Rheumatoid Arthritis

Rheumatoid arthritis (RA) causes chronic inflammation of the joints, but in addition can cause inflammation of the tissue around the joints, as well as in other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.  It is typically a progressive illness that has the potential to cause joint destruction and functional disability.

The joint inflammation of rheumatoid arthritis causes swelling, pain, stiffness, and redness in the joints. The inflammation of rheumatoid disease can also occur in tissues around the joints, such as the tendons, ligaments, and muscles.

In some people with rheumatoid arthritis, chronic inflammation leads to the destruction of the cartilage, bone, and ligaments, causing deformity of the joints. Damage to the joints can occur early in the disease and be progressive.

Rheumatoid arthritis affects approximately 1.3 million people in the United States. The disease is three times more common in women as in men. It afflicts people of all races equally. The disease can begin at any age, but it most often starts between the ages of 30 and 50. In some families, multiple members can be affected, suggesting a genetic basis for the disorder.

Symptoms of rheumatoid arthritis

Signs and symptoms of rheumatoid arthritis may include:

·         Joint pain

·         Joint swelling

·         Joints that are tender to the touch

·         Red and puffy hands

·         Firm bumps of tissue under the skin on your arms (rheumatoid nodules)

·         Fatigue

·         Morning stiffness that may last for hours

·         Fever and Nausea

·         Weight loss

Symptoms may come and go
The symptoms of rheumatoid arthritis come and go, depending on the degree of tissue inflammation. When body tissues are inflamed, the disease is active. When tissue inflammation subsides, the disease is inactive (in remission). Remissions can occur spontaneously or with treatment and can last weeks, months, or years. During remissions, symptoms of the disease disappear, and people generally feel well. When the disease becomes active again (relapse), symptoms return. The return of disease activity and symptoms is called a flare. The course of rheumatoid arthritis varies among affected individuals, and periods of flares and remissions are typical.

When the disease is active, symptoms can include fatigue, loss of energy, lack of appetite, low-grade fever, muscle and joint aches, and stiffness. Muscle and joint stiffness are usually most notable in the morning and after periods of inactivity. Arthritis is common during disease flares. Also during flares, joints frequently become red, swollen, painful, and tender. This occurs because the lining tissue of the joint (synovium) becomes inflamed, resulting in the production of excessive joint fluid (synovial fluid). The synovium also thickens with inflammation (synovitis).

In rheumatoid arthritis, multiple joints are usually inflamed in a symmetrical pattern (both sides of the body affected). The small joints of both the hands and wrists are often involved. Simple tasks of daily living, such as turning door knobs and opening jars, can become difficult during flares.

Since rheumatoid arthritis is a systemic disease, its inflammation can affect organs and areas of the body other than the joints. Inflammation of the glands of the eyes and mouth can cause dryness of these areas and is referred to as Sjogren's syndrome. Rheumatoid inflammation of the lung lining causes chest pain with deep breathing, shortness of breath, or coughing. The lung tissue itself can also become inflamed, scarred, and sometimes nodules of inflammation (rheumatoid nodules) develop within the lungs. Inflammation of the tissue surrounding the heart can cause a chest pain that typically changes in intensity when lying down or leaning forward. Decreased white cells can be associated with an enlarged spleen and can increase the risk of infections. Firm lumps under the skin (rheumatoid nodules) can occur around the elbows and fingers where there is frequent pressure. Even though these nodules usually do not cause symptoms, occasionally they can become infected and nerves can become pinched. A rare, serious complication, usually with long-standing rheumatoid disease, is blood vessel inflammation, or vasculitis.  Vasculitis can impair blood supply to tissues and lead to tissue death.

Diagnosing rheumatoid arthritis

The symptoms and physical examination are the most important parts of the diagnostic process. The early joint symptoms of other conditions, such as lupus, are sometimes indistinguishable from those of rheumatoid arthritis, making a definitive diagnosis difficult soon after symptoms start. Blood and imaging tests are often ordered to help with diagnosis.

It's important to understand that it may take several weeks or months before you receive a definite diagnosis. People often find it frustrating to wait, and they worry that they are not receiving prompt treatment.

Your doctor may order several types of blood tests, because no one test is sufficient to confirm a diagnosis.