Barry Fox - Arthritis For Dummies

2 Almost as if they’re launching a counterattack, these abnormal cells invade the surrounding tissue — mostly the bone and cartilage.

3 The joint space begins to narrow, and the joint’s supporting structures become weak. At the same time, the cells that trigger inflammation release enzymes that start eating away at the bone and cartilage, causing joint erosion and scarring.

4 Reeling under this many-sided attack, the joint itself deteriorates, eventually becoming misshapen and misaligned.

See Figures 3-1 and 3-2 for comparison of a healthy joint to one with RA.

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FIGURE 3-1:In the healthy joint, the synovial membrane is thin and free from inflammation; the cartilage is smooth, thick, and even. The joint space is well defined, and the joint capsule assumes a normal shape.

© John Wiley & Sons, Inc.

FIGURE 3-2:In the joint affected by RA, the synovial membrane is inflamed and swollen, with infected cells invading both bone and cartilage. The cartilage is thin, the joint space narrowed, and the joint capsule swollen.

Rheumatoid arthritis insidiously makes its way through the body and (in more severe cases) can eventually spread to all of the joints. But the joints are not its only targets. RA is a systemic disease capable of attacking various parts of the body, not just the joints. It can cause inflammation of the eyes, skin, heart, blood vessels, and lungs, generally wreaking havoc on the body as a whole.

If the tear and salivary glands partially “dry up,” Sjögren’s can develop in association with RA. See Chapter 4for more on this “drying disease.”

Some people have RA for just a short time — a few months or a couple of years — and then it disappears forever. Others suffer through painful periods (flares) that come and go, although they can feel quite well in between episodes. Those with severe forms of RA, however, may be in pain a good deal of the time, experience symptoms for many years, and suffer serious joint damage.

If you have rheumatoid arthritis, the first thing you may notice is a dull ache, stiffness, and swelling in two matching joints — for example, both elbows, both knees, or both index fingers. The most typical sites for RA are the fingers and wrists, but it can also settle in the hands, elbows, shoulders, neck, hips, knees, ankles, and feet. See Figure 3-3.

Although pain and inflammation are early signs of RA, they’re not always the first to herald the arrival of the disease. RA typically begins with minor symptoms and slowly makes its presence known. But it can also strike dramatically, causing several joints to become inflamed all at once.

© John Wiley & Sons, Inc.

FIGURE 3-3:The areas where rheumatoid arthritis is most likely to strike.

Although the symptoms of rheumatoid arthritis vary, most people with RA experience one or more of the following:

Pain, warmth, redness, swelling, or tightness in a joint

Swelling of three or more joints for six or more weeks

Joints affected in a symmetrical, mirror-image pattern (for example, both knees, both shoulders, and so on)

Joint pain or stiffness lasting longer than 30 minutes upon arising or after prolonged inactivity

Pea-shaped bumps under the skin (called rheumatoid nodules ), especially on pressure points like the elbows or the feet, or overlying affected joints. In bedridden patients, they may also occur at the base of the scalp or on the back side of the hip

Evidence of joint erosion on an X-ray

Loss of mobility

General soreness, aching, stiffness

A general “sick” feeling (malaise)

Fatigue

Periodic low-grade fever and/or sweats

Difficulty sleeping

Anemia caused by chronic inflammation in the body

Blood tests showing the presence of positive rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) antibody. These are antibodies that are found in up to 80 percent of RA patients.

As RA progresses, the joints enlarge and can become deformed. They may even freeze in a semicontracted position, making complete extension impossible. The fingers can start to curl up, pointing away from the thumb, as their tendons slip out of place. RA may also attack other parts of the body, causing the following conditions:

Pleurisy: If RA attacks the lungs, it can cause pleurisy (inflammation of the membranes around the lungs), prompting difficulty in breathing, chest pain, and scarring and inflammation of the lungs causing chronic dry cough and difficult breathing, especially with exercise.

Episcleritis or scleritis: If it attacks the tissues covering the white part of the eye, it can cause eye pain, sensitivity to light, and tearing of the eye.

Pericarditis: If it settles in the membrane surrounding the heart (a condition called pericarditis ), it can cause chest pain while lying down, or impair the heart’s ability to pump blood properly.

Vasculitis: If it affects the blood vessels (vasculitis), the blood supply to other parts of the body can be cut off, causing nerve damage, skin ulcers, gangrene, and other types of tissue death.

Even though rheumatoid arthritis can have some very serious consequences, this disease can be managed. Many people with RA live long, successful lives, and we now have many FDA-approved medications that can improve quality of life, level of function, and protect the joints from permanent damage and deformity. But remember: Early treatment can make a big difference in RA, so don’t wait to see a doctor.The earlier RA is diagnosed and treated, the better the overall prognosis and the higher the likelihood that the disease can be controlled.

The truth is that nobody really knows what causes RA, although some believe it is linked to a defect in the immune system. Many people with RA have a particular genetic marker — HLA-DR4 — so it’s reasonable to suspect that this gene may be to blame. Yet, not everyone with this gene ends up with RA, and not everyone with RA has this gene. And scientists are certain that more than just one gene is involved: Perhaps HLA-DR4 is only one of several genes that can tip the scales in favor of developing RA. Most likely, genetic markers play a part in the development of the disease but aren’t the determining factor. Some researchers believe that RA may be triggered by a virus, or perhaps an unrecognized bacteria, that “wakes up” a dormant genetic defect and sets it in motion. As of yet, no such infectious agent has been discovered, and RA has not been found to be contagious.

Hormones or hormone deficiencies may also play a part, although their possible role is unclear. Women are more likely than men to develop RA, suggesting a possible link to estrogen. But, at present, doctors have more questions than answers about RA.