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Sock's Toxicity And Drugs In RA:
Symptoms
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Symptoms of rheumatoid arthritis differ from one person to the next. But,there are certain hallmark signs of the disease. The more obvious symptoms-swollen or deformed joints,reduced movement and pain-occur as the disease progresses.
 
Early symptoms can be much more subtle. Recent research has shown that,even as early as a year or two after onset of the disease, rheumatoid arthritis can cause irreversible damage of joints.
 
Rheumatologists urge primary care providers and others to stay alert to the early sighns of rheumatoid arthritis. The earlier that treatment begins,the better the chance of avoiding disability
 
The subtle early symptoms that might easily be mistaken for something else include:
 
1) Listlessness and fatigue.
2) Loss of appetite.
3) Soreness and some swelling in the joints.
4) Weight loss.
5) Joint stiffness,especially in the morning.
 
RA almost always eventually causes joints to become inflamed,making them sore and warm to the touch. The area may swell and turn red.  (redness is not a dominant feature). The joints may become painful and hard to move.
 
Although joint inflammation is a hallmark sign of RA,it can vary from one person to another ( same with medication response). In some people,joint inflammation flares up and then subsides,only to flare up again. In others,inflammation is always present and may even worsen as the disease progresses. About one person in ten experiences a single,or couple of episode or episodes of joint inflammation and then goes into remission.
 
As the disease progresses,RA may also create flu-like symptoms. You may feel listless and weak,run a low-grade fever,and have no appetite. In time,this may lead to weight loss and anemia.
 
Symptoms of RA may include inflamed tendons and tingling in the fingers. In about one person out of five,small bumps,known as rheumatoid nodules,appear under the skin on the elbows or on other parts of the body. These lumps are small lumps of tissue which develop around bony areas that are exposed to pressure (elbows are common ). It is rare,but it may even develop internally.
 
You may begin to have trouble getting dressed in the morning,your hands may fumble as you button-up or you may drop something while putting it away. It may become harder to get in and out of the bathtub,or to reach around to wash up. At work,you may find it difficult to do certain tasks that wasn't difficult to do before.
 
It is important to note these changes,as well as physical. Not only will it help your rheumatologist to determine how advanced your RA is,but it will also pinpoint activities that you may have to rethink and even learn how to do differently so that you can continue to live a fuller life.
 
It is possible to recover function. Just as the physical symptoms of your disease will require medication,the life-altering aspects can be addressed in many ways,but you must first acknowledge that a problem exists.
 
If you have a particularly severe form of RA or if the disease has progressed unchecked,your joints may become deformed  In some cases the disease may involve other areas:
 
1) Tissue in the eyes and mouth may become dry (Sjogren's syndrome.)
2) The tissues surrounding the heart may become inflamed (pericarditis.)
3) The tissues lining the lungs may become inflamed (pleuritis.)
 
Rarely,RA may affect blood vessels ( vasculitis ). If this happens,the skin,nerves,organs,and other tissues may be damaged.
 
Diagnosis is all the more challenging because RA causes different symptoms in different people. To further complicate the picture,some symptoms-particulairly pain and stiffness in the joints-are also symptoms of osteoarthritis. The feeling of overall weakness and lack of energy are also symptoms of other auto immune diseases such as lupus. To ensure that a diagnosis of RA is accurate, the rheumatologist will order various medical tests to supplement what he/she observe and what the patient have said about their symptoms.
 
To determine whether the symptoms are signs of RA or something else,your rheumatologist may look at the following:
 
1) Your medical history-the information the patient provide about duration and type of symptoms.
2) The result of a physical examination.
3) The results of blood tests,( X-rays are more useful at a later date for comparison purposes),and other medical tests.
 
Don't be concerned if your physician suggests that you return periodically for in-depth checkups that may involve many of the same questions and tests. Because RA can vary vary so much from one person to another,time and reassessment offer valuable perspectives about the course of the disease.
 
Although medical tests (covered in other parts of the site),the types of tests when RA is suspected may vary from the tests ordered for the diagnosis of other types of arthritis.

 
The initial evaluation of the patient with RA should document symptoms of active disease (i.e.,presence of joint pain,duration of morning stiffness,degree of fatigue},functional status,objective evidence of disease activity (i.e., synovitis,as assessed by tender and swollen joint counts,and the ESR and CRP level) mechanical joint problems (i.e., loss of motion-joint instability, malalignment,and/or deformity), the presence of extraarticular disease and the presence of radiographic damage. The presence of comorbid conditions should be assessed.
 
The patient's and physician's global assessment of disease activity and a quantitative assessment of pain using a visual analog scale or other validated measure of funcion or quality of life are useful parameters to follow during the course of the disease. This baseline information greatly facilitates assessment of these progression and response to treatment.
 
Baseline laboratory evaluations should include a complete blood cell count (with white blood cell differential and platelet counts),rheumatoid factor (RF) measurement,and measurement of ESR or CRP. Evaluation of renal and hepatic functions is necessary,since many antirheumatic agents cause renal or heptic toxicity and may be  contrainindicated  if these organs are impaired. Since the hands and feet are so frequently involved in RA,radiographs of these joints as well as other affected joints establish a baseline for future assessment of structural damage. Arresting and preventing structural damge is the primary goal of therapy.and radiographic studies of major involved joints may be needed periodically.
 
