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Rheumatoid arthritis

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A comparision between a normal joint in a body next to a joint that is affected by rheumatoid arthritis.

Rheumatoid arthritis (commonly known as RA) is a chronic arthritic disease affecting around 1% of the entire world’s population. It generally inflames and swells joints in the body causing different levels of pain depending on the person. As there is no specific or known cause for RA, there is also no real cure for the disease either. There are plenty of different ways that people have found to aid in the relief of their pain and lessen their symptoms, but there has been no known way of ridding the body completely of the disease yet. Some of the risk factors for potentially developing the disease can include: genetics, lifestyle, hormones, and environment. Women not only are three times more likely to have the disease than men, but also are more likely to develop it at a younger age than men too. The life expectancy of many RA patients is thought to be shortened by as much as 10 to 15 years than the normal, but many patients have reportedly lived well into their 80s and 90s. In addition to the symptoms of the disease, possible complications such as anemia, respiratory issues, eye inflammation, etc. may also occur. Some patients may pay as much as $20,000 in treatment fees annually. The earlier the better when it comes to treatment related to rheumatoid arthritis for the best possible results.[1]

Symptoms

The effects of Swan Neck Deformity in a 65 year old RA patient.

The length of time that symptoms can occur for people with rheumatoid arthritis can vary depending on the person. Activity length and intensity rate can change and are specific to who the person is. Some can experience only a few symptoms while others can experience many. In the joints, common cases can include stiffness cause less mobility and movement for the joint, especially in the mornings. Another symptom, swelling can occur when fluid fills the joints and the joint becomes puffy. Other cases have reported inflammation and pain while also experiencing redness or warmth around the affected areas. While the hands are usually the most common area to be affected, other areas may include wrists, knees, elbows, feet, hips, shoulders, the neck and even possibly the jaw.[2]

In around 40% of patients with RA, symptoms do not involve joints. Some of the nonjoint areas that can be affected include the skin, lungs, eyes, heart, bone marrow, blood vessels, salivary glands, kidneys, and nerve tissues.[3] It is common to feel fatigued, a loss of appetite (sometimes leading to weight loss), muscle aches, and/or sickness. Inflammation may occur in the lining around the heart or lining in the lungs. As a result, shortness of breath or chest pain may be common but a doctor can prescribe drugs to help with reducing inflammation. One of the joints in the voice box can be affected and cause hoarseness. A very small percent of people with RA may find their eyes red, in pain, or dry.[2]

Causes

An example of swelling that can occur in different parts of the body from rheumatoid arthritis. In this case, the example is a capture of the knee.

Rheumatoid arthritis occurs when the membrane lining around joints is attacked by the immune system in the body. This lining of the membrane, or the synovium, can become inflamed and thicken, causing the destruction of that joints cartilage or bone. The joints can become unaligned from the result of stretched out and weakened tendons and ligaments.[3] The body's immune system cells attack the healthy tissue as they think the tissue is an invader to the body. The resulting chain reaction causes damage to the tissue all around. The inflammation may continue to spread causing ongoing pain or fatigue.[4]

Although doctors do not exactly know what causes RA, they do have many ideas. The most common thought is that it stems from genes and environmental factors. The genes themselves do not totally start the symptoms of RA, but they make it easier for people to get infections like viruses or bacteria that may trigger the disease.[3] The idea that the virus or bacteria is a common one, but doctors have not come up with which virus or organism triggers RA.[4]

Management

A box of 10mg/ml of methotrexate teva that is used in many RA patient's treatment, aiding as an antimetabolite drug.

When it comes to the treatment of rheumatoid arthritis, the earlier the better. Progression rate can be greatly decreased if the disease is taken care of and treated as quickly as possible. It is recommended by the ACRSRA (The American College of Rheumatology Subcommittee on Rheumatoid Arthritis) that within three months of diagnosis, the patient undergoes the beginning of treatment to bring out the best results. The resulting goals of many treatments is to hopefully preserve the quality and function of life and to reduce inflammation and swelling of the joints. These goals can help to minimize pain and protect the patient's body from any further complications. Patients that have minimal swelling and pain are usually observed every few months to make sure their symptoms do not increase while they generally receive anti-inflammatory drugs to reduce pain. The anti-inflammatory drugs, usually NSAID (Nonsteroidal Anti-Inflammatory Drugs), are utilized for the initial treatment of RA and should be used alone. NSAIDs do not alter the course of the disease, but instead reduce the joint pain and swelling. Because RA patients using NSAIDs are two times more likely to experience complications that can seriously affect them with symptoms related to gastrointestinal side effects, the patients using them must be observed much more closely than those with osteoarthritis.[5]

