Sunday, June 12, 2011

RA - Rheumatoid Arthritis

Overview, Causes, & Risk Factors

Rheumatoid arthritis, also called RA, is an inflammation in the lining of the joints and other internal body organs. RA belongs to a group of diseases called autoimmune disorders, in which the body makes antibodies against its own tissues. It is a fairly common form of arthritis.
What is going on in the body?
In RA, for reasons unknown, the body's immune system malfunctions and begins making antibodies against its own tissues. Antibodies are proteins that help the body to fight infection. These antibodies are made by the immune system in response to a trigger called an antigen. This trigger is often a substance that the body sees as "foreign." These foreign substances can include things like bacteria and viruses. This immune reaction causes an inflammation of the synovial membrane lining the joints.
This chronic inflammation produces enzymes that can invade and damage cartilage and bone within the joint. Sometimes this form of arthritis is mild, but 70% of people who have it develop chronic problems, and 15% have severe crippling disease. Young children can have a form called juvenile RA.
What are the causes and risks of the disease?
The causes of RA are not yet fully understood. Experts suspect that some type of virus can trigger RA in people who have certain genes that give one a tendency to develop the disease.
RA affects 2.1 million people in the U.S. and can develop at any age. Most often, it starts in middle age, but it is also common in people in their 20s and 30s. More than 70% of the people who have RA are women.
There is currently research into a number of factors that may trigger RA, including:
  • certain abnormal genes found in some, but not all, people who have RA

  • certain viruses or bacteria that trigger the autoimmune response of RA

  • hormone imbalances

    • Symptoms & Signs

    What are the signs and symptoms of the disease?
    Joint pain, swelling, and stiffness that is especially severe and prolonged in the morning are the most common symptoms of RA. The same joint on both sides of the body is usually involved, and RA most often starts in the hands or feet. However, the problems may move from one joint to another. Usually many joints throughout the body are affected at the same time.
    Because RA is a disease that can affect the whole body, the person may have other symptoms:
  • fatigue

  • a vague feeling of illness called malaise

  • occasional fever

  • loss of appetite

  • loss of energy

  • lumps of tissue under the skin called rheumatoid nodules, often over bony areas exposed to pressure (especially near the elbow)

    • Diagnosis & Tests

    How is the disease diagnosed?
    Observing the person and his or her pattern of symptoms, along with a medical history and physical exam, helps the doctor to diagnose RA. A blood test for the rheumatoid factor is positive in about 80% of cases but does not mean the person has RA.
    Other blood tests, such as a complete blood count, called CBC; C4 complement components; C-reactive proteins, called CRP; and antinuclear antibody, called ANA; tests may be done. People with RA are often anemic and have a low number of red blood cells in their blood count. Joint aspiration, which means removing joint fluid with a needle under local anesthesia, might be done. Synovial fluid that is cloudy, milky, or dark yellow and that contains many inflammatory cells will help detect RA.
    Joint X-rays may also be ordered to help diagnose RA. It is important to rule out other diseases and conditions, such as other types of arthritis, as well as condition such as systemic lupus erythematosus and Borrelia burgdorferi.\ It is passed to humans through tick bites. ',CAPTION,'Lyme Disease');" onmouseout="return nd();">Lyme disease.

    Prevention & Expectations

    What can be done to prevent the disease?
    RA can't be prevented.
    What are the long-term effects of the disease?
    RA may be progressive and can affect many joints. This can make walking very difficult and can interfere greatly with the function of the hands. Disability can be severe and may cause depression.
    Rheumatoid arthritis can cause deformities such as misshapen fingers, bunions, hammertoe, and knock-knees. The affected joints are swollen and warm.
    Other body parts can also be affected by rheumatoid arthritis. The rheumatoid process can involve the eye, known as episcleritis, and the lungs, known as interstitial disease. There may be an inflammation of blood vessels or the lining around the heart, known as vasculitis or pericarditis. Osteoporosis, which is the loss of bone density, is also more common in people who have RA than in the larger population.
    What are the risks to others?
    RA poses no risk to others.

    Treatment & Monitoring

    What are the treatments for the disease?
    People who have RA should learn all they can about self-care and managing their disease. There are many treatment approaches.
    Overview
    Early treatment is the key. Effective self-management of RA will focus on the following goals:
  • relieve pain

  • decrease inflammation in the joints

  • slow down or stop damage to the joints

  • improve joint function and ability to do daily activities

  • increase feelings of general well-being

    • Specific self-care measures may include:
  • managing one's stress

  • applying splints to rest acutely inflamed joints

  • using assistive devices, such as zipper pulls, to decrease strain on joints

    • Medicine
    Symptom control and disease management may be enhanced when medicines are started early in treatment. A wide variety of highly effective medicines are used to treat RA. Most fall into one of two groups, including medicines that relieve symptoms and medicines that actually modify the disease process. These two types of medicines are sometimes used in combination. Examples of medicines that relieve symptoms include:
  • anti-inflammatory medicines, called NSAIDs, such as aspirin, naproxen, and ibuprofen

