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Arthritis - Rheumatoid, Osteoarthritis Information

Rheumatoid, Osteoarthritis Information

What is it

Rheumatoid arthritis is a common disorder of joints. The main feature is inflammation of joints. A joint between two bones is contained by a capsule. The lining of the capsule (synovium) makes a thick lubricating fluid (synovial fluid). This acts like an oil, allowing free movement between the cartilages that cover the bone ends, like friction bearings.

In rheumatoid arthritis, the synovium becomes thickened, hot and swollen. It produces a large amount of fluid, and soon the whole joint swells with fluid, and looks tense, hot, and is painful to touch and move. These changes disappear if the inflammation settles, but if it continues, the underlying bone and cartilage can become permanently damaged.

Tendons are housed in sheaths lined by synovium (imagine a bicycle brake cable in its housing). This too can become inflamed, causing pain and sometimes lumpiness and sticking of tendons. Occasionally rheumatoid arthritis can affect other organs in the body like the lungs and eyes. This is rare.

Who gets it

Rheumatoid arthritis affects 1 in 50 people. It is three times more likely to occur in women than in men (1). It can happen at any age, but usually begins between ages 20 and 60. It happens more often in women at age 45, and is rare after the age 75. In men it is rare before 45, but continues to get more common thereafter (2). It occurs worldwide, in all races, with variations on the age and sex differences.

How does it occur

The short answer is that no one knows. The risk is increased if there is a family history of rheumatoid arthritis, and if an individual has a particular gene (HLA DR4), though the way this works is not understood. It can be triggered by general illnesses and severe emotional or physical trauma, pregnancy, and sometimes blood transfusions.

What are the symptoms

The chief symptom is joint pain, with redness, warmth and tenderness in any joint in the body. The joints most commonly affected are the hands, wrists, elbows, shoulders, feet and ankles.

Experience of stiffness in the morning is common. The severity waxes and wanes. During a flare-up there may be a low-grade fever, and general illness. This can be similar to having a bout of flu, with a feeling of tiredness.

What are the risks

The greatest risk is of progressive disability and permanent deformity of joints. This is most likely if treatment is not sought or isn't followed carefully. Fortunately this happens to only 5% of sufferers. 30% will recover completely within a few years, and 65% will continue having joint pain. swelling and flare-ups.

Rheumatoid arthritis has a bad name and conjures up images of people crippled by the disease and confined to wheelchairs. This is an image generated by older patients who did not benefit early on from the range of modern treatments available nowadays. Those who have just received a diagnosis of rheumatoid arthritis should take professional medical advice and be positive about the future. The chances of maintaining a good quality of life are ever increasing.

What tests are useful

It can sometimes be difficult to make a hard and fast diagnosis of rheumatoid arthritis, but several tests help:

  • A full blood count (FBC) may show increased white blood cells activity during a flare-up
  • The erythrocyte sedimentation rate (ESR) is a broad measure of inflammation. If it is very active, rheumatoid arthritis is more likely to be happening
  • Rheumatoid factor (RA Factor) is an antibody (defensive protein of the immune system) which sometimes (not always) appears in the blood in rheumatoid arthritis
  • X-rays may show thickening of the synovium in early disease, and bone changes (erosions) in later stages. They can be useful in severe disease to assess the rate of progression and response to treatment
  • Blood and urine tests are used to monitor possible side-effects of the treatments for severe rheumatoid arthritis

What treatments are there

Good treatment of rheumatoid arthritis will involve many different health professionals, and a coordinated team approach gives the best outcome for patients (4,5).

Rest: Rest is one of the best treatments for inflamed joints, but too much rest can cause joints to stiffen and muscles to weaken, so common sense and flexibility are important. Splints to rest the joint may be helpful. The ultimate is bed rest at home or in hospital. Hospital care is most useful in patients with long-standing severe disease (3).

physiotherapy: This helps to relieve pain and promote mobility. An exercise routine keeps muscles from becoming weak; this is important as fit muscles support joints better than weak ones.