Living with rheumatoid arthritis can mean living with chronic and ongoing pain. The best way to manage this pain is to learn about it and what RA is doing to the body. Finding different ways to improve your health, such as exercise to improve flexibility or help in weight loss can aid in managing the pain from RA. Staying active is important and can help your overall health. One way to ensure your ability to stay active is to protect the stiffened areas and joints of the body. Learning new ways around your pain and how to use your body without causing more pain to those areas will help in the long run. Assistive devices such as splints and canes can aid in walking and physical activity in daily life.[6]

History

A visual of acupuncture, a common treatment in the Far East for RA. It was later found that this method failed to aid in treating or managing rheumatoid arthritis symptoms.

The first reference to RA was most likely in 1500 BC describing a condition very similar to the disease in the Ebers Papyrus. Also, in many ancient Egyptian mummies, evidence of RA can be found in their bodies. In fact, G. Elliot notes in his studies that it was a prevalent disease in Egypt. The Charak Samhita, a piece of Indian literature written around 300-200 BC, describes a similar disease to RA. This said disease apparently caused joint swelling, pain, and loss of mobility and function. The term “rheumatismus” was first introduced by Galen around 129-216 AD. One suggestion around the early 16th century was from Paracelsus, stating that substances not passed in the urine of the body would store up and collect in areas around the body, especially near the joints, causing the arthritis. In 1858, A. B. Garrod replaced the old terms, arthritis deformans and rheumatic gout, with the new name, rheumatoid arthritis. This also caused the distinction between the similar yet different terms and diseases such as rheumatoid arthritis, gout, and osteoarthritis. The first description of RA was in 1896 by Bannatyne and later Camroe coined the term rheumatologist in 1940 while Hollander coined rheumatology in 1949.[7]

On December 7th, 1953, the FDA first approved the use of methotrexate for the treatment of patients. [8] Methotrexate, an antimetabolite drug, is very helpful in RA treatment by altering the immunity as it blocks the metabolism (production and destruction of cell components) in cells.[9] In the very early days, leeching and bloodletting were very popular treatment used to decrease symptoms of RA. Solutions such as acupuncture, acupressure, moxibustion (heat), and cupping were used quite often in the Far East. These treatments all ended in failure and did not prove to aid in managing RA. Heavy metals such as gold, bismuth, arsenic, and copper salts have been used for RA and even different diseases for treatment with varying success rates. Gold, the most successful metal, is a part of DMARDs (Disease Antirheumatic drugs) and these DMARDs are highly used on RA patients even today.[7]

Video

Explanation of how Rheumatoid arthritis can affect the body.

Immune Diseases

References

  1. Rheumatoid Arthritis Facts and Statistics Rheumatoid Arthritis. Web. Last Modified August 3, 2016. Unknown Author.
  2. 2.0 2.1 What Are the Symptoms of Rheumatoid Arthritis? WebMD. Web. Last Modified February 11,2014. Unknown Author.
  3. 3.0 3.1 3.2 Mayo Clinic Staff. Rheumatoid arthritis Mayo Clinic. Web. Last Edited March 18, 2016.
  4. 4.0 4.1 What Causes Rheumatoid Arthritis? WebMD. Web. Last Modified June 22, 2016. Unknown Author.
  5. Rindfleisch, J. Adam M.D. and Muller, Daniel M.D. Diagnosis and Management of Rheumatoid Arthritis American Family Physician. Web. Published on September 15, 2005.
  6. Poinier, Anne C. M.D. and Shadick, Ann M.D. Arthritis: Managing Rheumatoid Arthritis WebMD. Web. Last Modified August 21, 2015.
  7. 7.0 7.1 Mandal, Ananya MD. Rheumatoid Arthritis History New Medical Life Sciences. Web. Last Modified March 13, 2013.
  8. FDA Approves Dava’s Methortrexate World History Project. Web. Last Accessed March 19, 2017. Unknown Author.
  9. Ogbru, Omudhome PharmD. methotrexate, Rheumatrex, Trexall MedicineNet. Web. Last Modified September 11, 2015.