Rheumatoid Arthritis

Rheumatoid arthritis (R.A.) is a progressive and disabling disease that affects about 2 million Americans (about 1 percent of the general population). It is often more severe than other forms of arthritis. The peak age of onset for R.A. is between twenty to forty years of age, but about one-third of all cases are diagnosed among those age 60 and older. R.A. is three times more common in younger women than in men.

R.A. involves an inflammatory process that affects the joints and connective tissues. The inflammation releases chemicals into the joints that digest the cartilage, bone, tendons and ligaments. The joints become inflamed, painful and swollen. Eventually the joint can be destroyed and deformities occur. R.A. can affect any joint but the most common sites are the wrists, knuckles, and feet. R.A. involves the immune system and can affect the whole body. Often it causes overall muscle pain and stiffness, fatigue, anemia, and low-grade fever. The cause of R.A. is unknown although some speculate that it may be triggered by an infection.

An on-line booklet called Handout on Health: Rheumatoid Arthritis describes how rheumatoid arthritis develops, how it is diagnosed, and how it is treated, including what patients can do to help manage their disease. It also highlights current research efforts supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and other components of the National Institutes of Health (NIH).

Symptoms of Rheumatoid Arthritis

• Swelling in joints
• Early morning stiffness
• Recurring pain or tenderness in joints
• Decreased range of motion in joint
• Redness or warmth in joint

Management of Arthritis

The pain associated with arthritis often results in deconditioning, restrictions in motion, and disability. Individuals need to be educated about exercising, eliminating risk factors, protecting their joints, and including rest periods. Arthritis is effectively managed using a combination of the following.

1. Pharmacologic therapy. The mainstay of drug therapy arthritis is:

Pain Medication Acetaminophen is usually the first line of defense for the pain of OA.

Aspirin and Non-steroidal anti-inflamatory drugs are useful in reducing both pain and inflammation. Unfortunately, aspirin or NSAIDs cause an upset stomach in 30% of patients and with long-term use can cause gastrointestinal bleeding or ulcers.

The COX-2 inhibitors are new. These "super aspirins" relieve pain and inflammation with fewer stomach side effects. They are quite expensive and can cost up to $900 a year.

2. Heat and cold. Soaking joints in warm water or using hot packs or electric heating pads can increase circulation, ease pain and relax tense muscles. Applying cold compresses such as ice packs can dull the pain during the initial day or two of a flare-up.

3. Exercise and Rehabilitation. Many of the problems that people with arthritis encounter are attribute to the progression of the disease when, in fact, they are the consequences of prolonged inactivity. People with arthritis tend to have higher rates of inactivity that those in the general population (MMWR, May, 1997). Older adults who limit their activities for prolonged periods are at risk for deconditioning, muscle atrophy, and contractures. People with arthritis can exercise safely and achieve significant benefits.

Physical and occupational therapy is key to educating older adults on how to maintain their functioning by maintaining muscle tone while protecting their joints. An evaluation for assistive devices should be done. A cane or walker can help decrease the stress on the joint by up to 40% and reduce the risk of a fall. Simple tools (e.g. door openers, jar openers) can dramatically improve the independence of individuals.

The Arthritis Foundation has developed a group exercise program called People with Arthritis Can Exercise (PACE) which is designed specifically for people with arthritis. It includes specially designed exercises to help increase joint flexibility, range of motion, maintain muscle strength and increase overall stamina. The program can help reduce pain, stiffness as well as lowering feelings of isolation and depression.

4. Counseling. Arthritis causes chronic pain, deformity and disability which can lead to depression. Counseling may be needed to help individuals cope with the disease.

5. Weight loss. Weight loss can prevent or slow the deterioration of the joints by relieving stress.

6. Surgery. Surgical interventions are one of the major advances in treatment of arthritis. An arthroscopy with joint debridement (e.g., removal of cartilage, loose bodies) is sometimes beneficial when conservative measures don't work. Patients with severe arthritis may need a total joint replacement (e.g. hip, knee). These prostheses can dramatically restore function and range of motion. Intensive rehabilitation is necessary after a joint replacement and the best results are obtained with patients who actively participate in their therapy.