rheumatoid arthritis: intro

Re: Rheumatoid Arthritis (RA), Introduction
Fr: “It’s a real pain!” Friday (2007 Oct 5-11), pp. 58-62.

• Diagnosis

“RA is a chronic autoimmune disease (i.e.,… the immune system attacks the joints and surrounding soft tissues) that causes stiffness, pain, loss of mobility, inflammation and erosion (deterioration) in the joints.”
“… Normally, once our body clears out an infection, inflammation stops. In RA, however, the body’s immune system mistakes some organs as foreign and attacks them. This causes damage to the joints and other organs [… a SYSTEMIC disease].
Other symptoms:
- fatigue, fever, nodules under the skin (esp in elbows), & a sense of not feeling well (malaise)
- possible: anemia, vasculitis (inflammation of blood vessels), systemic complications, and other co-existing autoimmune disorders; dry eyes and mouth (seen in Sjogren’s syndrome)

Rate:
- about 1% of the population; 75% women; usually 30-50 years old

Tests:
- no definitive test; usually blood test (ESR = erythrocyte sedimentation rate and CRP = C-reactive protein: to measure level of body inflammation)

Risk factors:
- smoking increase the risk factor for RA (p. 60)

• Course

Varied: (1) one joint, then others; (2) all joints at once

• Prognosis

RA is a PROGRESSIVE DISEASE: erosion and disintegration of lining of joints  cartilage  bones. Deterioration is IRREVERSIBLE. Damage is PERMANENT. Medicines don’t affect the disease process causing damage. May be POTENTIALLY FATAL.
“Left untreated, RA can shorten a person’s lifespan and can, within a few years, leave about 30-40% of those affected too disabled to work.
“Once STRUCTURAL DAMAGE sets in, it’s beyond repair. You can only prevent further deterioration.” (pp. 60 & 62)

emotional impact: depression and low self-esteem, especially in later stages, i.e., feels helpless, crippled and dependent

• Treatment:

- drug therapy
(1) DMAD = disease modifying antirheumatic drugs – used earl in treatment; for symptom relief; side effects to be monitored
(2) Biologics = Biologic Response Modifiers – reduce inflammation and relieve pain while fighting the disease; help slow progression of RA; prescribed if DMARD treatment goals not reached, or for additional benefits with DMARD; really effective in most cases but prohibitively expensive

- exercise
can sometimes help alleviate the condition, but depends on the patient and needs to be discussed with the doctor and physiotherapist; but strenuous exercise never advised!

- rest
- joint protection
- physical and occupational therapy
- surgery (when necessary)