Anti-inflammatory drugs: These are good at relieving pain and inflammation, and can help to maintain mobility, but do not alter the course of the condition.

Disease-modifying drugs: This would include penicillamine (a distant cousin of penicillin), sulphasalazine, methotrexate, steroids and gold, by mouth or injection. These change the progress of the disease itself, but all have a wide range of side-effects so are reserved for rheumatoid arthritis resistant to simpler treatment. Research is examining the role of antibodies in treatment(6), and this area shows promise for the future.

Surgery: This has its place: some severely affected joints can be replaced with artificial joints in a few patients; an alternative is fusing the bones so there is no further movement provides relief from pain, and stability. This sounds drastic, but it can radically improve the quality of life of someone with fiery and unstable joints.

What are the treatment side effects

All drugs can cause allergic reactions, which may show as a rash or general illness. All drugs can cause a host of rare but important side-effects which will be detailed in the information leaflet dispensed with the medication, and their importance can be put into perspective for an individual by the prescribing doctor.

The major side effects are as follows. Anti-inflammatory drugs can all cause indigestion and diarrhoea. If the indigestion is ignored, a stomach ulcer can develop, and occasionally bleeding into the gut. Thus it is important to speak to your doctor if indigestion happens. Ibuprofen is known to be the safest from this point of view.

Disease modifying drugs each have their own set of major and likely side-effects. These will always be explained if this treatment becomes necessary, and they will be monitored with blood and urine tests.

What self-help strategies are there

    Understand the condition. This will make coping from day to day much easier, and will enable the family to adapt too

    Eat well and sensibly. Good nutrition helps the body to recover from flare-ups, and reduces the risk of relapses. Beware faddy diets, which come and go like annual fashions. They are largely unproven and may offer false hope of a cure

    Natural remedies including acupuncture, and aromatherapy help restore well-being and control pain. Beware unproven treatments peddled by unscrupulous suppliers, and remember that most prescribed medicines are derived originally from plant extracts, and natural herbal remedies can have side effects too.

    Exercise will keep you mobile and active, and prevent joints from seizing up.

    Excess weight unnecessarily stresses the joints. Lose weight if you need to

    A positive mental attitude is the most important way to help yourself. Focus on recovery, not relapse; ableness, not disability. Keep an active and energetic approach to maintaining mobility.

Where can I get further information

Apart from contacting your Gp, the following organisations may offer further help:

The Arthritis Research Campaign (ARC)
Copeman House
St Mary's Court
St Mary's Gate
Chesterfield
Derbyshire
S41 7TD
Telephone: 01246 558033

Arthritic Association
The Secretary
1st Floor Suite
2, Hyde Gardens
Eastbourne
BN21 4pN
Telephone: 020 7491 0233

Arthritis Care
Cathy Irving
Information Officer
18, Stephenson Way
London
NW1 2HD
Helpline: 0800 289170 (12.00-16.00 Monday-Friday)

References

  1. AKIL M. and AMOS, R. (1995) Rheumatoid Arthritis: Clinical features and diagnosis, British Medical Journal, Mar 4th pp.587
  2. SYMMONS D. et al. (1994) The incidence of rheumatoid arthritis in the United Kingdom: results from the Norfolk Arthritis Register, British Journal of Rheumatology, 33(8) pp.735-9
  3. VliET-VliELAND, T. et al. (1995) In-patient treatment for active rheumatoid arthritis: clinical course and predictors of improvement, British Journal of Rheumatology, Sep 1995 34(9) pp.847-53.
  4. pORTER, D. and STURROCK, R. (1993) Medical management of rheumatoid arthritis, British Medical Journal, Aug 14th pp.425
  5. AKIL, M. and AMOS, R. (1995) Rheumatoid arthritis: care and treatment,British Medical Journal, Mar 11th 1995 pp.652
  6. HORNEFF, G., EMMRICH, F. and BURMESTER, G. (1993) Advances in immunotherapy of rheumatoid arthritis: clinical and immunological findings following treatment with anti-CD4 antibodies, British Journal of Rheumatology, Jun Suppl 4 pp.39-47.
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