What happens in Rheumatoid arthritis?

Other changes in the body may include

Diagnosis

The blood tests may include

Treatment

Rheumatoid arthritis is an inflammatory illness that affects the joints and because it is "systemic" (affecting the entire body), it can affect other parts of the body as well. It occurs in about1-2% of the population and is more common in women, affecting them 3 times more often than men. It can begin at any age but commonly first occurs between the ages of 35 and 45.

Some people will have a mild form of rheumatoid arthritis. This may require only intermittent treatment for minor symptoms and may not lead to misshapened joints. 1 person in 6 affected by rheumatoid arthritis will have a more serious form that can cause painful, misshapened joints.

It is a chronic disease and may last a lifetime. Often, however, people experience periods of remission when the disease subsides. Remissions can last for short periods of time or, for several years. There is no cure for rheumatoid arthritis, but advances in scientific research mean people with rheumatoid arthritis can be assured of effective treatment, resulting in much less pain and fewer disabilities.

What happens in Rheumatoid arthritis?

Rheumatoid arthritis is a result of changes in the body's immune system. For reasons not fully understood, the body's immune system attacks its own organs, in this case the tissue of the joints.

This auto-immune reaction causes inflammation of the joints, particularly the synovial membrane that lines them. This causes an over-production of synovial (joint) fluid which, combined with the inflammation, causes the joints to become swollen and painful. If the process continues, damage to the cartilage and other soft tissue can cause joint deformities.

The effects differ from person to person. Most people first become aware of pain, swelling and stiffness in the small joints of the hands or feet. However other joints may also be involved. The joints are often more painful and stiff in the mornings. As the day progresses, there may be some improvement, but they may become painful again in the evenings. Sometimes it is difficult to pick things up and your grip is much weaker.

Rheumatoid arthritis does not only involve the joints - it has other features, often described as "flu-like" symptoms. These are called systemic features which include:

• tiredness,
• lack of energy,
• loss of appetite,
• inability to sleep,
• perhaps some weight loss and
• a low fever.

The muscles are often quite painful and uncomfortable. These features are more marked when the disease is active and tend to disappear when the disease is under control.

Tendons, which are the structures connecting muscle to bone, may also become involved, especially those connecting the muscles in the forearm to the ends of the fingers. These tendons allow the fingers to be straightened and bent. The lining around the tendons is made of cells similar to those lining the joints, so inflammation can affect them as well.

Acute Rheumatoid Arthritis.

Chronic Rheumatoid Arthritis.

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Other changes in the body may include

• Anaemia
• Nodules (occur in 30% of people) - these are little lumps under the skin about the size of a pea
• Inflammation of the eye
• Enlargement of the lymph glands
• Dry eyes and mouth

Diagnosis

When rheumatoid arthritis first begins, it is often difficult to diagnosis it clearly. Sometimes it is several months before the blood or x-ray changes occur that enable the doctor to make a diagnosis of rheumatoid arthritis. Diagnosis will be made on an evaluation of the symptoms and tests including a physical examination which will look at each joint for signs of inflammation or other problems. The blood tests and x-rays, as well as helping with the diagnosis, also help in monitoring the progress of the disease and the effectiveness of treatment.

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The blood tests may include

• Haemaglobin; the measure of the number of red blood cells. If these are low, you may be anaemic. Anaemia occurs in rheumatoid arthritis when it is active and may be one of the causes of tiredness.
• White cell count; these cells help in preventing infection. There are some drugs used in the treatment of rheumatoid arthritis that can affect the production of white blood cells by the bone marrow. Regular blood tests can detect any decrease in these numbers early before they produce problems.
• ESR (Erythrocyte Sedimentation Rate); this blood test measures the amount of inflammation that is occurring in the joints. If it is high, it means there is a considerable amount of inflammation. However, if it is low, this means that the inflammation is being kept under control or has resolved. It is a useful test to measure the effectiveness of treatment.
• Rheumatoid factor; this is an antibody in the blood, being present in about ¾ of people with rheumatoid arthritis. It is occasionally found in people without rheumatoid arthritis, but it is not known exactly how or why it develops. It is a useful test in helping to make a diagnosis, but you can have rheumatoid arthritis without having the rheumatoid factor present. Similarly, many people, especially in the older age group, will have a positive test without having rheumatoid arthritis. This is a common misdiagnosis and leads to poor medical management.

X-rays of joints, particularly of the hands and feet, may be taken at regular intervals every 1-2 years. If there is evidence of damage to the joints, or damage is progressing, it may be necessary to change or modify the treatment.

Blood or urine tests may be taken, and the doctor may also drain fluid from the joint to make sure the Arthritis is not caused by an infection.

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Treatment

Because rheumatoid arthritis is a chronic disease, treatment may consists of a number of other components besides medication. No two people with rheumatoid arthritis are alike, and treatment must be designed to individual needs. Your doctor is likely to advise a variety of treatments that take into account the severity of the disease, what joints are affected, your symptoms, other medical problems, your age, occupation and every day activities. A specialist rheumatologist may be consulted, and as with other forms of arthritis, the role of allied health professionals will be crucial. Treatment may include:

• Physiotherapy
• Medication
• Rest and guided exercise
• Surgery

See the treatment section of this site for more information.

Want to know more? Click brochure to download our Rheumatoid Arthritis brochure.

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