Arthritis, Rheumatoid

General Illness Information

Common Name: ARTHRITIS, RHEUMATOID

Medical Term: None Specified

Description:

A chronic auto-immune disease characterized by inflammation, swelling and pain in the joints, and it affects muscles, membrane linings of the joints and cartilage. Usually joints of the hands and feet are symmetrically inflamed. It is a multi-system disease, and sometimes the eyes and blood vessels are affected. It is 3 times more common in women than men. It begins between ages 20 and 60, with a peak incidence between ages 35 and 45.

Causes:

Unknown, but probably an auto-immune disease. Both genetic and environmental factors may play a role in initiating the disease.

Prevention:

Use of condoms during sexual activity. Treatment of all sexual partners of any infected person (usually 2 weeks of an oral antibiotic such as tetracycline).

Signs & Symptoms

  • Slow or sudden onset of:
  • Redness, pain, warmth and tenderness and swelling in any or all active joints in the hands, wrists, elbows, shoulders, feet and ankles.
  • Morning stiffness.
  • Low-grade fever.
  • Nodules under the skin (sometimes).
  • Fatigue.
  • Eye involvement- kerato-cojunctivitis, scleritis.
  • Anemia, Felty’s syndrome(enlarged spleen and neutropenia-low white blood cell count)
  • Cardiac – pericarditis and myocarditis.

Risk Factors

  • Family history of rheumatoid arthritis or other auto-immune disorders.
  • Genetic factors, such as auto-immune system defects.
  • Female age 20-50.
  • Native American ethnicity (prevalence is higher in this group).

Diagnosis & Treatment

General Measures:

  • Laboratory blood studies (Rheumatoid Factor test, Erythrocyte sedimentation rate test, and Anti-nuclear antibody test to rule out lupus, complete blood count to look at hemoglobin and platelet levels in particular)
  • X-rays of affected joints (may show joint space narrowing, erosions of the bone, bone demineralization, and/or absence of bone repair).
  • Splints at night may be helpful to support and protect a joint with active disease.
  • Gloves at night to retain heat.
  • Relieve pain with heat, including hot soaks, heat lamps, heating pads or whirlpool treatment.
  • If you don’t have a firm mattress, place 3/4-inch plywood between your bedsprings and mattress to support your back.
  • Consider moving to a dry climate. Damp weather aggravates symptoms.
  • Additional information available from the American Rheumatism Association, telephone (800) 282-7023; or Arthritis Foundation, 1314 Spring Street N.W., Atlanta, GA 30309. Telephone (800) 283-7800. In Canada, contact the Arthritis Society at 1-800-321-1433.

Medications:

Medical therapy of Rheumatoid Arthritis generally progresses in the following fashion:

  1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS);
  2. Disease Modifying Anti-Rheumatic Drugs (DMARDS);
  3. Corticosteroids.
  4. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS), including aspirin and other salicylates are usually given with a prostaglandin E analog (misoprostil) to protect the stomach against gastric ulcers.
  5. Disease Modifying Antirheumatic Drugs (DMARDS), may induce disease remission unlike NSAIDS e.g. gold, methotrexate, antimalarials (e.g. chloroquine). Delayed onset of action (approximately 8-12 weeks).
  6. Corticosteroids, drugs usually relieve pain dramatically for short periods, but they are less effective for long-term use. They don’t prevent progressive joint destruction, and they sometimes have hazardous side effects. Cortisone injections into joints can temporarily relieve pain.

Caution:

Most non-steroidal anti-inflammatory drugs may cause stomach ulcers and gastritis.

There is now a new class of NSAIDS called COX-2 Inhibitors, which in clinical trials, have been proven to be very effective, but with much less likelihood of causing gastritis. This development is very promising.

Other therapies:

In addition to drugs, which are prescribed to reduce inflammation in the joints and physiotherapy to mobilize the joints in order to prevent frozen joints, surgery may be needed. The surigcal procedures may involve fusion of joints or in cases of advanced joint disease, joint replacement is the most effective way to restore mobility and function and reduce pain.

Activity:

  • Stay in bed, except to use the bathroom, until fever and other signs of an active flare-up disappear.
  • Remain active, but include daily rest periods. Sleep for 10-12 hours each night. Don’t become overtired.
  • Stand, walk and sit erectly.
  • When able, exercise actively to preserve strength and joint mobility. Build up slowly to the amount suggested. Exercising in a heated pool is good for stiff joints.
  • Exercise disabled joints passively to help prevent contractors.
  • Physiotherapy may be prescribed.

Diet:

  • Eat a normal, well-balanced diet.
  • Avoid arthritis diet fads, which are common. However, diet rich in fish oils and plant oils but low in red meats may be beneficial.
  • Lose weight if you are obese. Obesity stresses the joints.

Possible Complications:

  • Impaired vision.
  • Permanent deformity and crippling.
  • Drugs used in treatment can induce complications, such as gastric problems, and those associated with long-term steroid use.

Prognosis

The disease may be mild or severe. It is presently incurable, but pain relief, prevention of disability and an active, normal life span are usually possible with early diagnosis. Conservative treatment relieves symptoms in 1 year in 75% of patients. About 5% to 10% of patients are eventually disabled, despite treatment.

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Connected Drugs :

Rheumatrex (Methotrexate)

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Celestone (Betamethasone)

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Flexall (Menthol)

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MSD

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Hexadrol (Dexamethasone Sodium Phosphate)

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