goodtoknow says: Around 1 in 50 people will get Rheumatoid Arthritis, one of the most common forms of arthritis which affects three times as many women as men. But don't panic if you've been diagnosed because there are lots of successful treatments which can help you lead a full and relatively normal life. The main symptoms of Rheumatoid Arthritis are pain and stiffness in the joints, particularly the hands, wrists and feet, which is usually worse in the morning. Most people have good spells followed by 'flare ups' which can remain mild for many years.
For a full medical explanation of the causes, symptoms and treatments of rheumatoid arthritis from patient.co.uk, read on.
Rheumatoid arthritis causes inflammation, pain, and swelling of joints. In time, affected joints typically become damaged. The severity can vary from mild to severe. Treatments include medication to ease the pain, and medication to slow down the progression of the disease. Surgery is needed in some cases if a joint becomes badly damaged.
Arthritis means inflammation of joints. Rheumatoid arthritis (RA) is a common form of arthritis. About 1 in 50 people develop RA at some stage in their life. It can happen to anyone. It is not a hereditary disease. It can develop at any age, but most commonly starts between the ages of 40 and 60. It is three times more common in women than in men.
A joint is where two bones meet. Joints allow movement and flexibility of various parts of the body. The movement of the bones is cased by muscles which pull on tendons that are attached to bone.
Cartilage covers the end of bones. Between the cartilage of two bones which form a joint there is a small amount of thick fluid called synovial fluid. This fluid 'lubricates' the joint which allows smooth movement between the bones.
The synovial fluid is made by the synovium. This is the tissue that surrounds the joint. The outer part of the synovium is called the capsule. This is tough, gives the joint stability, and stops the bones from moving 'out of joint'. Surrounding ligaments and muscles also help to give support and stability to joints.
RA is thought to be an 'autoimmune disease'. The immune system normally makes antibodies to attack bacteria, viruses, and other 'germs'. In people with autoimmune diseases, the immune system makes antibodies against tissues of the body. It is not clear why this happens. Some people seem to have a tendency to develop autoimmune diseases. In such people, something might trigger the immune system to attack the body's own tissues. The 'trigger' is not known.
In people with RA, antibodies are formed against the synovium (the tissue that surrounds each joint). This causes inflammation in and around affected joints. Over time, the inflammation can cause damage to the joint, the cartilage, and parts of the bone near to the joint.
The most commonly affected joints are the small joints of the fingers, thumbs, wrists, feet, and ankles. However, any joint may be affected. The knees are quite commonly affected. Less commonly the hips, shoulders, elbows, and neck are involved. It is often symmetrical. So, for example, if a joint is affected in a right arm, the same joint in the left arm is also often affected.
In some people, just a few joints are affected. In others, many joints are involved.
The common main symptoms are pain and stiffness of affected joints. The stiffness is usually worse first thing in the morning, or after you have been resting. The inflammation causes swelling around the affected joints.
These are known as 'extra-articular' symptoms of RA (meaning 'outside of the joints'). A variety of symptoms may occur. The cause of some of these is not fully understood.
In most cases the symptoms develop gradually - over several weeks or so. Typically, you may first develop some stiffness in the hands, wrists, or soles of the feet in the morning which eases by mid-day. This may come and go for a while, but then becomes regular. You may then notice some pain and swelling in the same joints. More joints such as the knees may then become affected.
In a small number of cases, less common patterns are seen. For example:
RA can vary greatly from person to person. It is usually a chronic relapsing condition. Chronic means that it is persistent. Relapsing means that at times the disease flares-up (relapses), and at other times it settles down. There is usually no apparent reason why the inflammation may flare-up for a while, and then settle down.
Most people with RA have this pattern of flare-ups followed by better spells. In some people, months or even years may go by between flare-ups. Some damage may be done to affected joints during each flare-up. The amount of disability which develops usually depends on how much damage is done over time to the affected joints. In a minority of cases the disease is constantly progressive, and severe joint damage and disability develop quite quickly.
Smoking seems to be a possible factor as, on average, the severity of RA tends to be worse in smokers than non-smokers.
