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Thursday, May 20, 2010

Autoimmune Disease Topic: Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease, so called because the person’s immune system, whose purpose is to protect the body from disease and infection begins, for unknown reasons, to attack the body. In rheumatoid arthritis it attacks the joints. When this happens, the white blood cells, which are the warriors of the immune system, travel to the synovium or joint lining, causing an inflammatory response. This inflammation causes the warm, red, tender joints, which are typical of rheumatoid arthritis.


Many of us know someone who has or have experienced for ourselves painful arthritic joints. Rheumatoid arthritis, however, differs from other types of arthritis in several key ways. For example, rheumatoid arthritis generally occurs in a symmetrical pattern, meaning that if one knee or hand is involved, the other one will likely be, too. Additionally, people with rheumatoid arthritis may also suffer from fatigue, occasional fevers, and a general sense of not feeling well.
Here are the features typically associated with rheumatoid arthritis:

Tender, warm swollen joints
Symmetrical pattern of affected joints
Joint inflammation often affecting finger joints closest to the hand
Joint inflammation sometimes affecting other joints including the neck, shoulders, elbows, hips, knees, ankles, and feet
Fatigue, occasional fevers, and a general sense of not feeling well
Pain and stiffness lasting for more than 30 minutes in the morning or after an extended rest
Symptoms that last for many years
Variability of symptoms among those affected with the disease


The goals for treatment of rheumatoid arthritis are to relieve the pain and inflammation; stop joint damage; and improve the person’s ability to function. Towards that end, treatment recommendations include medication; surgery; lifestyle changes; as well as routine monitoring and ongoing care.

Most people with rheumatoid arthritis take medications. Some of them are for pain, while others reduce inflammation. Still others, called disease-modifying antirheumatic drugs (DMARDs), are used to try to actually slow the course of the disease. Biologic response modifiers are new drugs used for the treatment of rheumatoid arthritis, for their ability to help reduce inflammation and structural damage to the joints by blocking the action of cytokines, proteins of the body's immune system that trigger inflammation during normal immune responses. The person’s general condition, the severity of the disease, the length of time the person will take the drug, as well as the drug’s effectiveness and potential side effects are all important factors that must be considered when prescribing appropriate medications for rheumatoid arthritis.

Surgery is another treatment option for some with severe joint damage. Common surgeries include joint replacement, tendon reconstruction and synovectomy.

Before any surgical intervention, both patient and doctor must carefully consider factors such as the patient’s overall health, condition of the affected joint or tendon, costs of the procedure, as well as the potential risks and benefits of the surgery.

Treatment recommendations may also include lifestyle changes. An exercise program that respects the patient’s limits and abilities can help preserve muscle strength and mobility, promote more restful sleep, decrease stress, and promote a positive attitude. Along with exercise, a balanced and sensible diet can help one maintain or reach a healthy weight, resulting in less stress on the joints. Rest is also an important component of these lifestyle changes. It helps fight fatigue and reduces inflammation. It may be necessary to rest more when the disease is most active, and exercise when it is not. Splints may be useful by giving afflicted joints of the wrist or hands, for example, support and allowing the joint to rest, thereby reducing swelling and pain. Other self-help devices like zipper pullers reduce stress on the joints and assist with daily functioning.

It is important that patients with rheumatoid arthritis see their doctors regularly for routine monitoring. During these visits, the doctor will monitor the course of the disease, determine the effectiveness of the treatments, look for negative side effects of medications, and change therapies when necessary. People with rheumatoid arthritis should discuss ways to prevent osteoporosis, since the risks of developing it are increased, especially if corticosteroids are used.

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