Rheumatoid
Arthritis is a Treatable Disease
Rheumatoid
arthritis (RA) is a common form of chronic inflammatory arthritis
that affects about 1% of the adult population. It tends to
affect women more then men (3:1). The peak of onset is middle
age (men typically a little later), and some authorities feel
that people who smoke are more at risk for developing the
disease. Although this article will focus on adults, it is
important to realize that children and young adults also develop
forms of RA. We hear a lot of publicity about juvenile diabetes
but more children have inflammatory arthritis then suffer
from diabetes.
RA
is a type of inflammatory arthritis. This means, inside the
joint, inflammatory proteins are being signaled into the joint.
If the disease is left untreated, this inflammation causes
destruction of the lining of the joint and eventually the
cartilage and bone. These changes cause pain and subsequent
deformity and dysfunction of the joint. Within one year of
active disease, erosions (bone destruction) can be seen on
x-ray.
What
most people do not realize is that RA is a systemic disease
meaning it can affect any part of the body. The inflammation
that causes problems in the joints can also cause problems
in the rest of the body. People can develop nodules under
the skin (usually on pressure point areas), skin diseases
(pyoderma gangrenosum), inflammation in the blood vessels
(vasculitis), inflammation of linings in the body (like pleuritis),
lung disease, nerve involvement (like carpal tunnel syndrome),
eye disease, blood count abnormalities and even certain types
lymphoma. Recent studies are also reporting a higher incidence
of heart disease.
RA
can have a variable start with symptoms developing over weeks
to months. There is a minority of patients in which the disease
develops with a severe sudden onset. People tend to develop
symptoms first of pain in the small joints, particularly the
knuckles, wrists and feet. There can be visible swelling and
these symptoms tend to be symmetrical. There can be a lot
of stiffness particularly in the morning lasting more than
30 minutes. Some people also suffer from fatigue, weight-loss
and even low-grade fevers. I have had patients have these
types of symptoms for two years without telling their primary
doctor about them. When I ask them why it took so long to
seek treatment, the answer usually is "Because it's just arthritis."
It is important to be aware of these symptoms and let your
doctor know as soon as possible, because as you have learned
rheumatoid arthritis is not " just arthritis." We are discovering
the faster we can make the diagnosis and initiate treatment,
the less joint damage occurs, not to mention the effects on
the rest of the body.
When
you make your primary doctor aware of your symptoms they of
course will ask you several questions as well as evaluate
your joints. More than likely they will do some initial blood
work to see if anything else is going on. Many times they
will want to consider a referral to a rheumatologist because
they understand how crucial it is to make an early diagnosis.
When you see the rheumatologist, potentially more testing
might be needed but when the diagnosis is made, they will
begin the discussion of treatment.
The
treatment of rheumatoid arthritis has made dramatic improvements
in the last 20 years and recent research is proving to provide
very promising drugs on the horizon. There are a handful of
oral medications that many rheumatologists will try first
for many reasons, such as effectiveness, limited side effects,
and cost. Methotrexate is one oral medication considered to
be the standard of care. Not everyone gets complete responses
from the oral medications alone though, and now there are
alternatives. There are injectible and intravenous (IV) medications,
commonly called biologic medications. These biologics are
very effective at slowing or stopping the disease, as long
as the drug is maintained. Most studies show that the combination
of medications like methotrexate with a biologic is superior
at stopping the disease then either alone. These new medications
are proving they can stop the pain and inflammation of disease,
and subsequently the x-ray changes and disability. Overall,
with better control of the disease, we are also seeing less
of the systemic complications of the disease as well.
Rheumatoid
arthritis, for many people, is a treatable disease but your
doctor must be aware of your symptoms so they can help you.
There are many good sources of information locally. If you
would like more information on a specific arthritis related
disease or local arthritis awareness activities for children
and adults, you can contact the local branch of the Arthritis
Foundation, which is working hard to raise awareness in our
area.
