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Signs and symptoms of rheumatoid arthritis

Unlike osteoarthritis, which results from wear and tear on your joints, rheumatoid arthritis is an inflammatory disease. The exact cause of rheumatoid arthritis is unknown but is believed to be the body's immune system attacks the lining of the joints (Synovial membrane).

Rheumatoid arthritis is 2-3 times more common in women than in men and usually strikes between the ages of 20 and 50. But rheumatoid arthritis also can affect children and adults over 50 years of age.

There is no cure for rheumatoid arthritis. But with proper treatment, a strategy for joint protection and changes in lifestyle, can live a long and productive life with this condition.
Signs and symptoms

The signs and symptoms Rheumatoid arthritis may come and go over time. They include:

* Pain and swelling in joints, particularly in small joints of the hands and feet
* Widespread pain or stiffness of joints and muscles, especially after sleep or after periods of rest
* Loss of movement affected joints
* Loss of strength in the muscles to the joints affected
* Fatigue, which may be severe, during an outbreak
* Low-grade fever
* Deformity of the joints over time
* Feeling generally unwell (malaise)

Rheumatoid arthritis usually causes problems in several joints at once. In early rheumatoid arthritis, the joints in your wrists, hands, feet and knees are most frequently affected. As the disease progresses, your shoulders, elbows, hips, jaw and neck can become involved. It usually affects both sides of your body at the same time. The joints of both hands are one example.

Small pieces, called rheumatoid nodules, may form under the skin at pressure points and can occur at your elbows, hands, feet and Achilles tendons. Rheumatoid nodules may occur anywhere, including the back of the scalp, on the knee or even in your lungs. These nodules vary in size – from as small as a pea to as large as a walnut. Usually these blocks do not are painful.

In contrast to osteoarthritis, which affects only your bones and joints, rheumatoid arthritis can cause inflammation of the gland lacrimal, salivary glands, the linings of your heart and lungs, the lungs and, in rare cases, your blood vessels.

Although arthritis Rheumatoid arthritis is a chronic disease is often tends to vary in severity and may come and go. Periods of disease activity – called flare-ups or flares – Alternate with periods of relative remission, during which the swelling, pain, difficulty sleeping, and weakness fade or disappear.

Swelling or deformity may limit the flexibility of your joints. But even if you have a severe form of rheumatoid arthritis, you probably will maintain flexibility in many joints.
Illustration comparing with rheumatoid arthritis and osteoarthritis

Osteoarthritis, the most common form of arthritis, involves the wear cartilage that covers the bones in your joints. Rheumatoid arthritis, the synovial membrane that protects and lubricates the joints becomes inflamed, causing pain and swelling. joint erosion may follow.
More on this topic

* Osteoarthritis

Causes

As with other forms of arthritis, Rheumatoid arthritis is an inflammation of the joints. A membrane called synovium lines each of your movable joints. When you have rheumatoid arthritis, white blood cells – whose usual job is to attack unwanted invaders such as bacteria and viruses move – from his movement blood in your synovium. Here, the blood cells appear to play an important role in determining the synovial membrane to become inflamed (synovitis).

This inflammation results in release of proteins that over months or years, cause thickening of the synovial membrane. These proteins can also damage the cartilage, bone, tendons and ligaments. Gradually the joint loses its shape and alignment. Eventually, it can be destroyed.

Some researchers suspect that rheumatoid arthritis is triggered by an infection – possibly a virus or bacterium – in people with an inherited susceptibility. Although the disease itself is not inherited, certain genes that create an increased susceptibility are. People who have inherited these genes will not necessarily develop rheumatoid arthritis. But they may be more likely to do so than others. The severity of the disease also may depend on inherited genes. Some researchers also believe that hormones may be involved in the development of rheumatoid arthritis.
Illustration showing the inflammation of rheumatoid arthritis

Rheumatoid arthritis usually strikes the joints, causing pain, swelling and deformity. As their membranes become inflamed synovial thickening, fluid accumulates in the joints and erode and degrade.
Risk factors

The exact causes of rheumatoid arthritis are not clear, but these factors may increase the risk:

* Aging, because the incidence of rheumatoid arthritis increases with age. However, the incidence begins to decline in women over 80 years of age.
* Being females.
* Being exposed to an infection, probably a virus or bacterium, which may trigger rheumatoid arthritis in patients with a susceptibility hereditary.
* Inheritance specific genes that may make it more susceptible to rheumatoid arthritis.
* Smoking cigarettes over a long period of time.

