Rheumatoid arthritis (often shortened to "RA") is a disease in which the immune system attacks the body's own tissues. The joints of the hands, wrists, ankles, knees, and feet are usually the most seriously affected, but the severity and pattern of the disease varies substantially from one person to another Figure 01. Common early symptoms of rheumatoid arthritis include pain, swelling, and stiffness of the joints. Later, symptoms may include joint deformity and loss of joint movement. The pain and swelling may disappear at times as if the disease has been cured (a period called remission), only to flare up again later.
Figure 01. Common pain sites of rheumatoid arthritis
Without early treatment, the damage that rheumatoid arthritis causes can become worse over time. The disease has the potential to damage the joint's tissues and the bones. In rheumatoid arthritis, continuous inflammation in the spaces between the joint gradually damage the fibrous connective tissue that holds the skeleton together at the joints (cartilage), narrowing the joint space and eventually eroding bone. Under normal circumstances, inflammation is a product of the body's immune system, which fights off invaders and infections, and heals injuries. Inflammation usually dies down once the body has gotten rid of the problem. But in rheumatoid arthritis, the body's immune system continues to attack the joints, which leads to persistent inflammation, for reasons that are not yet understood. This process gradually ruins cartilage and erodes the bones.
Rheumatoid arthritis can strike people as early as age 30, but it most often occurs in people between the ages of 40 and 60. Prior to 60 years of age, it affects women three times as often as it does men. After age 60, there is an equal frequency of men and women.
There are several different types of rheumatoid arthritis. Your diagnosis will be based upon your symptoms and the results of tests and x-rays.
The diagnosis of RA is a clinical one, supported by laboratory tests and x-rays. The various types of rheumatoid arthritis are differentiated by the symptoms they produce and the presence or absence of a certain protein in the bloodstream. This protein, known as an autoantibody, is called the rheumatoid factor (RF), and is produced as a result of the body attacking its own immune system. The presence or the absence of RF does not indicate whether or not you actually have rheumatoid arthritis. It can, however, indicate what type of the disease you have.
About 80% of people with rheumatoid arthritis have a positive test for rheumatoid factor. This form of rheumatoid arthritis is called rheumatoid factor—positive (or seropositive) rheumatoid arthritis.
In contrast, some people with rheumatoid arthritis consistently have a negative test for rheumatoid factor. This form of rheumatoid arthritis is called rheumatoid factor—negative (or seronegative) rheumatoid arthritis. It tends to be milder than the seropositive type.
Rheumatoid factor status can fluctuate in some people with rheumatoid arthritis.
A team of health care providers often manages rheumatoid arthritis. A rheumatologist—a doctor who specializes in musculoskeletal conditions—most commonly treats rheumatoid arthritis. However, a primary care doctor plays an important role in monitoring the effectiveness of treatment, treating other medical conditions, and addressing the psychological and social effects of rheumatoid arthritis. Who you see will depend on the severity of your rheumatoid arthritis. A physical therapist will help you to rehabilitate any loss of movement you may experience. An occupational therapist will help you to improve and recover your ability to perform tasks in your daily living and working environments. Your team of health care professionals may also include a surgeon and a psychiatrist or psychologist to help you with the emotional stress of the condition.
Most people with rheumatoid arthritis can still participate in family, occupational, and social activities. Aggressive treatment during the first few months after diagnosis will keep your condition under control. While there may be some days where your pain and discomfort may prevent you from participating in your regular activities, there is a good chance that you could enjoy long periods of disease control.
Rheumatoid arthritis is thought to result from a combination of genetic susceptibility and exposure to some “trigger.” The specific trigger for rheumatoid arthritis has not been identified at this time. Researchers are still looking for the factor that suddenly initiates rheumatoid arthritis in susceptible people. They suspect that some infectious agent, perhaps a bacterium or virus, triggers the inappropriate immune reaction.
If you have rheumatoid arthritis in your family, you may be more susceptible to the disease yourself.
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