Rheumatoid arthritis

Rheumatoid arthritis

Arthritis has been known to mankind since ancient times and the first knowledge about this problem dates back to 4500 BC. Remarkablym, the first traces of this illness was not only found in the remnants of ancient people but also in written resources which described symptoms of arthritis in 123 AD. However, it was clearly defined and got its name only in 1859. Rheumatoid arthritis is one of the gravest forms of arthritis. It is a chronic, inflammatory disease which results in the immune system attacks of the joints. As a result, individual suffering from this disease loses mobility because of the inflammatory that provokes pain and joint destruction. Moreover, what increases sufferings of patients is the fact that the disease may be chronic and may eventually lead to loss of function and complete disability. What is more, the disease may produce negative impact on extra-articlar tissues of the body.
Features
Speaking about potential ‘victims’ of this diseas, it should be pointed out that people at the age of 20-40 are the groups of a higher risk though the other age categories are not totally prevented against this health problem. Also, the family history may increase the risk of this disease if there are clinical cases in the family tree. Remarkably, women are three times more exposed to this disease than men as well as smokers are also at four times greater risk than non-smokers.
As it has been already mentioned above, RA is a chronic, inflammatory, autoimmune disorder in the result of which joints are affected in polyarticular manner. A particular feature of this type of arthritis is inflammation and soft-tissue swelling of many joints at one and the same time. The joints are dramatically affected and its manner gradually transforms from asymmetrical to symmetrical. The affected joints provoke serious pain if used and usually in the morning they are characterized by stiffness within an hour.
As the disease progress, the affected joints are getting to be deformed because of erosion and destruction. Remarkably the first joints exposed to the disease are those of fingers, wrists and feet.
Often the disease is accompanied by anemia, provoked either by disease itself or by drugs used in treatment, as well as splenomegaly, and leukopaenia. Also salivary and lachrymal glands may be affected by lymphocytic infiltration.
There may also occur dermatological, pulmonary, autoimmune, renal, ocular, cardiovascular, and neurological consequences of RA.
Diagnosis
Traditionally there are defined the following criteria which help define clearly the diagnosis of the RA. To put it more precisely, according to the research of Arthritis Foundation (1)they are as follows
• Morning stiffness of >1 hour.
• Arthritis and soft-tissue swelling of >3 of 14 joints/joint groups
• Arthritis of hand joints
• Symmetric arthritis
• Subcutaneous nodules in specific places
• Rheumatoid factor at a level above the 95th percentile
• Radiological changes suggestive of joint erosion
Basically, it is considered that four criteria have to be met in order to define that it is the RA, though these criteria may be not typical for early stages of the development of the disease.
On diagnosing the disease, it is necessary to take into consideration the following factors: medical history and physical examination, regarding the joints affected, joint swelling, warmth and range of movement, as well as the presence of nodules under the skin (2)
In order to define the degree of joint involvement or joint damage X-rays, sonograms or magnetic resonance imaging may be used.
A blood etst may be also helpful in diagnosing the RA since it can reveal the presence of an antibody called rheumatoid factor (RF), which is found in 80 percent of people with RA, although it is present in 10% of healthy population. Because of the low specificity of a blood test, a new serological test has been recently developed, which detects the presence of so called anti-citrullinated protein (ACP) antibodies. Like RF, this test can detect about 80% of all RA patients, but it can hardly be positive in non-RA patients, giving it a specificity of around 98%. Moreover, this test can detect ACP antibodies in early stages of the disease, or even before disease onset.
Treatment
Basically, the treatment is focused on the prevention of the cause of the disease, decreasing of pain and swelling, as well as prevention the dangerous effect of the disease such as stiffness and damage of joints.Treatment plans often use to combine the rest, exercise, joint protection, use of heat or cold to relieve pain, and physical or occupational therapy.
Disease-modifying antirheumatic drugs (DMARDs), anti-inflammatory agents and analgesics make up pharmacological treatment of RA that are traditionally used to slow down the progression of the disease. In particular they prevent bone and joint damage from occurring after the uncontrolled inflammation. This is important as such damage is generally irrevocable. Anti-inflammatories and analgesics can help to improve pain and stiffness but do not prevent joint damage or slow the disease progression.
A lot of rheumatologists consider that permanent damage to the joints can occur at early stages of disease. Earlier the treatment started with just anti-inflammatory drugs along with the clinical and X-ray assess of the progression. Disease-modifying antirheumatic drugs would be prescribed if any joint damage was detected. The use of ultrasound and MRI have revealed the fact that joint damage occurs much earlier than was previously thought. For this reason, it is logical to start a DMARD once the diagnosis of RA is certain in order to prevent damage. Even a few months of therapy delay can result in worse outcomes.
Another way to lessen the pain and stiffness associated with arthritic inflammation is to keep to a carefully controlled diet and to exercise regularly.


Conclusion
Rheumatic arthritis is a severe chronic inflammatory disease. It generally affects joints and results in chronic pain, impairment of range of joint movement, loss of functionality and can eventually cause disability.
Nobody’s certain about the causes of rheumatic arthritis. It can be caused by an infection as well as it can be a family history.
The main symptoms of rheumatic arthritis are as follows: painful and swollen joints, especially in your hands, feet and knees, difficulty moving joints, fever, fatigue, and loss of appetite. Your joints can be especially painful and stiff in the morning for about an hour or so. As the joints are involved in different kind of work, the pain improves.
The progression of the disease differs greatly from patient to patient. Some patients have mild short-term symptoms, but generally the pathology is progressive for life. After 5 years of disease, about 33% of patients will lose their ability to work. After 10 years, the patient will have substantial functional disability in half of the cases. Life expectancy for RA patients is shortened by five to ten years, although lower mortality rates are expected if the patient responds to therapy.
The rheumatic arthritis is a lifelong pathology. If it’s properly treated, it can go away for some time, but generally it comes back again. One should consult his doctor once he has any of the symptoms.


References

1. “Rheumatoid Arthritis Fact Sheet.” Arthritis Foundation. <www.arthritis.org/conditions/Fact_Sheets/RA_Fact_Sheet.asp>
2. “Rheumatoid arthritis.” Wikipedia, The Free Encyclopedia. 13 Oct 2006, 15:32 UTC. Wikimedia Foundation, Inc. <http://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&oldid=81224260>.