When to seek medical advice

Consult your physician if you have persistent discomfort and swelling in multiple joints on both sides of your body. Your doctor can work with you to develop a pain management and treatment plan. Also consult a doctor if you experience side effects of their arthritis medicines. Side effects may include nausea, abdominal discomfort, or tar black stools, changes in bowel habits constipation and drowsiness.
Screening and diagnosis

If you have signs and symptoms of rheumatoid arthritis, your doctor will probably perform a physical examination and laboratory request to determine if you have this type of arthritis. These tests may include:

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The blood tests. A blood test that measures your erythrocyte sedimentation rate (ESR or sed rate) can indicate the presence of an inflammatory process in the body. People with rheumatoid arthritis tended to have elevated ESRs. The ESRs those with osteoarthritis tend to be normal.

Another blood test for an antibody called rheumatoid factor. Most people with rheumatoid arthritis eventually have this abnormal antibody although it may be absent early in the disease. It is also possible to have rheumatoid factor in blood and not having rheumatoid arthritis.
* Imaging. Doctors can take X-rays of your joints to differentiate between osteoarthritis and rheumatoid arthritis. A sequence of X-rays obtained over time can show the progression of arthritis.

Complications

Rheumatoid arthritis causes pain and stiffness and may also cause fatigue. May cause difficulties with daily tasks, like turning a doorknob or holding a pen. Dealing with the pain and unpredictability of rheumatoid arthritis can also cause symptoms of depression.

Rheumatoid arthritis may also increase the risk of osteoporosis, especially if you are taking corticosteroids. Some researchers believe that arthritis arthritis may increase the risk of heart disease. This may be due to inflammation that causes rheumatoid arthritis can also affect the arteries and muscle tissue the heart.

In the past, people with rheumatoid arthritis may have ended up confined to a wheelchair because damage to joints made it difficult or impossible to walk. This is not like today, probably because of better treatment and self-service methods.
More on this topic

Osteoporosis *

Treatment

The treatments for arthritis have improved in recent years. Most treatments involve medications. But in some cases, surgical procedures may be necessary.

Medicines
Drugs for rheumatoid arthritis can relieve symptoms and slow or prevent its progression. They include:

