Rheumatoid arthritis

• What is Rheumatoid Arthritis
• Statistics on Rheumatoid Arthritis
• Risk Factors for Rheumatoid Arthritis
• Progression of Rheumatoid Arthritis
• Symptoms of Rheumatoid Arthritis
• Clinical Examination of Rheumatoid Arthritis
• How is Rheumatoid Arthritis Diagnosed?
• Prognosis of Rheumatoid Arthritis
• How is Rheumatoid Arthritis Treated?
• Rheumatoid Arthritis References

What is Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a disease in which the joints in the body become inflamed. RA is the most common form of inflammatory arthritis. It is different to osteoarthritis. You may have heard of people referring to their rheumatism. This is a non-medical word that people use to describe a range of joint problems some of which may be RA.
In RA, the body’s own immune system gets confused and attacks the joints and sometimes other tissues. The immune cells that normally fight infections turn on the body’s own tissues. This self attack (autoimmune) causes inflammation in the joints. People notice this as painful, swollen, red joints.
Usually it affects the joints of the hand and feet and then the larger joints. It usually affects both sides of the body.
There are many good treatments for RA now. Most people are able to continue working.

Statistics on Rheumatoid Arthritis

RA affects 0.5-3% of the population depending on where people come from. It may start at any time from early childhood (rare) to old age. However it usually starts between 30-50 years of age.
Before menopause women are affected 3 times more often than males. Following menopause the frequency in both sexes is similar. A family history of RA is common.
People who have a family member with RA are slightly more likely to get RA. However their risk is still very small.

Risk Factors for Rheumatoid Arthritis

Doctors don’t know the exact reason. They know that it is a mixture of a person’s genes and things that they are exposed to can cause it, such as smoking. However, even identical twins don’t always both get it. One study showed less than one in six identical twins both get it if one already has it. It is thought that a chain of events occur that leads the immune system to be confused.

Symptoms of Rheumatoid Arthritis

RA affects the whole body but mostly affects the joints. It causes pain and swelling in the joints which makes people stiff especially in the morning. The joint problems make it hard to do things day to day like turning on a tap. If the inflammation is left untreated, it can cause damage to the joints, causing them not to work properly.
The chemicals from the inflammation in the joints spill in the bloodstream. This makes people with RA more tired – a bit like as if they had the flu.
Everyone with RA is slightly different and it means different things to different people. Some people have more pain than stiffness, some have tiredness as their main problem, some experience dry eyes.  Listen to the case histories to hear how it has affected other people. Most people get their RA under control but still sometimes it can get active.

How is Rheumatoid Arthritis Diagnosed?

There is no one test to say a person has RA. It is diagnosed on a mixture of their story, what is found on examination by the doctor and a range of blood tests and x-rays.

Prognosis of Rheumatoid Arthritis

How is Rheumatoid Arthritis Treated?

Unfortunately there is no cure for RA and it only rarely goes away. So people with RA are treated with medications to suppress the inflammation and allow them to do normal things.
People with RA are usually looked after by several medical personnel. This might include a rheumatologist, a GP, a physiotherapist and occupational therapist. The medications used to treat RA fall into two main groups. The first group aims to put the fire out by suppressing the inflammation in the joints. The first group is given the long name: disease modifying anti-rheumatic drugs (DMARDs). You might see your medications called DMARDs. Commonly used DMARDs are methotrexate, sulfasalazine, leflunomide, prednisone and hydroxychloroquine.
The second group helps with pain. It includes medications like paracetamol and anti-inflammatories like Brufen, Celebrex. The name anti-inflammatories is a bit confusing. These medications can help with the inflammation from things like a sprained ankle but do not treat the inflammation in RA.
The aims of treatment are to suppress joint inflammation to prevent day to day pain and stiffness hence to prevent long term joint damage. Unfortunately the medications that treat RA work well but most take several weeks to months to have there full effects. So don’t worry if it doesn’t work straight away. Also, like all medications these drugs can have some side effects. Most patients need to have regular blood tests whilst they are on medication for their RA. This is also the reason that people are started on lower doses on some medications like methotrexate and then have them increased.
This information is only meant as a starting point. Use it to help you understand RA. Ask you medical team for further information.
(Kindly contributed by Dr Malcolm Turner, Rheumatology Research fellow at the Diamantina Institute for Cancer, Immunology and Metabolic Medicine, Princess Alexandra Hospital, Brisbane, Queensland and Editorial Advisory Board member of the Virtual Rheumatology Centre.)

Rheumatoid Arthritis References

1. Amos M. ‘ABC of Rheumatology: Rheumatoid Arthritis-II: Treatment,’ BMJ 1995; 310: 652-654.
2. Apley G. Concise system of orthopaedics and fractures. 2nd ed. Arnold, 2001.
3. Buckley C. ‘Treatment of rheumatoid arthritis,’ BMJ 1997; 315: 236-238.
4. Collier, Longmore, Scally. Oxford handbook of clinical specialties, 6th ed. 2003, Oxford University Press.
5. Hakim A, Clunie G. Oxford Handbook of Rheumatology, Oxford University Press, London, 2002.
6. Kumar and Clark. Clinical Medicine 5th ed. WB Saunders, 2002.
7. O’Dell J, ‘Therapeutic Strategies for Rheumatoid Arthritis,’ NEJM 2004, 350: 25; 2591-2602.
8. Sadovsky R. Preventing Progression of Rheumatoid Arthritis. Am F Phys 2000. (online) http://www.aafp.org/afp/20000315/tips/12.html
9. Smith R, Smolen J. ‘Rheumatoid Arthritis,’ eMedicine. Web MD, 2006. Accessed (online) from http://www.emedicine.com/med/topic2024.htm (2/4/06).

(Kindly reviewed by Dr John Quintner MB BS MRCP FFPMANZCA, Consultant Physician in Rheumatology and Pain Medicine, Western Australia.)