Inflammation can damage the cartilage which may become eroded or worn. The bone underneath may become thinned. The joint capsule and nearby ligaments and tissues around the joint may also become damaged. Joint damage develops gradually. Over time it may lead to deformities. It may become difficult to use the affected joints. For example, the fingers and wrists are commonly affected, so a good grip and other tasks using the hands may become difficult.
Most people with RA develop some damage to affected joints. The amount of damage can range from mild to severe. At the outset of the disease it is difficult to predict for an individual how badly the disease will progress.
There is no single test which clearly diagnoses early RA. When you first develop joint pains, it may be difficult for a doctor to say that you definitely have RA. This is because there are many other causes of joint pains.
Blood tests can detect inflammation, characteristic antibodies, and anaemia. These may suggest that you have RA, but do not prove that you definitely have it as these blood results can be caused by other conditions.
You may have a time of uncertainty when early symptoms 'could be' RA. In time, X-rays of joints may begin to show typical erosions (early damage) and other features of RA which makes the diagnosis more certain.
The risk of developing certain other conditions is higher in people with RA. These include: heart disease, stroke, infections (joint infections and non-joint infections), gut problems, osteoporosis (thinning of the bones), and certain cancers.
It is not entirely clear why these conditions develop more commonly in people with RA. One reason is that, on average, people with RA tend to have more 'risk factors' for developing some of these conditions. For example:
Other complications which may develop include:
There is no cure for RA. However, much can be done to help. The aims of treatment are:
During a flare-up of inflammation, if you rest the affected joint(s) it helps to ease pain. Special wrist splints, footwear, gentle massage, or applying heat may also help. Medication is also helpful. Medicines which may be advised by your doctor to ease pain and stiffness include the following.
These are sometimes just called 'anti-inflammatories' and are good at easing pain and stiffness. There are many types and brands. Each is slightly different to the others, and side-effects may vary between brands. To decide on the right brand to use, a doctor has to balance how powerful the effect is against possible side-effects and other factors. Usually one can be found to suit. However, it is not unusual to try two or more brands before finding one that suits you best.
The leaflet which comes with the tablets gives a full list of possible side-effects. The most common side-effect is stomach pain (dyspepsia). An uncommon but serious side-effect is bleeding from the stomach. Your doctor may prescribe another medicine to 'protect the stomach' from these possible problems. If you develop abdominal (stomach) pains, pass blood or black stools, or vomit blood whilst taking anti-inflammatory painkillers, stop taking the tablets and see a doctor soon.
Paracetamol often helps. This does not have any anti-inflammatory action, but is useful for pain relief in addition to, or instead of, an anti-inflammatory painkiller. Codeine is another painkiller that is sometimes used.
Steroids are good at reducing inflammation. However, because of the problem of possible side-effects, steroids are not recommended for routine use. This is not to say that they are never used. The main side-effects from steroids occur when they are used for more than a few weeks. Therefore, a short course of steroid tablets such as prednisolone is sometimes used. This may be prescribed to treat a flare-up which has not been helped much by a non-steroidal anti-inflammatory. A short course of steroids may also be used whilst waiting for a disease modifying drug (see below) to take effect.
An injection of steroid directly into a joint is sometimes used to treat a bad flare-up in one particular joint.
The serious side-effects that may occur if you take steroids for more than a few weeks, or if you have injections frequently, include: thinning of the bones (osteoporosis), thinning of the skin, weight gain, muscle wasting and an increased risk of serious infection.
Note: non-steroidal anti-inflammatories, ordinary painkillers, and steroids ease the symptoms of RA. However, they do not alter the progression of the disease or prevent joint damage. You do not need to take them if symptoms settle between flare-ups.
There are a number of drugs called 'disease-modifying antirheumatic drugs' (DMARDs). These are drugs that ease symptoms but also reduce the damaging effect of the disease on the joints. They work by blocking the effects of chemicals involved in causing joint inflammation. They include: sulfasalazine, methotrexate, gold injections, gold tablets, penicillamine, leflunomide and hydroxychloroquine. It is these drugs which have improved the outlook (prognosis) in recent years for many people with RA.
