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Rheumatoid Arthritis: More than Achy Joints by Roberta Greenwood

Mention arthritis and most people think of a disease of the aging: knees that ache, fingers that can’t open jars as deftly as they used to, and joints that don’t move as smoothly as they once did. In truth, arthritis is a complex autoimmune disease that affects over 30 million Americans with symptoms ranging from joint pain to systemic disorders of the body. The result is chronic pain, loss of function and disability. While the more common osteoarthritis affects joint function by wearing away healthy cartilage that buffers the shock of movement on the body, rheumatoid arthritis is a chronic disease characterized by the inflammation of the synovium (lining) of the joints and can affect skin tissue, the lungs, eyes and blood vessels.

Rheumatoid arthritis (RA) is the second most common form of arthritis. It affects 1.3 million Americans and is three times more common in women than men. Studies conducted in the U.S. and Sweden indicate that women often develop RA at times when sex hormones are changing — such as pregnancy or menopause — and although the visible symptoms are the same, women indicate they feel more pain than their male counterparts and appear to respond to treatment less well. According to the National Institute of Arthritis, when the body’s own defense system doesn’t work properly, the immune system attacks the tissues of the joints, leading to pain, inflammation and, eventually, joint damage and deformity. RA may also affect internal organs and systems, causing some patients to suffer chronic fatigue, fever and depression.

Typically, RA progresses in three stages. First, the synovial lining swells; patients report pain, stiffness, redness and swelling around the joint. Many patients report a feeling of warmth at the affected sites. RA is often symmetrical — an inflamed joint on the left side of the body (in a hand, wrist or knee, for example) will also be inflamed on the right side. Second, a rapid division and growth of cells causes the synovium to thicken and inhibit movement. In the third stage, the inflamed cells damage bone and cartilage, often causing deformity of the joint, increased pain and loss of mobility. While RA affects patients differently, researchers have determined that bone damage usually occurs during the first few years, and that early diagnosis and treatment can have a significant impact on the progression of the disease.

While joint pain and loss of movement are the most common symptoms of RA, many patients develop other symptoms that compromise their overall health. A systemic disease, RA often affects organs in the body. Inflammation of the blood vessels can occur, affecting the lungs and the sac which encloses the heart; anemia (decrease in the production of red blood cells), dry eyes and mouth, neck pain and chronic fatigue are also attributed to RA.

CAUSES OF RA

The Arthritis Foundation reports that rheumatoid arthritis can affect people differently and that symptoms range from very mild to severe. For some, it lasts only a short period of time (often a few months) and doesn’t cause any noticeable damage. Others have mild to moderate forms of the disease, with periods of worsening symptoms (flares) and periods in which they feel better (remissions). However, many have a severe form of the disease that is active most of the time, lasts for many years or a lifetime, and leads to serious joint damage and disability.

The cause of rheumatoid arthritis is still unknown — researchers haven’t determined what causes the immune system to turn against itself and damage the body. Certain genetic factors may contribute to the tendency to develop RA, and the disease seems to run in families. Many scientists think a viral or bacterial infection may trigger symptoms in people who are susceptible to the disease. Hormonal factors may also be involved; pregnancy is thought to improve the disease — with flare-ups occurring after delivery. Breast-feeding for longer than six months has been shown to decrease the risk of RA, and some studies indicate that women with highly irregular menstrual cycles have a slightly higher risk. Of possible environmental factors, only smoking has been associated with RA.

While an exact cause isn’t yet known, early diagnosis and aggressive treatment have been shown to decrease the joint damage and pain associated with RA. New drugs, joint protection techniques and self-care strategies can be combined to treat RA and increase the likelihood of maintaining an active and productive lifestyle.

DIAGNOSIS AND TREATMENT

Establishing a complete medical history and communicating clearly with a health care provider is crucial for a correct diagnosis; RA can have symptoms that are similar to other forms of arthritis or joint conditions. Accurately describing symptoms — pain, stiffness, lack of motion — is important because RA can develop over time, with only a few symptoms present in the early stages. Physical exams focus on joint mobility, skin conditions, reflexes and muscle strength. Often, primary care physicians will refer patients to rheumatologists once the initial diagnosis is confirmed.

