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Posted: Mar 19, 2009 1:34 PM
Updated: Mar 19, 2009 12:00 AM

Rheumatoid arthritis develops when the immune system's white blood cells attack healthy tissues, a process called an "autoimmune response." The most common
target is the lining of a joint, called the synovium, but damage can also occur in
organs such as the heart, lungs, and eyes. The synovium becomes inflamed during
the assault, and the cartilage that cushions the joint starts to expand. While the
cartilage grows abnormally, the bones, ligaments, and muscles in the joint slowly
erode.
Nobody knows why the body turns against itself; although it's possible an unknown
virus may spur the white blood cells into action. Experts also think genetics may
make some people more susceptible to the condition than others. Though rheumatoid arthritis can strike at any age, it most commonly begins between the ages of 20
and 50 (unlike osteoarthritis, which tends to afflict older people), and it's three times
more common in women than in men.

How do I Know that I have it?

People with rheumatoid arthritis feel pain when they move certain joints, especially those in the fingers, knuckles, wrists, elbows, shoulders, knees, and ankles.
Affected joints are usually swollen and may also feel warm to the touch. Patients
often feel extremely stiff when they wake up, although some flexibility typically
returns within a few hours.
The symptoms of rheumatoid arthritis are usually symmetrical: If one ankle is sore
and swollen, the other is, too. And even though the pain may start in just one location,
the condition almost always involves at least five joints. In some cases, the earliest symptoms have nothing to do with the joints. Patients can feel lethargic or depressed
for weeks or months before pain and stiffness set in. Many lose all energy several
hours after waking up. Some also have a low-grade fever of 99 to 100 degrees.
Doctors diagnose the disease by assessing a patient's symptoms and feeling the
joints. Blood tests can also detect an abnormal antibody called rheumatoid factor,
which is present in up to 90% of rheumatoid arthritis patients (although it is
sometimes present in people who don't have the disease).
Rheumatoid arthritis takes many different courses, and it's impossible to predict
how it will progress in any one individual. For a lucky few -- less than 10% -- the
condition vanishes completely within six months. Others suffer attacks of acute pain followed by long periods of relief. For most people, symptoms fade in and out from
day to day or hour to hour, but steadily worsen over time.
As the disease progresses, tendons often rupture, bones disintegrate, and joints become permanently deformed. The damage is often most visible in the hands, with knuckles, wrists, and finger joints becoming swollen and lumpy, and fingers protruding
at odd angles.
In many cases, the joints look worse than they feel. Even a person with misshapen fingers may still be proficient at typing and needlework. But as time goes on, many patients start to lose mobility in their joints. And within 10 years, 60% can no longer
do the jobs they did before they were diagnosed. However, with early and aggressive treatment many of these problems can be delayed and even prevented.
There are no guarantees, but your doctor can try to assess your future by checking
for the rheumatoid factor antibody. Patients who don't have the antibody are more
likely than others to have mild symptoms or go into total remission. In contrast,
patients with high levels of the antibody face the greatest risk of permanent joint
damage and disabilities.

What's the Treatment?

Rheumatoid arthritis once consigned many people to wheelchairs, but that doesn't
have to be your fate. Doctors today can prescribe several different medicines that
attack the disease itself-not just the symptoms-early on. Many researchers think
that a greater understanding of these medicines, known as disease-modifying
antirheumatic drugs (DMARDs), could one day make long-term disabilities from rheumatoid arthritis a thing of the past.
No matter what drugs you take, it's important to hit rheumatoid arthritis hard and
early, as the disease can do much of its worst damage in the first few years. See a
doctor as soon as you notice symptoms. He or she may have you start on large
doses of one or a combination of DMARDs and then slowly taper off the medications.
Or you may start with moderate doses and stay on them for a while. Either way,
you'll be giving yourself a good fighting chance against the disease.
While these drugs are busy attacking the disease, aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) can help ease pain and swelling. Unfortunately, large doses of these drugs can also cause stomach ulcers and other complications. Your doctor may choose to use newer forms of NSAIDs called Cox-2 inhibitors. These medications, Bextra, Celebrex, and Vioxx, aren't more powerful than older anti-inflammatory drugs, but they do seem to be safer on the stomach and intestines.
The second step in treating Rheumatoid Arthritis is often low doses of the steroid
anti-inflammatory drugs. These are usually given in 2 forms, those that are in injection
form and those that are taken orally such as prednisone. The third group of medications
to treat Rheumatoid Arthritis include the slow acting or disease modifying drugs. Gold
shots, Methotrexate and Arava are members of this family. The newest group of medi-cines are the biological agents to treat Rheumatoid Arthritis. Remicade and Enbrel
have have been used in this manner for 2-3 years. More recently Kineret and Humira
have been approved by the FDA. We have extensive experience in treating thousands
of patients with Rheumatoid Arthritis. One specific medicine or combination of medi-
cines would be used depending on the extent of the patient's disease. Dramatic
responses have been seen in many patients on Remicade or Enbrel.
While medications are important, you need to do your part to stay healthy. On days when your symptoms are mild-and as long as your physician approves-stretching, weight lifting, and moderate aerobic exercise can all help improve mobility and reduce pain. When pain flares up, however, you should rest your joints as much as possible
to prevent any further damage.
It's also important to watch your weight. Shedding extra pounds can help relieve
strain on your joints and speed your recovery.
If, despite all efforts, your disability becomes severe, surgery to replace a damaged
joint may be an option. Artificial joints have been especially effective for the knee, hip, wrist, and elbow. And even without surgery, your doctor or a physical or occupational therapist can help you find many ways to live more comfortably with the disease. For instance, walking with a cane can protect an arthritic knee, or it may help to wear a
wrist splint at night.