ARTHRITIS, RHEUMATOID

Rheumatoid arthritis (RA) causes inflammation leading to pain, stiffness, and swelling in joints. The joints most frequently affected are the hands, wrists, feet, and knees. Fatigue can also be severe in RA. Less commonly, RA can cause inflammation in other parts of the body including the lungs, eyes, heart, blood vessels, skin, and nerves. Rheumatoid arthritis used to be called "crippling" arthritis because of the potential joint damage. Now, because of better treatment, less joint damage may occur.

Although certain hereditary and environmental factors may increase an individual's risk of developing RA, the exact cause of RA is unknown. Rheumatoid arthritis is not an infectious illness. In other words, you cannot "catch" it from another individual.

Rheumatoid arthritis affects 1% to 5% of the adult population throughout the world. It occurs two to three times more frequently in women than in men, and occurs more commonly during a woman's childbearing years. To diagnose RA, a physician obtains a medical history, performs an examination of the joints, and orders laboratory tests and possibly x-rays of the joints. Laboratory tests may include an erythrocyte sedimentation rate (ESR), which measures inflammation in the body, a complete blood cell count (CBC), and a test called a rheumatoid factor (RF). Because only 75% of individuals with RA have a "positive" RF and other individuals without RA may also have a positive test, this blood test does not confirm a diagnosis of RA with 100% accuracy.

Rheumatoid arthritis causes joint pain and stiffness that can affect your ability to do daily activities. Rheumatoid arthritis of the hands, wrists, or shoulders can decrease your ability to write, open jars, dress, and carry items. Arthritis affecting hips, knees, or feet can decrease your ability to walk, bend, or stand. If arthritis affects your neck, it may limit your ability to look around. There is no cure for RA. However, with earlier detection, improved medications, and comprehensive treatment, individuals with RA can lead a full life.

The best way to manage RA is with a combination of medications, therapies, exercise, education, and "pacing" of activities to prevent fatigue. Medications help decrease the inflammation that causes pain and swelling. Nonsteroidal antiinflammatory drugs (NSAIDs) are often the first line of therapy. If these medications do not adequately control the pain and swelling, a physician may prescribe "disease modifying" medications that may slow down the RA disease process. These medicines include hydroxychloroquine, methotrexate, and gold shots. Because these medications may take up to a few months to be effective, the doctor may prescribe prednisone. Prednisone is a strong antiinflammatory medication that works quickly.

All medications can cause side effects. The NSAIDs may cause stomach upset, diarrhea, constipation, ulcers, headache, dizziness, difficulty hearing, or a rash. Hydroxychloroquine may cause nausea, diarrhea, and a rash, and rarely it may affect the eyes. Methotrexate and gold shots may affect your blood, liver, or kidneys and may cause a rash. Prednisone may cause skin bruising, high blood sugar, increased blood pressure, difficulty sleeping, cataracts, weight gain, and thinning of the bones.

Learning about your arthritis is essential because you may have RA for a long time, maybe for the rest of your life. Exercise is important to maintain joint movement and muscle strength. Alternating periods of rest and activity helps to manage fatigue.

• Take your medication as prescribed.
• Call your doctor if you are experiencing side effects from medications.
• Ask your doctor which over-the-counter pain medications you may take with your prescription medications.
• Exercise to maintain joint range of motion and muscle strength.

• Wait to see whether a possible medication side effect will go away on its own.
• Give up. If one medication doesn't work, discuss with your physician other medicines that might help decrease your pain and stiffness.
• Go on a special diet without the consent of your physician.
• Continue an exercise program that causes pain. If pain after exercise continues, it usually means the exercise program needs to be modified specifically for you.

• You experience side effects that you believe are caused by your medications.
• The medication and other treatments are not helping the pain, swelling, or fatigue.
• You believe you may need a referral to a physical or occupational therapist for exercise or joint protection.

Contact the Arthritis Foundation in your area. If you do not know the location of the Arthritis Foundation, you may call the national office at 1-800-283-7800 or access information on the Internet at www.arthritis.org




Rheumatoid arthritis can involve various organs and be associated with several medical disorders.

_______________________________________________________________________________________________________________________________
Copyright © 2000 Mosby, Inc.
All rights reserved.  No part of this publication may be reproduced or transmitted in any form or for any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher.
_______________________________________________________________________________________________
For Comments/Suggestion send email to: webmaster@apma-nc.com