Rheumatoid Arthritis

Rheumatoid arthritis is a disease attacking the lining of the joints. The white blood cells, whose normal job is to defend the body against viruses and bacteria, move into and attack the membranes surrounding the joints. The resulting inflammation not only causes swelling, but also aches and joint throbbing and can lead to deformation. Rheumatoid arthritis is more common in women and sufferers typically see onset between 40 and 60 years of age. However, rheumatoid arthritis can occur in children as well as the elderly.

Rheumatoid arthritis most often first occurs in the smaller joints. These joints include: hands, wrists, feet, and ankles. With disease progression, larger joints eventually become effected including: knees, hips, elbows, shoulders, neck, and the jaw. There are a variety of symptoms individuals should watch for that may indicate the onset of rheumatoid arthritis.

Joint tenderness, pain and swelling is one of the most common signs of the disease. Redness and puffiness in the hands may also occur. Rheumatoid nodules, hard tissue lumps under the skin especially on the arms, are common. Other less innocuous signs include: morning stiffness, fatigue, weight loss, and fever. In addition to these symptoms, individuals should be aware of the risk factors of this debilitating disease.

As mentioned, gender is a significant risk factor of rheumatoid arthritis, with women much more likely to contract the disease than men. Age too plays a factor, again with those between the ages of 40 and 60 at highest risk. Family history also plays a part. Those who have a family member with rheumatoid arthritis are more predisposed to developing the disease. Lastly, smoking has also been found to be a significant factor in the disease.

Currently, there is not a cure for those suffering from rheumatoid arthritis. However, there are a variety of treatment options available that can help in reducing inflammation and relieve associated pain, as well as slow or stop the rate of damage to the joints. Treatment plans most often consist of medications, although surgery is an option in instances where severe joint damage is present. In order to reduce disability from the disease, an aggressive and early treatment plan is recommended.

The medications prescribed vary depending on the severity of the patient's disease, the presenting symptoms, blood test results, x-rays, and the length the patient has been experiencing symptoms. Medications most often prescribed for rheumatoid arthritis include:

- NSAIDs (Nonsteroidal anti-inflammatory drugs)
- Steroids
- DMARDs (Disease-modifying antirheumatic drugs)
- Immunosuppressants
- TNF-alpha inhibitors
- Anakinra (Kineret)
- Abatacept (Orencia)
- Rituximab (Rituxan)

The American College of Rheumatology (ACR) now recommends minocycline or hydroxychloroquine for those suffering from rheumatoid arthritis for less than a period of two years. They also now recommend sulfasalazine for all levels of rheumatoid arthritis, when the prognosis is not poor. For those with or without a poor prognosis, the ACR recommends the use of leflunomide or methotrexate. Lastly, for those patients with severe rheumatoid arthritis, a combination of TNF-alpha inhibitor and DMARDs is the treatment recommended.