ARTRITIS REUMATOID

    More than one in seven Americans experience the nagging pains and physical limitations of arthritis. There are more than 100 forms of arthritis. Rheumatoid arthritis is among the most debilitating of them all, causing joints to ache and throb and eventually become deformed. Sometimes these symptoms make even the simplest things — like opening a jar or taking a walk — difficult to manage.

    Unlike osteoarthritis , which results from normal wear and tear on the joints, rheumatoid arthritis is an inflammatory condition. The exact cause of it is unknown. But it's believed to be caused by the body's immune system attacking the synovium — the tissue that lines the joints.

   Rheumatoid arthritis affects about 2.5 million Americans and about 20 million in the world. It's three times more common in women than in men and generally strikes between the ages of 20 and 50. But rheumatoid arthritis also can affect very young children and adults over age 50.

    There's no cure for rheumatoid arthritis. But with proper treatment, a strategy for joint protection and changes in lifestyle, you can live a long, productive life with the condition.

Signs and Symptoms

    The signs and symptoms of rheumatoid arthritis may come and go over time. They include:

    Pain and swelling in the smaller joints of your hands and feet Overall aching or stiffness of the joints and muscles, especially after sleep or after periods of rest Loss of motion of the affected joints Loss of strength in muscles attached to the affected joints Fatigue, which can be severe during a flare-up Low-grade fever Deformity of the joints as time goes on

    Rheumatoid arthritis usually causes problems in many joints at the same time. Joints in the wrists, hands, feet and ankles are the ones most often affected. The disease can also involve your elbows, shoulders, hips, knees, neck and jaw. It generally affects both sides of the body at the same time. The knuckles of both hands might be one example.

    Small lumps, called rheumatoid nodules, may form under the skin of your elbow, your hands, the back of your scalp, over your knee or on your feet and heels. These nodules can range in size — appearing as small as a pea to as large as a walnut. Usually the lumps aren't painful.

    In contrast to osteoarthritis, which affects only your bones and joints, rheumatoid arthritis can cause inflammation of tear glands, salivary glands, the lining of your heart and lungs, the lungs themselves and, in rare cases, your blood vessels.

    Although rheumatoid arthritis is often a chronic disease, it tends to vary in severity and may even come and go. Periods of increased disease activity — called flare-ups or flares — alternate with periods of relative remission, during which the swelling, pain, difficulty in sleeping and weakness fade or disappear.

    The flexibility of your joints may be limited by swelling or deformity. But even if you have a severe form of rheumatoid arthritis, you'll probably retain flexibility in many joints. You may also have less pain than the appearance of deformed joints suggests.

Causes

    As with other forms of arthritis, rheumatoid arthritis involves inflammation of the joints. A membrane called the synovium lines each of your joints. When you have rheumatoid arthritis, white blood cells — whose normal job is to attack unwanted invaders such as bacteria and viruses — move from your bloodstream into your synovium. There, these blood cells appear to play an important role in causing the synovial membrane to become inflamed.

    This inflammation results in the release of proteins that, over months or years, cause thickening of the synovium. These proteins also can damage cartilage, bone, tendons and ligaments. Gradually, the joint loses its shape and alignment. Eventually, it may be destroyed.

    Some researchers thinks that rheumatoid arthritis is triggered by an infection — possibly a virus or bacterium — in people with an inherited susceptibility. Although the disease itself is not inherited, certain genes that create a susceptibility are. People who have inherited these genes will not necessarily develop rheumatoid arthritis. But they may have more of a tendency to do so than others. The severity of their disease may also depend on the genes inherited.

Medical Advice Timing

    See western or Chinese Master if you have persistent discomfort and swelling in multiple joints on both sides of your body. Your physician can work with you to develop a pain management and treatment plan. Also seek medical advice if you experience side effects from arthritis medications. Side effects may include nausea, abdominal discomfort, black or tarry stools, changes in bowel habits, constipation or drowsiness.

Screening And Diagnosis

   Rheumatoid arthritis symptoms, your doctor will likely conduct a physical examination and order laboratory tests to determine if you have this form of arthritis. A blood test that indicates your erythrocyte sedimentation rate ( "seed" rate) can indicate the presence of an inflammatory process in your body. People with rheumatoid arthritis tend to have abnormally high seed rates. The seed rates in those with osteoarthritis tend to be normal.

    Another blood test looks for an antibody called rheumatoid factor. Four out of five persons with rheumatoid arthritis eventually have this abnormal antibody, although it may be absent early on in the disease. It's also possible to have the rheumatoid factor in your blood and not have rheumatoid arthritis.

    Doctors may take X-rays of your joints to differentiate between osteoarthritis and rheumatoid arthritis. A sequence of X-rays obtained over time can show the progression of arthritis.

Complications

  Rheumatoid arthritis causes pain and may also cause fatigue and stiffness. It can lead to difficulty with everyday tasks, such as turning a doorknob or holding a pen. Dealing with the pain and unpredictability of rheumatoid arthritis can also cause depression.

    In the past, people with rheumatoid arthritis may have ended up confined to a wheelchair because damage to joints made it difficult or impossible to walk. That's not as likely today because of better treatments and self-care methods.

Treatment

    Treatments for arthritis until today still depends on steroid for the western world, it is to help to reduce pain and to delay.

