during the full course of the disease and are chosen according to the individual patient situation.

No matter what treatment the doctor and patient chooses the goals are to:reduce inflammation slow down or stop joint damage,reduce pain and improve the sense of well-being and ability to function.

Research studies are being done on the complex relationships among the hormonal,nervous and immune systems in RA. They are exploring how and whether the normal changes in the levels of steriod hormones (such as testosterone and estrogen) during a person's lifetime may be related to the development,improvement and intermittent flares of the disease. 

Scientists are also looking at how these  systems interact with environmental and genetic factors.Results from these studies may suggest new future treatment strategies.

Scientists,now have a better understanding,and making rapid progress in the complexities of RA and why it develops,why some people get it,and others don't,why some people have the more  severe form.

Results from research are having an impact today,enabling people with RA to remain active in life,family,and work far longer than that was possible 10 years ago.There is also hope for the future as researchers continue to explore ways of stopping rheumatoid arthritis in the early disease process,before it becomes destructive.--visit my other sites.  Build Date 2001-S.F.K.