Selection of the treatment regimen requires an assessment of prognosis. Poor prognosis is suggested by earlier age at disease onset,high titer of RF,elevted ESr,and swelling of >20 joints. Extraarticular manifestations of RA,such as rheumatoid nodules,Sjogren's syndrome,episcleritis and scleritis,interstitial lung disease,pericardial involvement , systemic vasculitis and Felty's syndrome,may also indicate a worse prognosis,but have not been widely adopted for clinical practise.
 
The ACR criteria for 20 % clinical improvement (the ACR 20 ) requires a 20 % improvement in 3 of the following parameters;patient's global assessment,physician's globl assessment,patient's assessment of pain,degree of disability,and level of acute-phase reactant. These criteria have been expanded to include criteria for 50 % and 70 % improvement measures (i.e.,ACR 50,ACR 70). Other criteria,such as Paulus criteria,have bee employed. More recently,radiographic progression (e.g., the Sharp score ) has been utilized as an outcome measure.

 
Rheumatoid arthritis may be better classified into four different types: spontaneous remitting disease,remitting,remitting progressive,and progressive.
 
Spontaneous remission means that without treatment or just with NSAIDs,the symptoms of the disease disappear. They may return later,and you may need to start taking NSAIDs again,but for a while you have complete relief or almost. In rare cases,about 5 to 10 % of people with RA,the symptoms never return.
 
Remitting disease means that the person has a series of flare-ups with a return to  normal in between. This can be difficult to deal with,because it is not known when a remission is going to occur and when the symptoms will return. DMARDs may be needed to prevent joint damage during the flare-ups
 
People suffering from remitting progressive disease experience flare-ups but never quite return to normal in between. There is a good chance that the joints with this type of disease will be damaged without DMARD therapy.
 
The person with progressive disease never experiences remission or flare-ups,just a gradual increase in the pain,swelling,and joint damage over time. Usually the progression is slow,but in some cases one can become disabled rather quickly.
 
New ACR guidelines recommended DMARD therapy to all RA patients upon diagnosis.

Factors that correlate with prognosis: More favorable factors; Onset at a younger age,absence of rheumatoid nodules (small bumps over pressure points),absence of,or few,manifestations outside of joints,absence of rheumatoid factor in the blood and perhaps male gender.

Less favourable prognosis : Rapid onset at a older age,high levels of rheumatoid factor,early in the disease,early involvement of large joints,female,presence of rheumatoid nodules,early appearance of erosions in the joints,vasculitis (blood disorder ).manifestations outside of the joints,and scleritis. It was once though that the marker HLA-DR4 in the blood was a indicator of severe disease,but some recent research suggests it may not be related to severe disease. It remains debateable among researchers.

Management Of Rheumatoid Arthitis:
 
Rheumatoid arthritis cannot be cured,but it can be managed. As with other diseases,you can maintain your health as much as possible through a combination of diet,exercise,medication,complementary therapies,and regular monitoring. Know when the therapy is working and when it is not.
 
You must be an active participant in your medical care,but this is particularily true with rheumatoid arthritis. Because the disease varies,and the medication effects will vary with different individuals.  Symtoms may come and go,your rheumatologist will rely on you to keep track of new developments or changes,in disease flares,and how you have responded to various therapies.
 
Above all,remember that rheumatoid arthritis requires a muti faced treatment strategy. The exact combination of tactics will depend on your health,the severity of the disease,and your preferences.
 
Learning more about rheumatoid arthritis is the first step in becoming more empowered to cope with the disease and its treatments. Many studies also show that education and support help alleviate the pain and may reduce the number of times you visit your helth care team.
 
If you have rheumatoid arthritis,you may lose your appetite. A well balanced ,wholesome,nitritious diet is essential for good health-regardless of disease
 
Unfortunately,although a new "arthritis diet" seems to appear every week,there is no diet that will cure the disease. There is some evidence that eating foods high in omega-3 fatty acids,found in cold water fish such as mackerel,may make you feel better. And some patients find that certain foods don't agree with them. But then,that is true of anyone.
 
The best advice is eat your fruits and vegetables and lay off sweets. Try to eat less fat and more fruits and vegetables,less red meat and more fish. Try to consume low-calorie foods that will help you lose weight,which in turn decreases the pressure on your joints (if overweight).
 
Some people with RAbecome deficiant in certain vitamins,especially vitamin D,which helps maintain bones. Consider a calcium supplement (1,000 to 1,500 milligrams/daily-depending on age and medications that are currently being taken.
 
Regular exercise is essential and do it in a way that protect your joints. If you are physically fit you will be able to cope with your disease. The range of motion in the joints will be improved,fight fatigue,strengthen muscles to provide better support to the joints,and improve your over-well being.
 
The components of a good fitness plan include three major types of exercise:
 
1) Resistance exercises,which strengthen muscles and provide support to the joints.
2) Flexibility exercises,which improve the range of motion and reduce the risk of energy3) low impact aerobic exercises,which improve the functioning of your heart and lungs and increase endurance
3) Strengthening exercises to protect your joints (and not heavy weight lifting) -light weights if you can.
 
Since you want to protect your joints as much as possible,you might consider taking up swimming. And if you're experiencing a flare in symptoms or if your joints hurt before you even start,go easy on them. Try some gentle range-of-motion exercises to preserve mobility but otherwise rest your joints until the pain and inflammation subside. Flexing your fingers will help-the idea is to preserve mobility without strain.