rheumatoid arthritis A chronic, autoimmune
disorder in which nodules and INFLAMMATION
develop within the synovial capsules of the joints,
causing erosion of the BONEand connective tis-
sues, eventually deforming the JOINT. Synovial
membranes encapsulate the joints and secrete
synovial fluid, which lubricates the structures of
the joint so they move smoothly and freely against
each other. The antibodies that characterize
rheumatoid arthritis attack the cells of the syn-
ovial membrane, causing inflammation and an
IMMUNE RESPONSEthat treats the cells as though
they were invaders. The repeated inflammation
over time results in fibrosis (scarring) that destroys
the ability of the cells to produce synovial fluid
and constricts the movement of the joint.
About two million Americans have rheumatoid
arthritis, two thirds of them women. Rheumatoid
arthritis most commonly develops between the
ages of 20 and 50, though can occur in children
(juvenile rheumatoid arthritis). Although treat-
ments and lifestyle strategies can reduce inflam-
mation and relieve symptoms, at present there is
no cure for rheumatoid arthritis.
IS IT RHEUMATOID ARTHRITIS OR OSTEOARTHRITIS?
Arthritis is any condition of INFLAMMATIONthat
affects the joints. OSTEOARTHRITISis the form most
people identify; about 20 million Americans
have osteoarthritis. Though both forms involve
inflammation of the joints, the two conditions
are quite different. In osteoarthritis inflammation
occurs in response to damage, usually that of
repeated wear and tear, within the joints. In
rheumatoid arthritis, the inflammation occurs
first as a malfunction of the IMMUNE RESPONSEand
causes damage to the joints. Osteoarthritis is
more common in people over age 65, whereas
rheumatoid arthritis usually arises before age 50.Symptoms and Diagnostic PathThe symptoms of rheumatoid arthritis typically
include
- PAINand swelling in the joints, especially the
small joints of the hands and fingers - stiffness in the joints, especially upon awaken-
ing or after long periods of inactivity- low-grade FEVER
- fatigue and weakness
- rheumatoid nodules, painless bumps under the
SKINthat develop at pressure points - joint deformity as the disease progresses
- low-grade FEVER
The diagnostic path includes BLOOD tests to
detect antibodies and other indications of inflam-
mation. Many people who have rheumatoid
arthritis have a specific ANTIBODYcalled rheuma-
toid factor, though not all people who have
rheumatoid arthritis have this antibody, and con-
versely, rheumatoid factor may be present in peo-
ple who do not have rheumatoid arthritis. Blood
levels of C-REACTIVE PROTEIN also can indicate
whether inflammation exists in the body. X-rays
can help the doctor evaluate and monitor damage
to the joints and bones.Treatment Options and Outlook
Treatment typically blends lifestyle measures to
protect affected joints from undue stress and med-
ications to relieve inflammation and pain. Daily
exercise and activity that puts each affected joint
through its complete range of motion help keep
SCARtissue from contracting (tightening) within
the synovial capsule, maintaining relative freedom
of movement. Activities such as YOGAand TAI CHI
also improve FLEXIBILITY, range of motion, and bal-
ance. Omega-3 fatty acids and folic acid may block
steps in the inflammatory response that reduce its
intensity. Stress management methods such as
MEDITATIONhelp people to cope with the challenges
of a chronic health condition.
Mild rheumatoid arthritis symptoms, especially
pain, often respond to NONSTEROIDAL ANTI-INFLAM-
MATORY DRUGS(NSAIDS). Acetaminophen may also
relieve pain, though it does not reduce inflamma-
tion. Topical preparations such as capsaicin and
complementary therapies such as ACUPUNCTUREand
REIKI may provide relief from pain and other
symptoms. Medications for moderate to severe
symptoms may include CORTICOSTEROID
MEDICATIONS, which suppress the inflammatory
response, and DISEASE-MODIFYING ANTIRHEUMATIC
DRUGS (DMARDS), which block the immune
response in various ways, depending on the med-rheumatoid arthritis 291