What is Rheumatoid Arthritis
(RA)?
A chronic inflammatory disease that primarily affects the joints and
surrounding tissues, but can
also affect other organ systems.
Top
What are the symptoms of RA?
-
Fatigue
-
General discomfort, uneasiness, or malaise
-
Loss of appetite
-
Low-grade fever
-
Joint pain, joint stiffness, and joint swelling;
often symmetrical; may involve wrist pain, knee pain, elbow pain, finger pain, toe pain, ankle
pain, or neck pain
-
Limited range of motion
-
Morning stiffness lasting more than one hour
-
Deformities of hands and feet
-
Round, painless nodules under the skin
-
Skin redness or inflammation
-
Paleness
-
Swollen glands
-
Eye burning, itching, and discharge
-
Numbness and/or tingling
Top
How is RA Diagnosed?
Diagnosing rheumatoid arthritis is a process.
There isn’t a sure-fire test that can tell you positively that you have RA.
Instead your doctor relies on a number of tools to help him determine the best
treatment for your symptoms.
A diagnosis will be made from a medical history,
a physical exam, lab tests and X-rays.
Medical History
Medical history probably is your doctor’s best tool for diagnosing rheumatoid
arthritis. The more your doctor knows about you, the faster and better he will
be able to diagnose your condition and determine the best treatment for you.
Taking a medical history is the first line to finding out if you have rheumatoid
arthritis. What you tell him will allow him to determine if RA should be
considered a possible diagnosis or if he should look in another direction.
Following is a list of questions your doctor
might ask in a medical history:
-
Do you have joint pain in many joints?
-
Does the pain occur symmetrically – that is,
do the same joints on both sides of your body hurt at the same time? Or is the
pain one-sided?
-
Do you have stiffness in the morning?
-
When is the pain most severe?
-
Do you have pain in your hands, wrists and/or
feet?
-
If you have pain in your hands, which joints
hurt the most?
-
Have you had periods of feeling weak and
uncomfortable all over? Do you feel fatigued?
You may have to answer these questions at every
office visit so your doctor can best evaluate your pain and functionality
status. You also might find yourself taking a self-report questionnaire. These
are developed to help the doctor assess the impact of RA on your daily life. Two
of the most common are the Health Assessment Questionnaire (HAQ) and the
Arthritis Impact Measurement Scales (AIMS).
Physical Exam
Your doctor also will perform a physical exam to determine diagnosis and at most
following office visits. He will be looking for common features reported in RA,
including:
-
Joint swelling
-
Joint tenderness
-
Loss of motion in your joints
-
Joint malalignment
-
Signs of rheumatoid arthritis in other organs,
including your skin, lungs and eyes.
Lab Tests
While there is no one test to confirm whether or not you have rheumatoid
arthritis, your doctor may use several different tests and imaging studies to
help make a diagnosis. The most commonly used tests are listed below, but not
all doctors will use every test and some may use tests not described. You should
feel free to fully question your doctor for any tests he or she orders so you
understand what it is measuring and why. Most tests ordered to help with
diagnosis will only have to be taken once. Tests designed to measure improvement
or to check for drug side effects may need to be repeated regularly. For
additional information about lab tests, visit
Guide to Lab Tests.
Complete Blood Count
There are three types of cells in your blood: red blood cells, which carry
oxygen to tissues; white blood cells, which help fight infections; and
platelets, which help the blood clot. Each may be tested to check for
abnormalities that might exist or to monitor side effects of drugs and check
progress.
People with rheumatoid arthritis often have a low
red blood count, signally anemia, a common problem for people with RA. Anemia
can contribute to feelings of fatigue. People with more aggressive disease tend
to have more severe anemia.
White blood cells may be high, signaling that
infection is present in your body. A low white blood cell count could suggest
Felty’s syndrome, a complication of RA, or may be caused by some medications.
Your platelet count is elevated when you have
inflammation present in the body. It can also be lowered by certain drugs.
If you take nonsteroidal anti-inflammatory drugs
(NSAIDs), your platelet and white blood cell count will be monitored every six
months. People taking disease-modifying antirhuematic drugs (DMARDs), will be
checked every two to 12 weeks.
Erythrocyte Sedimentation Rate (ESR or sed
rate)
The erythrocyte sedimentation rate (ESR) measures the speed at which red
blood cells fall to the bottom of a test tube. The more rapidly your red blood
cells drop, the more inflammation is present in the body. A high sed rate
indicates inflammation and the higher it is, the more severe the RA is. Your sed
rate will be checked frequently to see if treatment is working successfully.
You should note that only about 60 percent people
with RA have an elevated sed rate. Because your treatment is based primarily on
clinical symptoms, a normal sed rate doesn’t mean that you are cured and no
longer need treatment for RA.
