Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a long-term disease that leads to inflammation of the joints and surrounding tissues. It can also affect other organs.

History of Rheumatoid Arthritis.

Arthritis was first diagnosed and documented around 4500 BC. However, the symptoms, quite similar to those of rheumatoid arthritis, were first documented in a text that dates back to 123 AD. These symptoms were noted in the Native American skeletal remains from Tennessee.

According to the available historical records of rheumatoid arthritis, it is quite clear that this condition was very rare in Old World, the period before the 15th century. It is, therefore, believed that it was during the Exploration Age that this condition spread across the Atlantic.

Jim Mobley of Pfizer, in one of his research, has attributed the rheumatoid arthritis spikes to the selective pressure that is caused in tuberculosis. However, surprisingly, no symptoms of tuberculosis were found in the Pre-Columbian bones excavated at Tennessee. But, later researches proved that the human immune system usually becomes hyper-vigilant against tuberculosis to the detriment of increased susceptibility to autoimmune diseases like rheumatoid arthritis. The detrimental effects of this condition have also been depicted in the incredible 16th century art of Peter P. Rubens. However, this fact is debatable as some people see his art as just another art form that followed the stylized conventions of the Mannerist Movement.

It was in the year 1800 that the very first detailed account of rheumatoid arthritis was documented by Dr. Augustine J. Landre-Beauvais, a French physician from the famous Paris hospital, named Salpetriere. The present day name, rheumatoid arthritis, was given to this condition in the year 1859 by Dr. Alfred B. Garrod, a British rheumatologist.

Causes, incidence, and risk factors

Fungal infection, bone marrow.

The cause of RA is unknown. It is an autoimmune disease, which means the body's immune system mistakenly attacks healthy tissue. This is a chronic disease, which means that it stays with the patient and people are never fully cured. But often patients can live without showing any symptoms of the diseases for many years. With the passing of the years, it can become progressive and can cause joint destruction and functional disability in people afflicted with the disease. RA can occur at any age, but is more common in middle age. Women get RA more often than men.Infection , genes, and hormone changes may be linked to the disease.

Symptoms

RA usually affects joints on both sides of the body equally. Wrists, fingers, knees, feet, and ankles are the most commonly affected.

The disease often begins slowly, usually with only minor joint pain, stiffness, and fatigue.

Joint symptoms may include:

X-ray of hand of a rheumatoid arthritis patient.

• Morning stiffness, which lasts more than 1 hour, is common. Joints may feel warm, tender, and stiff when not used for an hour.
• Joint pain is often felt on the same joint on both sides of the body.
• Over time, joints may lose their range of motion and may become deformed.
  
  

Other symptoms include:

• Chest pain when taking a breath (pleurisy)
• Dry eyes and mouth (Sjogren syndrome)
• Eye burning, itching, and discharge
• Nodules under the skin (usually a sign of more severe disease)
• Numbness, tingling, or burning in the hands and feet
  

  

  appearance of nodules

  
  

Signs and tests

There is not test that can determine for sure whether you have RA. Most patients with RA will have some abnormal test results, although for some patients, all tests will be normal.

Two lab tests that often help in the diagnosis are:

• Rheumatoid factor test
• 

  Anti-CCP antibody test

Other tests that may be done include:

• Complete blood count
• C-reactive protein
• Erythrocyte sedimentation rate
• Joint ultrasound or MRI
• Joint x-rays
• Synovial fluid analysis
  
  
  
  
  

  

  Rheumatic factor test

  
  
  
                                         
  
  
  Treatment

RA usually requires lifelong treatment, including medications, physical therapy, exercise, education, and possibly surgery. Early, aggressive treatment for RA can delay joint destruction.

MEDICATIONS

Disease modifying antirheumatic drugs (DMARDs): These drugs are the first drugs usually tried in patients with RA. They are prescribed in addition to rest, strengthening exercises, and anti-inflammatory drugs.

