Rheumatoid Arthritis

Signs & symptoms

Rheumatoid arthritis commonly affects joints in the hands and feet, but larger joints such as hips, knees and elbows also may be involved. The disease affects joints symmetrically, which means that if one hand is affected, the other also will be affected.

Symptoms of rheumatoid arthritis include:

• Swelling and pain in the joints
• Difficulty moving
• Loss of appetite
• Fever
• Decreased energy
• Lumps, called rheumatoid nodules, under the skin in areas subject to pressure, such as the elbows

The severity and range of symptoms may differ for each person. In addition, symptoms can affect other parts of the body in addition to the joints.

Diagnosis

Symptoms of rheumatoid arthritis differ for each person and can be similar to other forms of arthritis and joint conditions. As a result, your doctor will use a variety of tests to diagnose the disease and to rule out other conditions.

• Medical History Your doctor will begin by taking your medical history. This will include asking about your symptoms.
• Physical Examination Your doctor will conduct a complete physical examination, which will include your joints as well as other parts of your body.
• Laboratory Tests You will be tested for the rheumatoid factor, which is an antibody that is present in the blood of most patients with rheumatoid arthritis. However, not all people with rheumatoid arthritis test positive for rheumatoid factor and some who do test positive never develop the disease. Other common tests include the erythrocyte sedimentation rate, which indicates inflammation in the body, as well as a white blood cell count and a blood test for anemia.
• X-rays X-rays may be used to determine the amount of joint damage.

Treatments

There currently is no cure for rheumatoid arthritis, although highly effective medications are available. The major goals of therapy are to reduce pain and discomfort, prevent deformities and loss of joint function, and improve a person's function, well-being and quality of life.

Drug Therapy

There are three classes of drugs commonly used in the treatment of rheumatoid arthritis:

• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids
• Disease modifying anti-rheumatic drugs (DMARDs)

Medications relieve symptoms and work to slow the progression of the disease.

Physical Therapy

Exercise is an essential part of your treatment program. Your doctor and physical therapist will help you develop an exercise program to strengthen your joints without stressing them. However, rest also is important for people with active rheumatoid arthritis. Short period of rest are generally preferable to longer periods of inactivity.

Joint Protection

Canes, crutches or walkers may help relieve the stress and strain on arthritic joints. Learning ways to perform daily activities that are less stressful and painful on the joints also may be helpful. In addition, some people will use a joint splint for short periods to rest the joint as well as reduce pain and swelling.

Surgery

Several types of surgery are available to patients with severe joint damage. However, surgery is not for everyone and the decision to undergo surgery should be made only after careful consideration and discussion with your doctor. Commonly performed surgical procedures include:

• Joint Replacement The damaged joint is replaced with an artificial joint.
• Tendon Reconstruction The damaged tendon is rebuilt by adding one that is intact. This procedure is used most frequently on the hands.
• Synovectomy The inflamed synovial tissue, or the tissue that makes up the membranes surrounding joints and tendons, is removed, although it eventually grows back. This is typically done as part of reconstructive surgery, especially tendon reconstruction.