Because the symptoms of RA differ from one patient to the next, initial diagnosis is often difficult. While no single test for the disease exists, testing positive in a rheumatoid factor blood test is often the first indicator that RA is present. However, not all people with RA test positive for rheumatoid factor, while some test positive but don’t develop the disease. Other common laboratory tests include a test of the erythrocyte sedimentation rate (the sed rate), which measures inflammation in the body, and a test for C-reactive protein (also an inflammatory marker) which measures disease activity. X-rays can be used to determine the amount of bone damage present and are useful in monitoring the progression of the disease. Also, once treatment has begun, ongoing blood tests for liver function are critical as some medications prescribed for RA can damage the liver.

Once diagnosed, patients can expect a variety of approaches to treat rheumatoid arthritis. The overall goals are to relieve pain, reduce inflammation, slow down joint damage and improve the quality of life. A likely combination of treatment options will include lifestyle modifications, medications, routine monitoring and, in some cases, surgery. Rest and exercise are crucial to managing RA, and achieving a proper balance between the two can result in less pain, reduced joint inflammation, increased mobility and a sense of wellness.

Self-care plays an important role in controlling the pain associated with RA. Devices (zipper-pullers, jar openers, platforms that assist patients getting up from chairs or beds, and splints) reduce stress on joints and can aid patients in keeping up their current lifestyle. The reduction of emotional stress (through regular rest periods, meditation, acupuncture and visualization techniques) has been found to decrease the pain reported by RA patients. A healthy, whole-foods approach to diet is also considered part of a successful treatment plan. Researchers conducting a study at Penn State found that whole grains lowered the levels of C-reactive protein, which is also associated with high blood pressure and heart disease, by 38 percent. Additionally, researchers have found that the omega-3 fatty acids found in fish and plant seed oils reduce RA inflammation.

Most patients with RA will take some form of medication — these range from over-the-counter pain-relievers to steroids and disease-modifying antirheumatic drugs (DMARDS). Biologic response modifiers are newer treatments for RA, and they work to reduce inflammation and joint damage by blocking certain proteins that trigger inflammation. Current treatment protocols call for early, aggressive intervention and a combination of several medications isn’t uncommon. Appropriate follow-up care is essential to patient well-being, and once the disease is improved or in remission, medications may be reduced or even eliminated. Surgery is indicated for patients with severe joint damage; commonly performed procedures include joint replacement and tendon reconstruction. RA also increases the risk of developing osteoporosis, particularly if a patient is on corticosteroids; preventive actions such as taking calcium and vitamin D supplements, hormone replacement therapy or other osteoporosis treatments may be needed.

Rheumatoid arthritis can be a debilitating disease for women — one that is difficult to diagnose and challenging to treat. However, according to The National Institute of Arthritis, there are strategies available that can have a positive impact on a patient’s sense of well-being. While scientists don’t know why it develops or why some patients get the disease more severely than others, the diagnosis isn’t as limiting as it once was. With the investigation of new technologies, increased research, and a deeper understanding of the mind-body connection, women diagnosed with RA can expect to remain active and engaged in life far longer than was possible even a decade ago.

Roberta Greenwood is a frequent contributor to Seattle Woman.

SYMPTOMS OF RHEUMATOID ARTHRITIS

• Tender, warm, swollen joints
• Symmetrical pattern of affected joints
• Joint inflammation often affecting the wrist and finger joints closest
to the hand
• Joint inflammation sometimes affecting other joints, including the neck, shoulders, elbows, hips, knees, ankles and feet
• Fatigue, occasional fevers, a general sense of not feeling well
• Pain and stiffness lasting for more than 30 minutes in the morning or
after a long rest
(courtesy of the NIH)

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