•      Methotrexate (Rheumatrex) is the most commonly used DMARD for rheumatoid arthritis.
  •  Leflunomide (Arava) and sulfasalazine may also be used.
  • These drugs may have serious side effects, so you will need frequent blood tests when taking them.
    
    

  Anti-inflammatory medications: These include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naprosen.

  • Although NSAIDs work well, long-term use can cause stomach problems, such as ulcers and bleeding, and possible heart problems.
  • Celecoxib (Celebrex) is another anti-inflammatory drug, but it is labeled with strong warnings about heart disease and stroke. Talk to your doctor about whether COX-2 inhibitors are right for you.
    
    

  Antimalarial medications: This group of medicines includes hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine), and is usually used along with methotrexate. It may be weeks or months before you see any benefit from these medications.

  Corticosteroids: These medications work very well to reduce joint swelling and inflammation. Because of long-term side effects, corticosteroids should be taken only for a short time and in low doses when possible.
  

  

  one injection to cure arthritis within 5 years.

  
  

  BIOLOGIC AGENTS:

  Biologic drugs are designed to affect parts of the immune system that play a role in the disease process of rheumatoid arthritis.

  They may be given when other medicines for rheumatoid arthritis have not worked. At times, your doctor will start biologic drugs sooner, along with other rheumatoid arthritis drugs.

  Most of them are given either under the skin (subcutaneously) or into a vein (intravenously). There are different types of biologic agents:

  • White blood cell modulators include: abatacept (Orencia) and rituximab (Rituxan)
  • Tumor necrosis factor (TNF) inhibitors include: adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), golimumab (Simponi), and certolizumab (Cimzia)
  • Interleukin-6 (IL-6) inhibitors: tocilizumab (Actemra)

  Biologic agents can be very helpful in treating rheumatoid arthritis. However, people taking these drugs must be watched very closely because of serious risk factors:

  • Infections from bacteria, viruses, and fungi
  • Leukemia or lymphoma
  • Psoriasis
    
    

  

  bone and joint pathology: this is the synovium in rhematoid arthritis.

  SURGERY

  Occasionally, surgery is needed to correct severely damaged joints. Surgery may include:

  • Removal of the joint lining (synovectomy)
  • Total joint replacement in extreme cases; may include total knee, hip replacement, ankle replacement, shoulder replacement, and others

  PHYSICAL THERAPY

  Range-of-motion exercises and exercise programs prescribed by a physical therapist can delay the loss of joint function and help keep muscles strong.

  Sometimes therapists will use special machines to apply deep heat or electrical stimulation to reduce pain and improve joint movement.

  Joint protection techniques, heat and cold treatments, and splints or orthotic devices to support and align joints may be very helpful.

  Frequent rest periods between activities, as well as 8 to 10 hours of sleep per night, are recommended.
  
  

  
  

  Expectations (prognosis)

  How well a person does depend on the severity of symptoms.

  People with rheumatoid factor, the anti-CCP antibody, or subcutaneous nodules seem to have a more severe form of the disease. People who develop RA at younger ages also seem to get worse more quickly.

  Without proper treatment, permanent joint damage may occur. However, early treatment with many of the newer medicines have decreased joint pain and damage.

  Complications

  Rheumatoid arthritis can affect nearly every part of the body. Complications may include:

  • Damage to the lung tissue (rheumatoid lung)
  • Increased risk of hardenign of the arteries
  • Spinal injury when the neck bones become damaged
  • Inflammation of the blood vessels (rheumatoid vasculitis), which can lead to skin, nerve, heart, and brain problems
  • Swelling and inflammation of the outer lining of the heart (pericarditis) and of the heart muscle (myocarditis), which can lead tocongestive heart failure

  The treatments for RA can also cause serious side effects. Talk to your doctor about the possible side effects of treatment and what to do if they occur.
  

                 
  

  
  

  
  

  
  

  Prevention
  There is no known prevention. Proper early treatment can help prevent further joint damage.