It is usual to start a DMARD as soon as possible after RA has been diagnosed. This is to try and limit the disease process as much as possible. In general, the earlier you start one, the more effective it is likely to be.
DMARDs have no immediate effect on pains or inflammation. It can take up to 4-6 months before you notice any effect. Therefore, it is important to keep taking a DMARD as prescribed, even if it does not seem to be working at first. After starting a DMARD, many people continue to take an anti-inflammatory tablet or steroid tablets for several weeks until the DMARD starts to work. Once a DMARD is found to help, the dose of the anti-inflammatory tablet or steroid can be reduced or even stopped. It is then usual to take a DMARD indefinitely.
Other DMARDs include azathioprine, cyclosporin, and cyclophosphamide. These are usually reserved for people who do not respond well to the more commonly used DMARDs, due to the risk of serious side-effects.
Each of the DMARDs has different possible side-effects. If one does not suit, a different one may well be fine. Some people try two or three DMARDs before one is found to suit. (Some side-effects can be serious. These are rare, but it is usual to have regular tests - usually blood tests - whilst you take a DMARD. The tests look for possible side-effects before they become serious.)
A new class of drugs which have recently been developed are drugs that modify the effect of TNF-alpha. The chemical TNF-alpha plays an important role in causing inflammation in joints. Blocking the effect of TNF-alpha has been shown to reduce damage to joints, and reduce symptoms. Drugs which modify or block the effect of TNF-alpha include: etanercept, infliximab, adalimumab, and anakinra. They show promise but their long-term benefits are still being evaluated.
One problem with these drugs is that they need to be given by injection. They are also expensive. Recent guidelines state that one may be tried if there has been little success when using standard DMARDs.
As mentioned, if you have RA you have an increased risk of developing diseases such as heart disease, stroke, osteoporosis, and certain cancers. Therefore, you should consider doing what you can to reduce the risk of these conditions by other means. For example, if possible:
See leaflet called 'Osteoporosis' for more details.
To prevent certain infections, you should have:
Some people try complementary therapies such as special diets, bracelets, acupuncture, etc. There is little research evidence to say how effective such treatments are for RA. In particular, beware of paying a lot of money to people who make extravagant claims of success. For advice on the value of any treatment it is best to consult a doctor, or contact one of the groups below.
The outlook is perhaps better than many people imagine.
However, these figures are probably becoming out of date as treatment has improved in recent years. Symptoms can often be well controlled with medication. Because of the newer and better drugs, in particular the newer disease modifying drugs, the outlook for a person who is diagnosed with rheumatoid arthritis these days is likely to be much better than it was a few years ago. Follow up studies of people being treated with the newer drugs should give a clearer idea of prognosis over the next few years.
Another factor to bear in mind is that because of the increased risk of developing 'associated diseases' such as heart disease (see above), the average life expectancy of people with RA is a little reduced compared to the general population. This is why it is important to tackle any factors that you can modify such as smoking, diet, weight, etc.
* A disease-modifying drug which reduces joint damage. You should take this all the time. It may take up to 4-6 months to begin working.
* An anti-inflammatory painkiller to ease pain. This helps symptoms but does not affect the progress of the disease. You do not need to take this if symptoms settle.
Arthritis Research Campaign - ARC
Copeman House, St Marys Court, St Marys Gate, Chesterfield, Derbyshire, S41 7TD.
Tel: 0870 850 5000 Web: www.arc.org.uk
Arthritis Care
18 Stephenson Way, London, NW1 2HD
Helpline: 0808 800 4050 Tel: 020 7380 6555 Web: www.arthritiscare.org.uk
National Rheumatoid Arthritis Society (NRAS)
Unit B4 Westacott Business Centre, Westacott Way, Littlewick Green, Maidenhead, Berks, SL6 3RT
Helpline: 0845 458 3969 General Number: 01628 823524 Web: www.rheumatoid.org.uk
© EMIS and PIP 2005 Updated: August 2005 PRODIGY Validated