Myths of Rheumatoid Arthritis Explained:
Rheumatoid Arthritis is an chronic inflammatory disease that causes pain,swelling,stiffness
and loss of function in the joints.It has several special features that make it different from other types of arthritis.
RA occurs in a symmetrical pattern.If one knee or hand is involved the other one is usually,
also affected. The disease often affects the wrist and finger joints closest to the hand.It can also affect other parts
of the body beside the joints.
In addition people with the disease may have fatigue,and a general sense of not feeling
well (malise).RA often mimics other rheumatic diseases and at the early stages,the full symptoms may not appear till later
on in the course of the disease. RA affects patients in different forms and manner.
For some people the disease is mild,and non-erosive that lasts only a few months
or a year or two and goes away without causing any major damage. There are periods in which the patient may feel
better with little or no symptoms of the disease called remissions.
Still others,have moderate-severe-erosive disease that is active most of the time that lasts for
many years (life-time) and it can lead to serious disability and damage.
Rheumatoid Arthritis will profoundly change your life. Most people do not think about our health,until
it is threatened. Hardly any one thinks about joint disease until pain,stiffness and loss of function affects us.A disease
such as RA,which affects the whole system will limit quality of life.
It can be difficult to diagnose R.A. in its early stages.R.F.(rheumatoid factor)
is not always conclusive in the early stages since some people who do not have R.A.have a slight R.F.in the blood stream although
80% of R.A. patients do have positive R.F.
E.S.R. or "sed" is useful but not conclusive in the early stages-checks inflammation rate.
Anti-nuclear antibody testing-positive results, without underlying disease present-usually
helps in determining if inflammatory disease is involved-it's not conclusive.
Synovial fluid assessment can be taken and to assist the clinician's knowledge of
the amount of inflammation present in a joint.
X-rays should be taken at the start and later compared,but in the early stages of
disease it may not be helpful.
RA can not be diagnosed by one test alone,a number of tests are done and the
total results are analyzed for a formal diagnosis. A person may look "normal",yet have severe RA. This misconception
of the disease is one of the major factors contributing to the "myths"of RA.
There are three major forms
of R.A., mild, moderate and severe.A important factor is to have the disease determined as to its severity
and type. An excellent analogy is the weather conditions,Windy, Storm,and Hurricane, with respect to prognosis.
Medication,treatment and exercise capability of the patient will be different for each
case. Most of the damage is done in the early stages, estimated at 2 years after onset
of disease. Once damage is done it is not reversible.
Mild R.A.(30% of patients have the mild form)characterized
by symmetrical joint inflammation(both left and right sides)pain,swelling and stiffness,which usually occurs first thing in
the morning. Joint function may be slightly decreased.
The only extra-articular feature is painful inflammation of the tendons(tendonitis) R.F.
is usually negative or slightly positive in most patients diagnosed with mild R.A. The arthritis remains mild throughout its
course.
Some patients have a very short course,but in others it may recur or be constantly
present for years.Deformity may or not be present.
Medication: NSAIDs(non-steriodal anti-inflammatory drugs in the aspirin family.DMARDs
(disease modifying drugs)may,or may not be prescribed.
Moderate R.A.-30%-40% have the moderate type. They have
much more pain,swelling,stiffness, more joints affected,and loss of everyday function then those patients with the
mild form.
Hands,wrists,elbows,knees and feet are usually all involved. Often moderate R.A.is
accompanied by early loss of movement and morning stiffness that can last for 1 to 3 hours or more.
Tendonitis nodules(bumps over pressure points develop). Some may develop internal organ
disorder,R.F.increases 2 to 3 times normal.
Medication: NSAIDs and DMARDs. The use of DMARDs was once used mainly in severe
cases only,at the onset of disease.Since damage to joints is not reversible,DMARD therapy is encouraged at the early
stages of the disease process.
Severe R.A.:10% of RA patients have the severe form,severe means
severe,function is severely affected. Deformity usually occurs within the first few months. Sufferers of this type feel
tired,very weak,and ill. Severe RA is often accompanied by extra-articular features,besides
joint damage. Connective tissue may be involved.
Inflammation may develop subcutaneous nodules. The internal organs may become
involved in the on-going process of the disease. Lungs, rib cage muscles, jaw joints,eyes,and swelling of blood vessels
may also occur(vasculitis).
Often R.F. is strongly positive.Without a aggressive DMARDs therapy-disability,and a possible
shortened life span. Extra-articular features are usually involved.(EAFs are not limited to one class)
10 to 15% of all RA patients have the type of arthritis characterized by stiffness. This
type of RA leads to abnormal tightness rather then swelling in the small joints of the hands, wrist,shoulders,and occasionally
the feet and knees.
The stiffness is marked,EAFs are rare in this type of arthritis. Loss of function is the
major problem caused by this stiffness.
Most older DMARDS were drugs used in treating other diseases such as Cancer,T.B.,M.L.S.etc. Its possible,damaging
side efffects can cause other serious side effects to internal organs.
Physician monitoring of therapy through appropriate laboratory tests will eliminate most of the serious side
effects caused by some RA medications.