C-Reactive Protein
C-reactive protein (CRP) is found in the body and is elevated when inflammation
is found in the body. The higher the level of CRP the more disease activity is
involved. Although ESR and CRP reflect similar degrees of inflammation,
sometimes one will be raised when the other isn’t. This test may be repeated
regularly to monitor your inflammation and your response to medication.
Rheumatoid Factor
Approximately 70 to 80 percent of people with rheumatoid factor (RF) also have
rheumatoid arthritis. It is tested by measuring the amount of RF in your body.
The higher the amount of RH present in the body, the more active and severe your
disease is.
Some people with RA do not have RF in their
blood. They are called “seronegative.” People with RF in there blood are called
“seropositive.”
Antinuclear Antibodies (ANA)
This test detects a group of autoantibodies (antibodies against self), which is
seen in about 30 to 40 percent of people with RA. Although it commonly is used
as a screening tool, ANA testing isn't used as a diagnostic tool because many
people without RA or with other diseases can have ANAs.
Imaging Studies
Radiographs (X-rays)
Your doctor may take X-rays of your bones and joints upon diagnosis with RA to
provide a valuable baseline for comparison with later X-rays. They show the
swelling of the soft tissues and the loss of bone density around the joints –
the result of your reduced activity and inflammation. As your disease
progresses, your X-rays can show small holes or erosions near the ends of bone s
and narrowing of the joint space due to loss of cartilage. Doctors used to wait
until the appearance of erosion before beginning aggressive treatment of RA. Now
it is widely believed that it is better to treat aggressively before the
development of erosion.
Magnetic Resonance Imaging (MRI)
A MRI can detect early inflammation before it is visible on an X-ray, and are
particularly good at pinpointing synovitis (inflammation of the lining of the
joint)
Joint Ultrasound
Joint ultrasound is a much less expensive way to look for joint inflammation
before X-rays show damage. Although not currently used often, this procedure may
gain wider use over the next few years as doctors increase their efforts to
document early evidence of the disease.
Bone Densitometry (DEXA)
Bone densitometry is an important imaging study for measuring bone density, used
primarily to detect osteoporosis. Osteoporosis may be especially severe in
people with RA due to joint immobilization, the inflammatory response itself and
the use of certain therapies (such as glucocorticoids) that may hasten bone
loss. Some doctors suggest that a bone density test should be part of the
evaluation and monitoring of all people with RA, particularly for women after
menopause.
This section on Diagnosing RA taken from
http://www.arthritis.org/conditions/diseasecenter/RA/ra_diagnosis1.asp
Top
What are the treatments for RA?
RA usually requires lifelong treatment, including various medications,
physical therapy,
education, and possibly surgery aimed at relieving the signs and symptoms of the
disease.
MEDICATIONS:
For the past 10 years, studies have shown that early, aggressive treatment for
RA can delay the
onset of joint destruction. In addition to rest, strengthening exercises, and
anti-inflammatory
agents, the current standard of care is to initiate aggressive therapy with
disease-modifying
anti-rheumatic drugs (DMARDs) once the diagnosis is confirmed.
Anti-inflammatory agents used to treat RA traditionally included aspirin and
non-steroidal
anti-inflammatory drugs (NSAIDS), such as ibuprofen (Motrin, Advil), fenoprofen,
indomethacin,
naproxen (Naprosyn), and others.
These are widely used medications that are effective in relieving pain and
inflammation
associated with RA. However, side effects associated with frequent use of many
of these
medications include life-threatening gastrointestinal bleeding.
Similar drugs, called Cox-2 inhibitors, are now a mainstay of anti-inflammatory
therapy because
the risk of gastrointestinal bleeding is significantly reduced with these drugs.
Currently, there
are two available -- rofecoxib (Vioxx) and celecoxib (Celebrex).
As mentioned, DMARDs alter the course of the disease. Included in this group are
gold compounds,
which can be injectible (Myochrysine and Solganal) or oral (auranofin/Ridaura).
Methotrexate
(Rheumatrex) is the most commonly used DMARD for rheumatoid arthritis with good
proven
effectiveness.
Antimalarial medications, such as Hydroxychloroquine (Plaquenil), as well as
Sulfasalazine
(Azulfidine), are also beneficial, usually in conjunction with Methotrexate.
The benefits from these medications may take weeks or months to be apparent.
Because they are
associated with toxic side effects, frequent monitoring of blood tests while on
these medications
is imperative.
In the last few years, new and exciting medications have been introduced. A
promising medication
that is fast becoming a first-line agent for the aggressive treatment of RA is
called etanercept
(Enbrel). Enbrel acts by inhibiting an inflammatory protein, called tumor
necrosis factor (TNF).
