Periodic assessment of disease activity,drug toxicity,and the effectiveness of the treatment program is essential,with revisions of the treatment program as necessary.

 

Rheumatoid arthritis does not affect everyone in the same way,some will have the mild form,and others will have the moderate or severe form. Treatment and disease duration is also variable according to individual patient.

 

Early RA (less than 2 years )is the best time for treatment.The majority of patients have intermittent or steady progression of the disease and require continued treatment (progressive). If  and when  the symptoms of disease have subsided or have been successfully treated it is called remission.

 

Historically RA was classified in terms of how it interfeared with normal  everyday functioning:

 

1) Normal function.

 

2) Mildly limited function.

 

3) Moderately limited function.

 

4) Severely limited function (disabled).

 

And by bone damage caused by the disease that shows up on a x-ray film:

 

1) Normal bone.

 

2) Some bone change.

 

3) Moderate bone change.

 

4) Extensive bone change.

 

This classification shows how much damage the inflammation associated with RA has already done,but it does not help to show how severe or how fast the RA will progress.

 

The course of RA could be better classified by:

 

Mild,Moderate and Severe-and by how long it has been present.

 

1) Early (less than 2 years) -the best time for treatment.

 

2) Progressive-the majority of patients at this stage have intermittent or steady progression of the disease and need continuing treatment.

 

3) Controlled-when the symptoms of disease is in remission.

 

The inflammation asociated with RA also occurs outside the joints. Since RA can cause extra-articular features (described on my other site),it can be viewed as a disease  that can affect the whole body not just the joints.

 

EAFs can affect how you function,how you feel, and the quality of your life. EAFs affect the tendons,heart,lungs,nervous system, blood vessels,eyes and rheumatoid nodules may appear underneath the skin. EAFs are more common in the moderate and severe types of RA. They are usually  absent in the mild type of RA.

 

Many patients with the more severe type of RA feel ill as if they have a chronic bad flu. Patients feel tired,have no energy,feel nauseated,lose their appetite,and sometimes even lose weight. These symptoms are typical of RA and are called constitutional features.

 

All patients with RA feel unwell but patients with moderate and severe feel unwell the most. Like extra-articular features,the severity of these symptoms helps to separate RA from other forms of arthritis.

 

When determining the type of RA we must consider the following:

 

The severity:

 

1) Is the arthritis mild,moderate,or severe? Is it characterized more by "stiffening" than by swelling?

 

2) The rheumatoid factor test: The level of RF,an antibody found in the blood has known effects in the immune system,is partially related to the severity of RA. Patients with moderate or severe disease usually have much higher levels of RF than people with mild arthritis. Up to 20% of RA patients however never develop R.F.

 

10 to 15% of all RA patients have the type of arthritis characterized by stiffness. This type of RA leads to abnormal tightness rather than to swelling in the small joints of the hands,wrists,shoulders, and some patients have problems with the knees and feet. The stiffness is profoundly marked.  

 

Although the joints may look normal,the patient may find it very difficult to hold a glass of water or to lift their arms over their head. Normal every day activities can become impossible within a matter of weeks with this form of disease.

 

With the exception of inflammation of the tendons (tendonitis),E.A.F.'s are rare in this type of RA. The R.F. and the test for HLA genes are usually negative.Loss of function is the major problem caused by this stiffness. One may find it very difficult to move and do things normally, and if left untreated this loss can be pronounced and irreversible.

 

HLA genes were always associated with severity,but some recent research suggests,it may be less important. The debate continues.

 

In most patients,the type of RA  diagnosed at onset persists during the entire course of their disease. However,in some patients,the type do change. This usually happens early in the disease,before the full features of either moderate or severe RA have developed, making them difficult to distinguish from the mild form of disease.

 

Unfortunety, the disease most often "comes in quite and goes out with a roar". The opposite is rarely true. It is uncommon for moderate or severe disease to become mild without treatment.

 

Permanent deformity is a unwanted result of the inflammatory process. Persistent tenosynovitis and synovitis leads to the formation of synovial cysts and to displaced or ruptured tendons. Extensor tendon rupture at the dorsum of the hand is a common and disabling problem.

 

Bony erosions seen at the margins of the joint,at the attatchment of the synovium,are the hallmark of RA. Erosions occur rapidly within the first 2 years of the disease. These anatomic changes result in limitations in range of motion,flexion contractures,and subluxation (incomplete dislocation) of articulating bones.

 

A mild anemia with hematocrit values in the range of 30-34% occurs in approximately 25 to 35% of patients with RA. In most cases, the reduced red cell mass is caused by the anemia of chronic disease,a normocytic-normochromic process charachterized by a low concentration of serum iron,a low serum iron-binding capacity,and a normal or increased serum ferritin concentration.

 

However, occasionally  true iron deficiency anemia can develop secondary to intercurrent blood loss often from gastrointestinal (GI) bleeding due to NSAIDs.