Rheumatoid Arthritis

Rheumatoid arthritis is a chronic inflammatory disorder in which the immune system mistakenly attacks the body tissue by producing chemicals that break down the tissue and cause inflammation. This occurs particularly in the synovium- or joint lining. It often begins in smaller joints such as the fingers and toes and spreads to include other joints of the body. 

 

Symptoms

• Pain

• Stiffness- especially in the morning or after long periods of inactivity

• Swelling and inflammation

• Warmth around the joint

• Deformity or contracture

• Symptoms may occur in other systems of the body such as fever, fatigue, loss of appetite, and weakness.

• Symptoms can come and go as well as vary in severity

 

Causes

• Environmental factors or infection activates an inherited gene- rheumatoid factor

• This gene makes you more susceptible to certain environmental factors that may trigger the disease but does not necessarily “cause” the disease to present

• Tendons and ligaments that hold joint together weaken and tear as they are attacked as well, causing the joint to lose its shape and alignment

 

Risk Factors

• Women

• Can occur at any age but usually presents in middle age

• Smoking

• Exposure to environmental triggers such as asbestos

• Obesity

 

Prevention

• Avoidance of environmental triggers

• Non-smoking

• Maintain a healthy weight

 

Diagnosis

• Physician will take detailed medial history and physical exam

• Lab tests to check for rheumatoid factor, anti-cyclic citrullated peptide antibodies, erythrocyte sedimentation rate, or C-reactive protein

• X-ray and MRI to evaluate progression of disease

• Patient must have 4 of the 7 identifiable criteria:

  • Morning stiffness lasting an hour or more

  • Arthritis of 3 or more joints for 6 weeks

  • Arthritis of hand joints for at least 6 weeks

  • Arthritis on both sides of the body for at least 6 weeks

  • Rheumatoid nodules under the skin

  • Rheumatoid factor present in blood testing

  • Evidence of rheumatoid arthritis on x-rays

 

Treatment Options

Non-surgical:

• Medications: type of medication depends on the severity of the disease (NSAIDS, corticosteroids, or disease-modifying anti-rheumatic drugs (DMARDs))

• Physical therapy or occupational therapy to keep joints healthy

• Orthotics to make everyday tasks easier and less painful

 

Surgical:

• Synovectomy- removal of joint lining

• Tendon repair- to tighten the tendons stretched or damaged

• Joint fusion

• Joint replacement