Other new medications include infliximab (Remicade) that also blocks TNF and
leflunomide (Arava),
which blocks the growth of new cells. Anakinra is an even newer therapy that
blocks the action of
another inflammatory protein, interleukin-1. Anakinra and Etanercept are
injectable medications,
whereas Infliximab is given intravenously every 2 months.
Drugs that suppress the immune system, like azathioprine (Imuran) and
cyclophosphamide (Cytoxan),
may be used in people who have failed other therapies. These medications, which
are associated
with toxic side effects, are reserved for severe cases of RA.
Corticosteroids have been used to reduce inflammation in RA for greater than 40
years. However,
because of potential long-term side effects, corticosteroid use is limited to
short courses and
low doses where possible.
Side effects may include bruising, psychosis, thinning of the bones
(osteoporosis), cataracts,
weight gain, susceptibility to infections, diabetes, and high blood pressure. A
number of
medications can be administered in conjunction with steroids to minimize
resultant osteoporosis.
Consult a health care provider before long-term use of any medication, including
over-the-counter
medications.
SURGERY:
Occasionally, surgery is indicated for severely affected joints. The most
successful surgeries
are those on the knees and hips. Usually, the first surgical treatment is
removal of the synovium
(synovectomy).
A later alternative is total joint replacement with a joint prosthesis.
Surgeries can be expected
to relieve joint pain, correct deformities, and modestly improve joint function.
In extreme
cases, total knee or hip replacement can mean the difference between being
totally dependent on
others and having an independent life at home.
LIFESTYLE CHANGES:
Range of motion exercises and individualized exercise programs prescribed by a
physical therapist
can delay the loss of joint function.
Joint protection techniques, heat and cold treatments, and splints or orthotic
devices to support
and align joints may be very helpful.
Frequent rest periods between activities, as well as 8 to 10 hours of sleep per
night are
recommended.
OTHER THERAPY:
Prosorba column is a device approved by the FDA in 1999 for treatment of
moderate to severe RA in
adult patients with long-standing disease (who have not responded to DMARD's).
It works by removing inflammatory antibodies from the blood by a process called
apheresis. The
blood is removed through a small catheter and then passed through a column (the
size of a coffee
mug) that is coated with a substance called protein A.
Protein A binds with the antibodies and removes them from the blood. The blood
is then given
back. The procedure takes 2-3 hours, and must be done once a week for 12 weeks.
Studies have reported that one third to one half of the people who receive this
treatment may
slow down, or even stop the RA from worsening. Reported side effects include
anemia, fatigue,
fever, low blood pressure, and nausea. Some people have developed an infection
from the catheter.
Often there is a flare-up of joint pain for several days after the treatment.
Sometimes therapists will use special machines to apply deep heat or electrical
stimulation to
reduce pain and improve joint mobility.
Occupational therapists can construct splints for your hand and wrist, and teach
you how to best
protect and use your joints when they are affected by arthritis. They also show
people how to
better cope with day-to-day tasks at work and at home, despite limitations
caused by RA.
MONITORING:
Depending on the medications being taken, regular blood or urine tests should be
done to monitor
both progress and negative side effects.
Rheumatoid arthritis information taken from
http://health.yahoo.com/health/centers/arthritis_pain/0431 unless otherwise
noted.
Top
What is the difference between RA
and OA?
The principle features of the two conditions are not the same, and
their treatment is very different. In OA, the cartilage in the joint becomes
damaged and, ultimately, the joint degenerates. The joint is not primarily
inflamed, although inflammation may occur as a late result.
On the other hand, in RA, there is initial inflammation of the lining of the
joint. This produces a soft, tender swelling in contrast to the bony enlargement
of OA. Cartilage damage occurs later as a result of this inflammation. The pain
of OA is often least troublesome in the morning but may gradually worsen during
the day. With RA, the pain and stiffness usually is worst on waking, but
gradually improves during the day.
Rheumatoid arthritis is not just a disease of the joints. Abnormalities occur
in the blood vessels, circulating cells and proteins, as well as connective
tissue. Not surprisingly, RA is associated with more generalized disturbances -
such as anemia (low red blood cell count) - which are proportional to the
activity of the arthritis. Usually more than one joint is involved in RA, with
the hands almost always affected.
Top
IEP article
This is actually three articles in one.
It concerns Individualized Education Programs from a variety of standpoints.
Some are advice for parents, some are advice for teens. Some of it is a
bit repetitive. I copied the articles from
Arthritis Insight I hope
that the formatting I used is easy to read. More
Top
Stem Cell Article
This article was found in The
National Enquirer and it is about stem cells and RA. While many people
feel stem cell research is a controversy, my intent here is not to get
involved in controversy, but to inform only.
Read the article
Top
bravenet.com
