Understanding Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is a chronic autoimmune disorder classified as a type of arthritis which causes pain, swelling, fatigue and progressive joint damage. RA is typically found in a symmetrical pattern, that is, effecting both sides of the body simultaneously, such as in the hands, feet, knees, elbows and hips. Osteoarthritis is found in the same joints, but generally will not be symmetrical. RA typically begins in the small joints of wrists and fingers. It becomes progressively more difficult to perform simple tasks such as opening jars and bottles, buttoning shirts and tying shoestrings. As the disease progresses, RA effects elbows, feet, knees, and hip joints. Walking can become extremely painful and difficult. Sitting for long periods of time as well as sleeping at night will cause joint stiffness. It is as if the joints freeze up and become difficult to move.

RA affects the synovium, the fluid found within the membranes of the joints. This inflammation in the synovium produces proteins that cause the fluid to thicken. The proteins damage the ligaments, cartilage and bone causing the joint to lose its shape as well as its proper alignment.

Interview with Dianna

I have a friend, Dianna, who was diagnosed with Rheumatoid Arthritis in 2004. Prior to her diagnosis, she had osteoarthritis, hypothyroidism, irritable bowel syndrome and gastroesophageal reflux disease. She had no family history of RA, although her mother did exhibit early symptoms of the disease prior to her death ( from other causes) in 1991.

The Mental and Emotional Aspects of Rheumatoid Arthritis

There is currently no cure for RA but proper treatment can improve quality of life. Those who live with any chronic disease, such as RA, will need to allow for those days when flare-ups occur. Flare-ups in RA will require additional periods of rest, which can alter schedules and plans temporarily. Family members and friends need to know this and be understanding and accommodating. The RA patient will also need to remember that this disease process will necessitate changes in schedules from time to time and they should accept this as a fact of their life without feeling guilty. Any chronic disease that disrupts life can also cause depression. Accepting the disease as a part of life and knowing that interruptions can occur are all part of living with a chronic disease. Taking good care of yourself is key to living well with Rheumatoid Arthritis.

Interview with Dianna

My friend has found that it helps her a lot when people in her life are supportive and patient with her. She has good days and bad days and lives with pain on a constant basis. She states that she has no days when she is totally pain-free. She is able to function well most days, but suffers from fatigue as her day progresses.

What Are the Symptoms and How Is RA Diagnosed?

Signs and symptoms of RA can come and go and usually will begin in the smaller joints such as the fingers, wrists, ankles and toes. According to information provided by the Mayo Clinic, the following are typical symptoms of rheumatoid arthritis:

Joint pain and swelling with tenderness to the touch

Red and swollen hands

Bumps beneath the tissue of your skin, known as rheumatoid nodules

Fatigue

Morning Stiffness

Fever

Weight Loss

Difficulty sleeping due to pain

When a patient presents with these symptoms, the doctor will run some standard tests, which include blood tests to look for the rheumatoid factor. People with RA tend to have and elevated ESR or Sed rate which indicates an inflammatory process in the body. These factors can also be present in other autoimmune disorders and it is important to determine which disease process is at work. The doctor may also perform a needle aspiration of synovial fluid for analysis in order to rule out other conditions.

Interview with Dianna

Dianna has also had the standard tests for Rheumatoid Arthritis and has suffered from all of the symptoms of this chronic disease process.

Treatments for Rheumatoid Arthritis

Treatments range from NSAIDs, Steroids, Anti-Rheumatic Drugs, Immunosuppressants, TNF Inhibitors, such as Enbrel, Remicade, Humira. Those who do not benefit from TNF Inhibitors are often tried on Orencia or Rituxin to help reduce inflammation and joint pain.

Most RA treatments are trial and error and will be changed based upon the patient's response to each type of medication as the disease progresses.

Interview with Dianna

In the more than four years since Dianna's diagnosis, she has tried Methotrexate, Plaquenil, Prednisone, Humira, Orencia, and Rituxan. She has had very good results from Rituxin and has remained relatively symptom-free from the Rituxin IV infusions. She was able to function well for 21 months following the first treatment with Rituxin and has recently been treated a second time with this same medication. Rituxin has been the best treatment form for her to date even though she still has morning stiffness and more pain and stiffness in cold weather. She is able to perform most of her day-to-day activities but she does require additional rest as a routine part of her life.

It is important to have routine follow-up with your physician and to follow their instructions carefully. All of the drugs used to treat RA have side effects and any possible side effect should be immediately reported to your physician.

Interview with Dianna

Dianna states that side effects on Rituxin were hair loss and nausea which lasted about two months. The improvement she gained with this drug has been worth the temporary discomforts and she is doing well today. The average improvement from Rituxin treatments is from 6 months to 1 year, but Dianna had 21 months of relief from her first treatment and is hoping for at least that much improvement from her recent second treatment.

Sources:

Personal Interview

http://www.mayoclinic.com/health/rheumatoid-arthritis/DS00020

http://www.webmd.com/rheumatoid-arthritis/default.htm