* Nonsteroidal anti-inflammatory drugs (NSAIDs). This group of drugs that includes aspirin helps relieve pain and inflammation if you take the medicines regularly. NSAIDs are available over-the-counter include aspirin, ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve). These are available in larger doses, and other NSAIDs are available by prescription – like ketoprofen, naproxen (Anaprox, Naprosyn), Tolmetin (Tolectin), diclofenac (Voltaren), indomethacin, nabumetone (Relafen) and (Indocin). Taking NSAIDs can lead to side effects such as indigestion and bleeding in the stomach. Other side effects may include damage to the liver and kidneys, ringing in the ears (tinnitus), fluid retention and high blood pressure. NSAIDs, except aspirin, may also increase the risk of cardiovascular events such as heart attack or stroke.
* Inhibitors COX-2. This class of NSAIDs may be less harmful to the stomach. Like other NSAIDs, inhibitors COX-2 – such as celecoxib (Celebrex) – suppress an enzyme called cyclooxygenase (COX), which is active in joint inflammation. Other types of NSAIDs work against two versions COX enzyme that are present in your body: COX-1 and COX-2. However, there is evidence that by suppressing COX-1, NSAIDs can cause stomach problems and another because COX-1 is the enzyme that protects the stomach. Unlike other NSAIDs, COX-2 inhibitors suppress only COX-2, the enzyme involved in inflammation. The effects side effects may include fluid retention and causing or exacerbating high blood pressure. Moreover, this class of drugs has been associated with an increased risk heart attack and stroke.
* Corticosteroids. These medications such as prednisone and methylprednisolone (Medrol), reduce inflammation and pain, injuries joint and slow. In the short term, corticosteroids can make you feel much better. But when used for many months or years, they may become less effective and cause serious side effects. Side effects may include easy bruising, thinning bones, cataracts, weight gain, round face and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the aim of gradually reducing the medication.
* Disease modifying anti-rheumatic drugs (DMARDs). Physicians prescribe DMARDs to limit the amount of joint damage that occurs in rheumatoid arthritis. The use of these drugs in early stages of development of rheumatoid arthritis is especially important in the effort to reduce disease and save your joints and other tissues from permanent damage. Because many these drugs act slowly – it can take weeks or months before you notice any benefit – DMARDs typically are used with an NSAID or a corticosteroid. While NSAIDs or corticosteroids treat the immediate symptoms and limits inflammation the DMARD goes to work on the disease itself. Some commonly used DMARDs include hydroxychloroquine (Plaquenil) the gold compound auranofin (Ridaura), sulfasalazine (Azulfidine), minocycline (DYNACIN, Minocin) and methotrexate (Rheumatrex). Other forms of DMARDs include immunosuppressants and tumor necrosis factor (TNF) blockers.
* Immunosuppressants. These medications act to tame your immune system, which is out of control in rheumatoid arthritis. Furthermore, some of these drugs attack and eliminate cells that are associated with the disease. Some of the commonly used immunosuppressants include leflunomide (Arava), azathioprine (Imuran), cyclosporine (Neoral, Sandimmune) and cyclophosphamide (Cytoxan). These drugs can have potentially serious side effects, such as increased susceptibility to infection.
* TNF blockers. These are a class of DMARDs known as biologic response modifiers. TNF is a cytokine, or cell protein that acts as an inflammatory agent in rheumatoid arthritis. TNF blockers, or anti-TNF medications, target or block this cytokine and can help reduce pain, morning stiffness and tender or swollen joints – usually within a week or two after treatment begins. There is evidence that TNF blockers may halt progression of the disease. These medicines are often taken with methotrexate. TNF blockers approved for treatment Rheumatoid arthritis is etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira). Possible side effects include irritation at the injection site (Adalimumab and etanercept), worsening of congestive heart failure (infliximab), blood disorders, lymphoma, demyelinating diseases and increased risk of infection. If you have an active infection, do not take these medications.
* Receptor antagonist Interleukin-1 (IL-1Ra). IL-1Ra is another type of biological response modifier and is a recombinant form of natural receptor antagonist of interleukin-1 (IL-1Ra). Interleukin-1 (IL-1) is a cell protein that promotes inflammation and occurs in greater quantities than in people with rheumatoid arthritis or other types of inflammatory arthritis. If IL-1 is prevented from connecting to its receptor, decreases the inflammatory response. The first IL-1Ra has been approved by the Food and Drug Administration for use in people with moderate to severe rheumatoid arthritis that not responded adequately to DMARD therapy is anakinra (Kineret). Can be used alone or in combination with methotrexate. Anakinra is given as an injection Daily self-administered under the skin. Some potential side effects include injection site reactions, decreased cell count White blood, headache and increased upper respiratory infections. There may be a slightly higher rate of respiratory infections in people who have asthma or chronic obstructive pulmonary disease. If you have an active infection, do not use anakinra.
* Abatacept (Orencia). modulator abatacept, a type of costimulation approved in late 2005, reduces inflammation and joint damage caused by rheumatoid arthritis by inactivating T cells – a type of white blood cell. People that have not been helped by TNF blockers might consider abatacept which is administered monthly through a vein in your arm (intravenously). The effects side effects may include headaches, nausea and mild infections such as upper respiratory tract infections. severe infections as pneumonia, can occur.
* Rituximab (Rituxan). Rituximab reduces the number of B cells in your body. B cells are involved in inflammation. Although initially approved for use in people with non-Hodgkin lymphoma, rituximab was approved for rheumatoid arthritis in early 2006. People who have found relief with TNF blockers might consider rituximab, which is usually given along with methotrexate. Rituximab is administered as an infusion into a vein in your arm. The effects side effects include flu-like signs and symptoms, including fever, chills and nausea. Some people experience extreme reactions to infusion such as difficulty breathing and heart problems.
* Antidepressant drugs. Some people with arthritis also experience symptoms of depression. The most common antidepressants used to arthritis pain and poor quality sleep are amitriptyline, nortriptyline (Aventyl, Pamelor) and trazodone (Desyrel).

Surgical or other procedures
Despite a combination of medication and self-service is the first course of action for rheumatoid arthritis, other methods are available for severe cases:

* Prosorba column. This technique of filtering the blood removes certain antibodies that contribute to pain and inflammation in joints and muscles and is usually performed once a week for 12 weeks as an outpatient procedure. Some side effects include fatigue and a brief increase in pain and swelling joints for the first days after treatment. The treatment of spine prosorba is not recommended if you are taking angiotensin-converting enzyme (ACE) or if you have heart problems, high blood pressure or blood clotting problems.
* Joint replacement surgery. For many people with rheumatoid arthritis medicines and therapies can not prevent joint destruction. When joints are severely damaged, replacement surgery joint can often help restore joint function, reduce pain or correct a deformity. You may need to have a whole set replaced by a prosthesis metal or plastic. Surgery may also involve tightening tendons that are too loose loosening tendons that are too tight fusing bones to reduce pain or removing part of a diseased bone to improve mobility. Your doctor may also remove the inflamed joint lining (synovectomy).

