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ABCMD definition of Rheumatoid Arthritis: A long term, often wide-spread, disease of unknown cause that mostly affects the joints.

What is Rheumatoid Arthritis
Rheumatoid Arthritis is one of 2 diseases that people often refer to when they say they have “Arthritis.” The other is called Osteoarthritis. It is important for you to understand which type you have as treatments can be quite different. Please talk to your doctor if you are not sure which type of Arthritis you have. To read about
Osteoarthritis click here now.

Rheumatoid Arthritis is a disease of unknown cause that affects nearly 1-1.5% of the entire population worldwide and is a major cause of pain and disability in our society. Rheumatoid Arthritis is a type of chronic disease. What this means is 1) it is a disease you will have for a long period of time and 2) it is not curable (otherwise it would not be “chronic”). Doctors also refer to this disease often as being systemic. What this means is that really any part of your body can be affected, however most often the affected parts of your body are the joints (knees, hips, etc). Rheumatoid Arthritis is also what doctors call an autoimmune disease. For a reason that we do not know, your own body’s immune system (the same system that fights colds and infections) attacks parts of your body: usually the joints, but also can include your lungs, heart, skin, eyes, etc.

In a normal joint (elbows, knees, hips, fingers, etc) you have something called cartilage that covers the surfaces of the bones where they come into contact with each other at the joint. Normally cartilage acts as a shock absorber at the joint and allows some cushioning for when you put weight on your joints with activity. This prevents the bones from coming into contact and keeps you pain free and active. In Rheumatoid Arthritis, this cartilage is attacked and destroyed by your own immune system.

What causes Rheumatoid Arthritis
As was mentioned above, the cause of this disease is unknown. However, what doctors do know is that it is an autoimmune disease. This means your own body is the cause of this disease. For some reason, you begin to develop an immune response to parts of your own body (similar to one that would fight an infectious bug or virus for example). Doctors believe that people suffering from Rheumatoid Arthritis have the disease from genes they were given from their parents and also from something that triggered it in their environment.

Rheumatoid Arthritis is a disease that affects women far more then men. In fact around 3 women are affected for every 1 man affected.

What are some things people with Rheumatoid Arthritis experience
1. Symmetric polyarthritis: What this means is that there are usually many joints affected (usually at least 3) at the same time and if a joint is affected on one side, it is likely affected on the other. So for example, a patient may have both knees affected along with their knuckles.
2. Pain, swelling, deformity most often affecting the knuckles, wrists, elbows, knees and ankles.
3. Morning stiffness: in and around the joints and usually lasts longer then an hour.
4. Rheumatoid nodules: These are little bumps/balls felt in the skin and usually over bones. These are found in around 30% of people with Rhematoid Arthritis and are most often found on the forearms.
5. Patients may experience what doctors call constitutional symptoms: This means patients may experience things like fever, weight loss and a general feeling of being unwell.
6. Long term, untreated or severe Rheumatoid Arthritis can lead to severe joint deformity, functional decline (unable to perform usual activities) and even early death. A big hint to talk with your doctor is joint pain or symptoms of any kind that interfere with you being able to do the things you normally do during the day. This includes all the things necessary to take care of yourself (cooking, eating, bathing, etc) and all the things you do for fun or work. For your own sake, do not wait until it is too late to get some help.

How is Rheumatoid Arthritis diagnosed?
Your first symptoms of Rheumatoid Arthritis may be something you experience all of a sudden or they may present very slowly. This differs from person to person.

To diagnose Rheumatoid Arthritis your doctor will first have to take a history of your symptoms. Many of these symptoms have to be present for around 6 weeks before your doctor is willing to really look into the possibility of Rheumatoid Arthritis. Along with a history, they will perform a physical exam: looking for Rheumatoid nodules, looking at your joints and also looking for any other parts of your body that may be affected.. To really diagnose this disease however, your doctor will order blood tests and x-rays. An x-ray is basically a picture that allows your doctor to see your bones and the spaces between them. Normally you have a nice black space between the bones in your joints. This black space is where the cartilage is. In this disease as the cartilage is destroyed, that black space is much smaller then it should be and in severe cases can be nearly gone altogether signaling bone on bone contact. The blood test that doctors use as a gold standard to diagnose this disease is called Rhematoid Factor. This test tells your doctor if you do or do not have Rhematoid Factor present in your blood. Rhematoid Factor is what doctors call the immune response your body has to itself in Rhematoid Arthritis. If this is present, you likely have the disease. This test is not 100% however, as up to 10% of normal people have this present and do not have Rhematoid Arthritis.

The bottom line is if you have had many of the symptoms listed above for at least 6 weeks your doctor will order these tests as confirmation of a disease they already have a strong idea is present.

How is Rheumatoid Arthritis treated?
The biggest goals of treating Rhematoid Arthritis are to stop or try and decrease your body’s immune response to itself. This is best accomplished by going in to see your doctor early and starting treatment early before it is too late and your joints are already ruined!

The first recommendations that your doctor will make are likely to be for pain management. Many start with medications such as Ibuprofen (if you have no history of ulcers, intestinal bleeding, etc) or Tylenol. Along with this, your doctor may start medications that are in a group called “disease modifying agents.” These are a group of drugs designed for Rheumatoid Arthritis in order to really put a stop to your body’s immune response and to stop it from destroying itself. In very severe cases, your doctor may also add steroids to your treatment plan. These are not the body building steroids, but rather are drugs that further decrease your immune response and your body’s inflammation (swelling, pain, redness). Talk with your doctor before starting any medications, both prescription or over the counter, for managing pain. An endpoint of treatment options is replacing the joint with a total joint replacement. Talk with your doctor about the best way to begin treating your Rheumatoid Arthritis.

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