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Rheumatoid Arthritis: Inflammation of the Joints



A type of inflammatory arthritis, rheumatoid arthritis affects the hands, feet and other joints, resulting in swelling, pain and joint destruction. According to the Merck Manual of Health Information, it affects about 1 percent of the population worldwide and is the second most common form of arthritis after osteoarthritis. It usually appears between 25 and 50 years of age. About 2 to 3 times more women suffer from it than men. Although it can also appear in children (known as juvenile rheumatoid arthritis), they often experience different symptoms than adults.

Causes
Doctors don’t know exactly what causes rheumatoid arthritis, which is an autoimmune disease that attacks the soft tissue lining the joints. It may be that a viral or bacterial infection triggers this attack. This causes erosion of cartilage, ligament and bone. Instability, deformity and scarring can result from this erosion. In some cases, the immune system may also attack the connective tissue in other parts of the body such as the blood vessels and lungs. There is also a genetic component to the disease that may affect how fast the arthritis progresses.

Progression
The disease progresses at different rates. A middle-aged person, usually a woman, may wake up feeling tired and stiff, and the feeling continues for days or weeks, until her joints become painful, swollen and hot to the touch. A little later, her hands become painful and knuckles begin to swell. With time, the pain and stiffness can spread to all joints and become a major disability.

Sometimes, someone can have mild flare-ups and go long periods in remission with no symptoms. It may start suddenly, with all joints affected at the same time. Or it may be a much more rapid progression.

Symptoms
Inflammation in rheumatoid arthritis is symmetric. If you experience pain on your right knee, for example, your left knee will also become inflamed. Joints on the fingers, toes, hands, wrists, feet, ankles and elbows are affected first. Pain and stiffness is greatest upon awakening, lasting for 30 minutes or longer. A low-grade fever, tiredness and weakness sometimes occur also. Joints can enlarge and become deformed or freeze in one position, limiting the range of movement. Pinched nerves can result in tingling or numbness and evolve into carpal tunnel syndrome, a compression of the median nerve as it passes the wrist.

The legs can also develop cysts, which then rupture causing swelling and pain. Near sites of pressure under the skin, hard bumps called rheumatoid nodules can develop, such as behind the elbow. Tendons in the fingers can sometimes slip out of place, causing fingers to dislocate and point inward toward the little finger.

There can also be further complications, some of which can affect the vital organs. Inflammation of the sac surrounding the heart, known as the pericardium, or the lung membranes (pleura) can cause chest pain or shortness of breath. Blood supply to tissues can be cut off due to inflammation of blood vessels, known as vasculitis.

Red, painful eyes, Sjogren’s syndrome (dry mouth and eyes) or swollen lymph nodes have also been known to occur.

Diagnosis
Rheumatoid arthritis has a characteristic pattern of symptoms, which your doctor will use to in diagnosis. A biopsy of the rheumatoid nodules can allow the doctor to see the sample tissue under a microscope, or take a sample of the joint fluid with a needle.

A variety of blood tests can be useful. Active inflammation can be determined by testing the erythrocyte sedimentation rate (ESR). The doctor tests how quickly red blood cells settle to the bottom of a tube. This rate can be monitored to see the activity of the disease. Seventy percent of people with rheumatoid arthritis, according to Merck, have a distinctive antibody known as the rheumatoid factor. The more this rheumatoid factor appears in the blood, the more severe the symptoms of arthritis, although the rheumatoid factor may go down when the disease is in a period of remission or joints are less inflamed. The patient may have a low red blood cell count, known as anemia, or occasionally a low white blood cell count and an enlarged spleen. This is known as Felty’s syndrome when the person also has rheumatoid arthritis.



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