Rheumatoid arthritis is not associated with the wear and tear of use or with an injury. The disease can strike at any time, but most often it develops between ages 20 and 50 years. An esti¬mated 2 million Americans have rheumatoid arthritis, and roughly twice as many women as men are affected.
Rheumatoid arthritis is probably an autoimmune disease. That’s a disease in which your body’s immune system attacks itself. Researchers suspect that an as yet unidentified agent, possibly a virus or a form of bacteria, stimulates the immune system to attack the invading agent. In autoimmune diseases, the cells usually engaged in fighting the invader become confused and instead attack your joints.
The principal area of attack of rheumatoid arthritis is the lining of the joint. When you have rheumatoid arthritis, white blood cells-whose normal job is to attack unwanted invaders-move from your blood¬stream into your synovial membrane. There, the blood cells appear to cause the membrane to become inflamed.
The inflammation results in thickening of the synovial membrane and a release of chemicals from synovial membrane cells and blood cells that have entered the membrane. If the inflammation persists, the released chemicals begin to digest cartilage, bone, tendons and ligaments in the joint. Gradually, the joint loses its shape and alignment. Ligaments, muscle and bone weaken. This weakening may lead to looseness in the joint. Eventually, the joint may be destroyed.
Rheumatoid arthritis often is more disabling than osteoarthritis. A painful, deformed joint may lead to loss of mobility and stability. Joints affected will be swollen, painful, tender and warm during the initial attack and during flare-ups that may follow.
Symptoms of rheumatoid arthritis include the following:
Pain and swelling in the smaller joints of your hands and feet
Overall aching or stiffness of the joints and muscles, especially after you sleep or after periods of rest
Loss of motion of the affected joints
Loss of strength in muscles attached to the affected joints
Deformity of the joints as time goes on
Fatig_e (severe during a flare-up) ¬
Even if stricken with a severe form of rheumatoid arthritis, you’ll probably retain flexibility in many joints. You may have less pain than the appearance of your deformed joints suggests. .
Joints often affected by rheumatoid arthritis are those in your wrists, hands, feet and ankles. The disease also can invade your elbows, shoul¬ders, hips, knees, neck and jaw. It generally affects joints on both sides of the body at the same time; for example, the knuckles of both hands. The most frequently involved joints are those of the hands and feet.
In rheumatoid arthritis, other symptoms can occur outside the joints. In contrast to osteoarthritis, which affects only your bones and muscles, rheumatoid arthritis can affect your whole body, including such organs as your heart, blood vessels, lungs and eyes. Rheumatoid arthritis causes problems in many joints at the same time, but osteoarthritis usu¬ally causes symptoms in only one or a few joints, even though several joints may be affected.
Small lumps, called rheumatoid nodules, may form under the skin of your elbow, your hands, the back of your scalp, over your knee or under your toes. These nodules range in size from that of a pea to perhaps a walnut. Usually the lumps aren’t painful.
If you have persistent discom¬fort and swelling in multiple joints on both sides of your body, your doctor will examine you and order laboratory tests. A blood test that determines your erythrocyte sedi¬mentation rate (or “sed rate”) can indicate the presence of an inflam¬matory process in your body. This rate is often abnormal in rheuma¬toid arthritis and tends to be nor¬mal in osteoarthritis. It may also increase due to anemia, which is often present in chronic rheumatoid arthritis. Another blood test looks for an antibody called rheumatoid factor. Four of five persons with rheumatoid arthritis have this abnor¬mal antibody, which is typically not present in persons with osteoarthri¬tis. There are typical X-ray changes of each condition which are differ¬ent in osteoarthritis and rheumatoid arthritis. A sequence of X-rays obtained over time can show the progression of arthritis.
Often, rheumatoid arthritis is chronic, although it tends to vary in severity and may even come and go. Periods of increased disease activi¬ty, called flare-ups or flares, alternate with periods of relative remission, during which the swelling, pain, difficulty in sleeping and weakness fade or disappear.
When first diagnosed, it’s impossible to predict how severe your rheumatoid arthritis may eventually be. If you have fairly continuous symptoms for 4 or 5 years your condition is more likely to pose a life¬time challenge. Periodic examination of your joints and tests such as the sedimentation rate test can be done to monitor your rheumatoid arthri¬tis. After 10 or 20 years the symptoms of inflammation, especially joint swelling, may stabilize, but joint deformities and some pain remain.
The cyclic nature of rheumatoid arthritis presents researchers with one of the most confusing aspects of the puzzle. Flares and remissions can occur for reasons that are unclear, occasionally leading people to seek, or credit, treatments of questionable merit.
There’s no cure for rheumatoid arthritis, but with proper treatment, a strategy of joint protection and changes in lifestyle, most people live long, productive lives after their arthritis develops. As with osteoarthri¬tis, both professional care and self-care are essential. Starting early in the disease on a carefully planned, individualized treatment program outlined by your physician and other health professionals offers the best chance of reducing the impact of the disease on your lifestyle.