RHEUMATOID ARTHRITIS (RA)
AN AUTOIMMUNE DISORDER THAT AFFECTS THE JOINTS

Rheumatoid arthritis (RA) affects about 1 percent of the general population. This translates to more than 2 million Americans, with a 5:2 ratio of women to men. RA strikes many people in the prime of their lives, and most often affects people in their early 30s to 60s. Rheumatoid arthritis is a different illness than osteoarthritis. RA causes considerably more inflammation than osteoarthritis because it is an autoimmune disorder. This means that the body’s immune system reacts against itself. In the case of RA, the immune system destroys the joints. Inflammation results in swelling, warmth and subsequent pain in the joints. Unlike osteoarthritis, RA affects the entire body. People diagnosed with RA often complain of extreme fatigue and a general sense of malaise.

RA can range in severity from manageable to mildly disabling to completely debilitating. Early diagnosis is important in slowing the progression of joint damage, because damage can sometimes occur in as few as six months of the disease’s onset. The challenge, though, is early diagnosis, because RA can be difficult to identify in its initial stages.

Soreness, stiffness and aching usually begin in the small joints of the feet, wrists and hands. It is especially common in the knuckles and middle joints of the hands. Pain and inflammation typically occur in the same joints on opposite sides of the body. Morning stiffness usually lasts for 45 minutes or longer, although the stiffness improves throughout the day. Fatigue is common.

RA may affect joints other than the hands, including the feet, knees, elbows, neck, shoulders, hips and ankles. Sometimes it affects organ systems such as the lungs or kidneys. Over time, if left untreated, the inflamed joints may become irreversibly damaged and deformed, although this is not always the case.

A doctor can determine if you have RA based on your symptoms, a physical examination, and results of x-rays and blood tests. Laboratory tests3 can be very helpful in diagnosing RA. One of the more common diagnostic blood tests for RA screens for a substance in the blood called the rheumatoid factor (RF). Seventy-five percent of patients with RA have this abnormal protein in their blood, although people who do not have RA sometimes have RF in their blood. Some people with the rheumatoid factor develop lumps under the skin called rheumatoid nodules. The back of the elbow is a common location. These nodules are usually not painful and typically do not affect joint function.

A newer screening test for RA, called the anti-cyclic citrullinated peptide (CCP) antibody test, was introduced in 2003. This test is considered to be more accurate than screening for the rheumatoid factor in patients where RA is suspected. The anti-CCP test screens for the presence of antibodies to CCP (also known as “CCP autoantibodies”). The test has been found to be effective in identifying patients with early, mild arthritis who may be at increased risk for developing a more severe, erosive form of RA.

Two additional laboratory tests are also usually ordered when RA is suspected. The first is the erythrocyte sedimentation rate (ESR) test. The second is the C-reactive protein (CRP) test. Elevated CRP and sedimentation rate are measures of joint inflammation, a key sign of RA. Like osteoarthritis, there is no cure for rheumatoid arthritis. Treatment focuses on reducing inflammation and preventing further damage, which can help to relieve pain, improve joint mobility and decrease fatigue. Medications are prescribed to help in these areas and slow the progression of the disease. Diet, exercise and rest also play a role in improving range of motion, energy and sense of well-being.

The above information on rheumatoid arthritis is from Dr. Zashin's book, Arthritis Without Pain, a comprehensive guide for patients considering or undergoing treatment with the TNF blockers Enbrel®, Remicade®, or Humira®. All rights reserved.

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