Rheumatoid Arthritis

Rheumatoid arthritis is an inflammatory disease in which the immune system attacks the body’s tissues, particularly the joints. This causes pain, swelling, stiffness, and loss of function in the joints. Another characteristic of rheumatoid arthritis that sets it apart from other forms of arthritis is the  symmetrical pattern in which the disease may develop. For example, if one knee or hand is affected, usually the other one is also. The disease often affects the wrist joints and the finger joints closest to the hand. In severe cases, the joints become deformed and internal organs can be adversely affected. In addition to the pain people with rhematoid arthritis have, they may also experience fatigue, occasional fever, and a general sense of not feeling well.

How rheumatoid arthritis affects people varies a lot from person to person. For some, the symptoms may appear for only a few months or a year or two and then go away without causing any noticeable damage. But for others, there may be periods when the symptoms of the disease are worse (called flares) and periods in which they feel better (remissions). And others with a severe form of the disease may have  active symptoms most of the time, and these symptoms may last for many years, leading to serious joint damage and disability.

Diagnosing and treating rheumatoid arthritis is a team effort between the patient and several types of health care professionals. Family doctors, internists, or rheumatologists -- doctors specializing in arthritis and other diseases of the joints, bones, and muscles --  may be called in to help diagnose and treat the condition.

As treatment progresses, other professionals may help, including: nurses, physical or occupational therapists, orthopedic surgeons, psychologists, and social workers.

There is no single test for rheumatoid arthritis. Symptoms differ from person to person and can be more severe in some people than in others. Also, symptoms can be similar to those of other types of arthritis and joint conditions, and it may take some time for other conditions to be ruled out as possible diagnoses. Doctors use a variety of tools to diagnose the disease and to rule out other conditions including medical history, physical examination, blood tests, and x-rays.

Treatment may include lifestyle changes that encourage a positive outlook and active independence combined with rest and exercise. A good diet and reduction of stress is also key in treating rheumatoid arthritis. Some people find that using a splint or brace on the affected joint for a short time helps relieve pain and swelling. Other ways to reduce the stress on joints include self-help devices -- zipper pullers, long-handled shoe horns, and other devices that assist in taking the pressure off joints during every day activities.

Most people who have rheumatoid arthritis take medications. Some medications are used only for pain relief; others are used to reduce inflammation. Still others—often called disease-modifying antirheumatic drugs, or DMARDs—are used to try to slow the course of the disease. The person’s general condition, the current and predicted severity of the illness, the length of time he or she will take the drug, and the drug’s effectiveness and potential side effects are important considerations in prescribing drugs for rheumatoid arthritis.

Traditionally, rheumatoid arthritis therapy has involved an approach in which doctors prescribed aspirin or similar drugs, rest, and physical therapy first, and prescribed more powerful drugs later only if the disease became much worse. Recently, many doctors have changed their approach, especially for patients with severe, rapidly progressing rheumatoid arthritis. This change is based on the belief that early treatment with more powerful drugs, and the use of drug combinations in place of single drugs, may be a more effective way to halt the progression of the disease and reduce or prevent joint damage.

Surgical alternatives, such as joint replacement, tendon reconstruction, and synovectomy may also prove helpful in relieving pain.