Rheumatoid Arthritis.
Last updated Wednesday, September 14, 2005
SymptomsWhat are some initial warning signs of rheumatoid arthritis? Initial symptoms of rheumatoid arthritis (RA) are generally pain and stiffness in the morning and few symptoms with activity.
The pain and swelling will usually progress on to obvious joint
swelling and the level of stiffness in the morning increases. Other
symptoms include fatigue and difficulty sleeping due to joint stiffness.
What are symptoms of rheumatoid arthritis? Rheumatoid arthritis can be distinguished from other forms of arthritis by the location and number of joints
involved. The areas affected include the neck, shoulders, elbows,
wrists, and hands especially the joints at the base and middle of the
fingers but not the joints at the end of the fingers. In the lower
extremities, RA can affect the hips, knees, ankles, and the joints at
the base of the toes. RA tends to spare the low back. The joints
affected tend to be involved in a symmetrical pattern. That is, if
knuckles on the right hand are inflamed, it is likely that knuckles on
the left hand will be inflamed as well. This symmetry is not found as
often in most other types of arthritis.
Fatigue
in RA is due to many factors. It can be due to the inflammation which
produces chemicals called cytokines that commonly cause fatigue. People
with RA might have a mild anemia that also might contribute to fatigue
and the sleep disturbance from night time pain may also be a factor.
Finally, people with RA tend to decrease their exercise and thus lose stamina and strength and this might also play a role in their fatigue.
How do the symptoms of rheumatoid arthritis change over time? About one in 10 people with RA will have a single episode of disease
activity (or joint inflammation) and a spontaneous long-lasting
remission. However, in almost all people with RA, inflammation of the joints
will persist for a long period of time. The way RA acts will vary from
person to person. In some people the disease will be mild with periods
of activity (worsening joint inflammation) called "flares." In other
cases the disease will be continuously active and appear to get worse,
or progress, over time.
Inflamed joints will be warm, swollen, tender, often red, and
painful or difficult to move. These physical signs of arthritis are due
to inflammation of the lining of joints and tendons in a layer of
tissue that is called synovium. The cells of the immune system within
the synovium appear active and capable of causing tissue damage. If
this inflammation persists or does not respond well to treatment,
destruction of nearby cartilage, bone, tendons, and ligaments can
follow. This may lead to deformity and disability that can be permanent. However, many patients with rheumatoid arthritis are able to get improved function and pain relief from surgical reconstruction of the damaged joints, such as total hip arthroplasty, total knee arthroplasty, and total shoulder arthroplasty.
Over the last two decades, a much more aggressive approach to
treating RA has been advocated. It was recognized that once the joints
were damaged by the disease, the cartilage rarely returns to normal
even if the RA later goes away. Treatment is now much earlier that it
used to be. The goals of treatment are to relieve pain and
inflammation, slow down or prevent destruction of joints, and restore
the use and function of areas that already have been damaged.
Rheumatoid nodules
About one-fifth of people with RA also develop rheumatoid nodules,
which are lumps of tissue that form under the skin, often over bony
areas. These occur most often around the elbow but can be found
elsewhere on the body and even in internal organs. Occasionally, people
with RA will develop inflammation of the membranes lining that surround
the heart (pericarditis) and lung (pleuritis). RA can also cause an
emphesema like condition called rheumatoid lung that can affect a
person's ability to breath comfortably. People with RA often develop
dry eyes and a dry mouth due to inflammation of tear glands and
salivary glands (called sicca syndrome). Occasionally a low white blood
cell count may occur because of the rheumatoid arthritis. Rarely,
people with RA develop vasculitis inflammation of blood vessels that
can cause illness affecting the skin, nerves, and other organs or
tissues. An usual condition called Felty's syndrome is rheumatoid
arthritis, low white blood cell counts and enlargement of the spleen.
All of the above conditions are rare with the exception of rheumatoid
nodules. The nodules tend to occur in people with more serious forms of
RA.
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