• Rheumatoid Arthritis

    What Is Rheumatoid Arthritis?

    According to the Arthritis Foundation, rheumatoid arthritis (RA), a chronic condition characterized by inflammation of the lining, or synovium, of the joints, affects 2.1 million individuals nationwide. Although there is no known cure for RA, progressive new treatments, early detection and ongoing assessment by a Lahey rheumatologist can help patients manage their condition and maintain a better quality of life. 

    Symptoms of Rheumatoid Arthritis

    Early symptoms of RA can appear in any joint, although the condition typically begins in the smaller joints of the hands, wrists and fingers. Joint pain is typically symmetrical - if a joint hurts on your left hand, it is highly likely that the same joint will hurt on the right as well. A systemic disease, RA can move throughout a patient's body, causing problems in other organs. If not diagnosed and treated early, the condition can progress, leading to long-term joint damage, chronic pain, loss of function and disability.

    RA can present itself differently in different patients. Some of the more common symptoms that may appear in various stages of the disease include:

    • Fatigue
    • Stiffness, particularly in the morning and after sitting for long periods
    • Weakness
    • Flu-like symptoms, including low-grade fever
    • Symptom flare-ups and remissions
    • Rheumatoid nodules - lumps of tissue under skin - occur in one-fifth of patients with the condition, usually in the elbow (nodules are usually indicative of more severe disease activity)
    • Muscle pain
    • Loss of appetite and weight loss
    • Anemia
    • Depression
    • Cold and/or sweaty hands and feet
    • Involvement of glands around the eyes and mouth, causing decreased production of tears and saliva (Sjogren's syndrome)
    • Difficulty in performing daily tasks (e.g., combing hair, grasping fork, buttoning shirt)
    • Skin ulcers
    • General decline in overall health

    Am I at Risk for Developing Rheumatoid Arthritis?

    Rheumatoid arthritis is referred to as an autoimmune disease. In a healthy immune system, white blood cells produce antibodies that protect the body against foreign substances. In people with RA, the immune system mistakes the body's healthy tissue for a foreign invader and attacks it.

    Although the cause of RA is not known, researchers have identified certain factors that may increase a person's risk for developing the condition:

    • Gender: 70 percent of patients with RA are women
    • Age: most common between 30 and 50 years old
    • Onset after pregnancy, possibly due to a hormone connection
    • Genetics: Some people with the genetic marker HLA-DR4, which plays a role in helping the body distinguish between its own cells and foreign invaders, are at increased risk of developing RA.
    • Infection: In people with a susceptibility to RA, an otherwise harmless germ may trigger the disease.

    Diagnosing and Treating Rheumatoid Arthritis at Lahey

    Your Lahey rheumatologist will take a detailed medical history and perform a thorough physical exam. Lab tests and X-rays will be administered if necessary. Some of the physical clues your health care provider will look for when making a diagnosis include:

    • Joint swelling and tenderness
    • Loss of motion in the joints
    • Joint malalignment

    Signs of rheumatoid arthritis in other organs, including lungs, skin and eyes

    Your treatment plan may include exercise, education including joint protection and self-management techniques, medication and/or, less frequently, surgery. When necessary, you may be referred to another specialty at Lahey, such as pain management, physical and occupational therapy, or hand/orthopaedic surgery for further consultation.

    Some of the more common medications prescribed for RA include: 

    • NSAIDs (nonsteroidal anti-inflammatory drugs) - to reduce inflammation and relieve pain. Examples include aspirin and ibuprofen.
    • Analgesics - which relieve pain but don't affect inflammation. Examples include acetaminophen (Tylenol).
    • Glucocorticoids or prednisone - administered in low maintenance doses for the prevention of joint damage.
    • Disease-modifying antirheumatic drugs (DMARDs) - combined with NSAIDs and/or prednisone to slow joint destruction caused by RA over time.
    • Biologic response modifiers - modify the immune system by inhibiting proteins called cytokines, which contribute to inflammation. Examples include etanercept and infliximab.
    • Protein-A immunoadsorption therapy - a therapy, not a drug, that filters your blood to remove the antibodies and immune complexes that lead to inflammation.

    Although the specifics of each treatment plan are tailored to the individual, the overall goals are generally the same: to relieve pain, reduce inflammation, stop or slow joint damage, and improve function and a sense of well-being for all patients.

    Further information about rheumatoid arthritis

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