More on this topic

* Steroid use: Balancing the risks and benefits
* Are COX-2 drugs safe for you? An interview with a Mayo Clinic specialist
* Knee Replacement: Surgery can relieve pain

Self-care

Treating rheumatoid arthritis usually involves using a combination of medical treatments and self-care strategies. The following self-care are important elements to control the disease:

*

Exercise regularly. Different types of exercise achieve different goals. Check with your doctor or physiotherapist and then start a program of regular exercise to your specific needs. If you can walk, Walking is good exercise for beginners. If you can not walk, try a stationary bicycle with little or no resistance exercises or do hand or arm. A chair exercise program may be helpful. Aquatic exercise is another option, and many health clubs with pools offer such classes.

It's good to move each joint in its full range of motion every day. As you moves, keep a slow, steady rhythm. Do not jerk or bounce. Also, remember to breathe. Holding your breath can temporarily deprive your muscles oxygen and tire them. It is also important to maintain good posture during exercise. Avoid exercising tender, injured or severely inflamed joints. If you feel new joint pain, stop. New pain that lasts more than two hours after exercise probably means you are exaggerated. If pain persists for more a few days, call your doctor.
* Control your weight. Excess weight puts added stress on the joints in your back, hips, knees and feet – Places where arthritis pain is usually felt. Excess weight can also make joint surgery more difficult and risky.
Eat a healthy diet. A healthy diet emphasizing fruits, vegetables and whole grains can help control your weight and maintain your overall health, allowing you to better cope with their arthritis. However, there is no special diet that can be used to treat arthritis. There is evidence that eating a certain food will cause her pain or inflammation better articulate or worse.
* Apply heat. Heat will help ease your pain, relax tense, sore muscles and increase the regional flow of blood. One of the easiest and most effective to apply heat to take a shower or hot tub for 15 minutes. Other options include using a hot pack, an electric heating pad set in your configuration lower or a radiant heat lamp with a reflector lamp of 250 watts of heat to warm specific muscles and joints. If your skin has the feeling bad or if you have poor circulation, do not use heat treatment.
* Apply cold for occasional flare-ups. Cold may dull the sensation of pain. Cold also has a numbing effect and decreases muscle spasms. Do not use cold treatments if you have poor circulation or numbness. Techniques may include the use of cold compresses, soaking the affected joints in cold water with ice and massage.
* Practice relaxation techniques. Hypnosis, guided imagery, deep breathing and muscle relaxation can be used for pain control.
* Take your medication as recommended. By taking medications regularly instead to wait for pain to build, you will lessen the overall intensity of his discomfort.

Coping skills

The degree to which rheumatoid arthritis affects your daily activities depends in part on how well you deal with the disease. physiotherapists and occupational therapists can help you devise strategies to deal with specific constraints that may occur as a result of weakness or pain. Here are some general suggestions to help you cope:

* Keep a positive attitude. With your physician, make a plan for managing your arthritis. This will help you feel responsible for their illness. Studies show that people who take control of their treatment and actively manage their arthritis experience less pain and make fewer visits to the doctor.
* Use assistive devices. Knee pain may need a strap support. You may also want to use a cane to take some stress off the joint as you walk. Use the cane in the hand opposite to the articulation affected. If your hands are affected various helpful tools and gadgets are available to help you maintain an active lifestyle. Contact your doctor or pharmacist For information about ordering items that can help you more.
* Know your limits. Rest when tired. Arthritis can make it prone to fatigue and weakness. A rest or nap does not interfere with nighttime sleep may help.
Avoid grasping actions that strain on joints finger. Instead of using a clutch purse for example select with a shoulder strap. Use hot water to loosen a jar lid and pressure from the palm to open it, or use a bottle opener. Do not twist or use your joints forcefully.
* Spread the mass of an object over several joints. For example, use both hands to lift a heavy saucepan.
* Take a break. Periodically, relax and lengthen.
* Maintain good posture. Poor posture causes uneven distribution weight and may strain ligaments and muscles. The easiest way to improve your stance is on foot. Some people find that swimming also helps improve your posture.
* Use your strong muscles, favoring large joints. Do not push open a heavy glass door. Lean into it. To pick an object, bend knees and squat, keeping your back straight.

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