  • COX-2 specific inhibitor NSAIDs, such as celecoxib and rofecoxib

  • corticosteroids, such as prednisone, which can be taken orally or by injection into the joint

  • analgesics, such as acetaminophen or propoxyphene

    • Examples of medicines that modify disease include:
  • immunosuppressant medicines, which alter the body's immune response, such as methotrexate, azathioprine, and cyclophosphamide

  • anti-inflammatory medicines, such as infliximab and etanercept, which block the effects of a key protein involved in the rheumatoid process

  • antibiotics, such as doxycycline and minocycline

  • medicines that slow down joint destruction, such as d-penicillamine, sulfasalazine, hydroxychloroquine, and gold

    • Diet and Nutrition
    All people should be sure to eat a healthy diet, following the food guide pyramid. It's important to get the right amount of calories, protein, and calcium.
    The findings of some studies have shown that symptoms of RA improve with high doses of omega-3 fatty acids. These substances occur naturally in certain fish and in some plant seeds. However, it is hard to get enough of these acids to affect the disease, and some people cannot tolerate the high doses.
    There has been a great deal of interest in the last few years in the use of glucosamine and chondroitin, dietary supplements that may decrease the joint pain linked with another form of arthritis called osteoarthritis. People who have RA should discuss the value of such supplements with their doctors before taking them.
    Exercise
    Exercise is a key strategy in the treatment of arthritis, but the person with RA needs to be careful to balance exercise and rest to conserve energy. The exercise program should consist of a combination of aerobic exercise, strengthening (joint protection) exercises, and flexibility (or stretching) exercises.
  • For aerobic exercise, 30 minutes of moderate exercise a day can help prevent complications of arthritis, as well as heart disease, stroke, and diabetes. Exercise should be kept to a level where the person can talk without shortness of breath and is comfortable with the pace of the activity. The 30 minutes a day can be done in one session or broken up into several shorter segments. Walking and water aerobics are exercises that keep joint stress to a minimum.

  • Strengthening exercises can be done with light weights or a resistance band. The goal is to build strength and tone in the muscles around the joints affected by RA, rather than to build big muscles. Improving muscle strength and tone can help protect the joint and prevent further joint damage. Most people with RA should talk with a doctor or physical therapist to set up a program that is right for him or her.

  • Stretching exercises will help maintain flexibility and should be done each day. They can be done while lying in bed or in various positions or at different times during the day.

    • Surgery
    Surgery may be performed when pain cannot be controlled or when significant function is lost. Several types of surgery may be done, such as:
  • arthroscopy, a procedure that uses a small scope and instruments to get inside the joint without opening it

  • arthrotomy, which means opening the joint through a larger incision

  • synovectomy, which is the removal of the lining of the joint

  • osteotomy, which realigns the bone next to the joint

  • arthroplasty, which is the partial or total replacement of the joint. People with severe arthritis are often candidates for a knee joint replacement or a hip joint replacement.

    • Prosorba Therapy
    The Food and Drug Administration has approved a blood-filtering treatment called Prosorba for moderate to severe cases of RA that have not responded well to disease-modifying medicines. In this procedure, blood is drawn from the arm and then separated into two different parts called the plasma and the red blood cells. Next, the plasma is filtered through a special cylinder the size of a soup can that is filled with a sandlike substance. This is called a Prosorba column, and the filtering sand in it is coated with protein A, which removes certain antibodies from the plasma. These antibodies contribute to pain and inflammation in the joints. The plasma is then combined again with the red blood cells and put back into the person's body.
    Therapy is given once a week for 12 weeks as an outpatient procedure. Each session lasts 2 to 2.5 hours. This therapy can bring remission from RA symptoms, but it will take up to 12 to 16 weeks before the person begins to feel the benefits. Once remission is reached, it may last as long as a year and a half.
    What are the side effects of the treatments?
    Medicines used to treat RA may cause stomach upset or bleeding , allergic reaction, less resistance to infection, and other side effects. Surgery may cause bleeding, infection, or allergic reaction to anesthesia. Nearby bones, ligaments, tendons, nerves, or blood vessels can also be injured by accident.
    What happens after treatment for the disease?
    Treatment of RA is lifelong. There is no cure for the disease, but careful management can help to reduce some of its effects.
    How is the disease monitored?
    A doctor will watch the person's level of comfort and function of the joint. Any new or worsening symptoms should be reported to the doctor.

    Attribution

    Author:John A.K. Davies, MD
    Date Written:
    Editor:Crist, Gayle P., MS, BA
    Edit Date:09/28/02
    Reviewer:Kathleen A. MacNaughton, RN, BSN
    Date Reviewed:09/25/02

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