Medications

    Medications for rheumatoid arthritis can relieve its symptoms and slow or halt its progression. They include:

    Yet taking NSAIDs can lead to such side effects as indigestion and stomach bleeding. Other potential side effects may include damage to the liver and kidneys, ringing in the ears (tinnitus), fluid retention, and high blood pressure . However, there is evidence that by suppressing COX-1, NSAIDs may cause stomach and other problems because COX-1 is the enzyme that protects your stomach lining. The jury is still out, but some doctors are concerned that COX-2 inhibitors may increase a user's risk of HEART ACTTACK . Further review by the Food and Drug Administration is needed.

    Corticosteroids . These medications reduce inflammation and slow joint damage. In the short term, corticosteroids can make you feel dramatically better. But when used for many months or years, they may become less effective and cause serious side effects. Side effects may include easy bruising, thinning of bones, cataracts , weight gain, a round face, diabetes and high blood pressure . Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication. Disease-modifying ant rheumatic drugs (DMARDs) . Physicians have begun to prescribe DMARDs to limit the amount of joint damage that occurs in rheumatoid arthritis. Taking these drugs at early stages in the development of rheumatoid arthritis is especially important in the effort to slow the disease and save the joints and other tissue from permanent damage. Because many of them act slowly (it may be weeks to months before you notice any benefit), DMARDs typically are used with a NSAID or a corticosteroid

These medications can have potentially serious side effects such as increased susceptibility to infection and disease.

Self Care

    Treating rheumatoid arthritis typically involves using a combination of medical treatment and self-care strategies. The following self-care procedures are important elements for managing the disease.

    Exercise regularly. Different types of exercise achieve different goals. Check with your doctor or physical therapist first and then begin a regular exercise program for your specific needs. If you can walk, walking is a good starter exercise. If you can't walk, try a stationary bicycle with no resistance or do hand or arm exercise. A chair exercise program may be helpful. Aquatic exercise is another option, and many health clubs with pools offer such classes. It's good to move each joint in its full range of motion every day. As you move, maintain a slow, steady rhythm. Don't jerk or bounce. Also, remember to breathe. Holding your breath can temporarily deprive your muscles of oxygen and tire them. It's also important to maintain good posture while you exercise. Avoid exercising tender, injured or severely inflamed joints. If you feel new joint pain, stop. New pain that lasts more than 2 hours after you exercise probably means you've overdone it. If pain persists for more than a few days, call your doctor.

    Control your weight. Excess weight puts added stress on joints in your neck, hips, knees and feet — places where arthritis pain is commonly felt. Excess weight can also make joint surgery more difficult and risky. Eat a healthy diet. A healthy diet emphasizing fruit, vegetables and whole grains can help you control your weight and maintain your overall health, allowing you to deal better with your arthritis. However, there is no special diet that can be used to treat arthritis. It hasn't been proven that eating any particular food will make your joint pain or inflammation better or worse. Apply heat. Heat will help ease your pain, relax tense, painful muscles and increase the regional flow of blood. One of the easiest and most effective ways to apply heat is to take a hot shower or bath for 15 minutes. Other options include using a hot pack, an electric heat pad (set on its lowest setting) or a radiant heat lamp with a 250-watt reflector heat bulb to warm specific muscles and joints. If your skin has poor sensation or if you have poor circulation, don't use heat treatment.

    Coping Skills The degree to which rheumatoid arthritis affects your daily activities depends in part on how well you cope with the disease. Physical and occupational therapists can help you devise strategies to cope with specific limitations you experience as the result of weakness or pain. Here are some general suggestions to help you cope:

    Keep a positive attitude. With your doctor, make a plan for managing your arthritis. This will help you feel in charge of your disease. Studies show that people who take control of their treatment and actively manage their arthritis experience less pain and have less difficulty functioning. Use assertive devices. A painful knee may need a brace for support. You also might want to use a cane to take weight off the joint as you walk. The cane should be used in the hand opposite the affected joint. If your hands are affected, various helpful tools and gadgets are available to help you maintain an active lifestyle. Contact your pharmacy or health care provider for information on ordering items that may help you the most. Know your limits. Rest when you're tired. Arthritis can make you prone to fatigue and muscle weakness — a deep exhaustion that makes everything you do a great effort. A rest or short nap that doesn't interfere with nighttime sleep may help.

    Avoid grasping actions that strain your finger joints. Instead of using a clutch purse, for example, select one with a shoulder strap. Use hot water to loosen a jar lid and pressure from your palm to open it, or use a jar opener. Don't twist or use your joints forcefully. Spread the weight of an object over several joints. For instance, use both hands to lift a heavy pan.

    Take a break periodically to relax and stretch. Maintain good posture. Poor posture causes uneven weight distribution and may strain ligaments and muscles. The easiest way to improve your posture is by walking. Some people find that swimming also helps improve their posture. Use your strongest muscles and favor large joints. Don't push open a heavy glass door. Lean into it. To pick up an object, bend your knees and squat while keeping your back straight.

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Rheumatoid arthritis (often called RA) is a chronic (long-standing) disease that damages the joints of the body.

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Rheumatoid arthritis most often affects the smaller joints, such as those of the hands and/or feet, wrists, elbows, knees, and/or ankles. The symptoms often lead to significant discomfort and disability.