Barry Fox - Arthritis For Dummies

Rheumatoid arthritis can strike just about anybody — children, the elderly, the middle-aged, and people of almost all racial or ethnic groups. But RA has a particular affinity for women, especially those between the ages of 20 and 50. Women account for over two-thirds of the 1.5 million Americans who suffer from RA, making them about three times as likely as men to get the disease, although scientists have yet to determine why.

Lucille Ball, the famous comedienne and zany star of the I Love Lucy television series, was just 17 years old and working as a model in Hattie Carnegie’s internationally renowned dress shop when she suddenly developed a fiery pain in both her legs. “It was so bad, I had to sit down,” she wrote in her autobiography, Love, Lucy. She had recently recovered from a bout with pneumonia and a high fever; now this!

Hurrying to her doctor, she received the terrifying news: She had rheumatoid arthritis, a crippling disease that becomes progressively worse over time. In fact, it was conceivable that she would spend her life in a wheelchair. Lucy’s doctor sent her to an orthopedic clinic where she waited for three hours, nearly fainting from the pain, before the doctor informed her that there was no cure. He did ask if she would like to try an experimental treatment, though — injections of a kind of “horse serum.” Lucy agreed and received these shots over the next several weeks until she finally ran out of money. Unfortunately, the pain continued.

Discouraged but not about to give up, Lucy went back home to her parents, who massaged her legs, gave her money to continue the horse serum injections, and encouraged her to take better care of her health. Finally, months later, the pain began to ease, and Lucy was able to stand up on weak and shaky legs. Her left leg had shortened a bit during the course of the disease, so she added a 20-pound weight to her corrective shoe to stretch the leg out. (Note: RA is no longer treated with horse serum. We’ve come a long way since then!)

Lucy’s hard work and perseverance paid off. She was able to return to New York; she made several movies and eventually starred in her own television series, one that required vigorous physical comedy, stamina, and energy. She also starred in Broadway plays, performing eight shows a week while managing to sail through energetic song and dance numbers with a seemingly effortless grace and ease. Lucy remained active and healthy until her death in 1989, and in spite of her doctor’s ominous prediction, never spent a single day in a wheelchair.

Unfortunately, no one test can tell your doctor you definitely have RA. Instead, your doctor looks for a tell-tell pattern in the information taken from many sources, such as your medical history, physical examination, laboratory tests, X-rays, a fluid sample taken from affected joints, and, if rheumatoid nodules are present, a biopsy of those nodules.

During your initial examination, your doctor will ask about the onset of your symptoms, whether you’re experiencing any morning stiffness, the kind and amount of pain you feel, the presence of swelling, whether or not joints are affected on both sides of your body, and so on. Looking into your medical history is a way to see if your symptoms fit the general pattern of RA or suggest another disease instead. During your physical exam, your doctor will also check for tenderness, range of motion, and the presence of rheumatoid nodules.

Three tests typically help diagnose rheumatoid arthritis, all of which involve taking a sample of your blood and sending it to the laboratory for examination:

Rheumatoid factor (RF) test checks for the presence of a particular antibody that appears in the blood of the majority of people who have RA. But a positive RF test doesn’t necessarily mean you have rheumatoid arthritis. The RF antibody can also appear due to other rheumatic diseases, hepatitis C, and many other medical conditions.

Erythrocyte sedimentation rate (ESR or sed rate) measures the rate at which red blood cells settle in a test tube, which can indicate inflammation.This is a nonspecific marker of inflammation, which may be due to several factors, including age, obesity, infection, cancer, and autoimmune conditions.

C-reactive protein (CRP) is another nonspecific marker of inflammation. It checks for a protein that indicates inflammation is present somewhere in the body.

Cyclic citrullinated peptide (CCP) antibody checks for a type of antibody commonly produced in rheumatoid arthritis as well as certain other autoimmune disorders.

Complete blood count (CBC) checks for anemia (meaning there are not enough red blood cells) and thrombocytosis (the production of too many platelets), both of which can occur with chronic inflammation and are often seen in RA. These findings are not specific to RA, just a sign of chronic inflammation.

Antinuclear antibody (ANA) checks for antibodies to components in the nucleus of cells. This is very nonspecific test that is commonly positive in healthy individuals (up to 25 percent at low levels!), but may provide additional clues that you have RA, or another condition such as lupus.

Human leukocyte antigen tissue typing (HLA) checks for a genetic marker that indicates an increased likelihood for developing an immune-related condition like RA, reactive arthritis, or ankylosing spondylitis. HLAB27 is the test most commonly ordered, but is not routinely needed to evaluate someone for RA.

In addition, your doctor may perform the following tests:

Joint aspiration (arthrocentesis): The doctor inserts a needle into your affected joint(s) to remove some of the synovial fluid, which is examined under a microscope for evidence of infection or inflammation.

Imaging tests: A standard X-ray of your joints may be taken to check for bone and cartilage loss and/or serve as a baseline for comparison of future X-rays.However, X-rays aren’t sensitive enough to detect joint damage in the early stages of the disease. Magnetic resonance imaging (MRI) and ultrasound images may be helpful in detecting early signs of RA when the diagnosis is not clear since they can provide more information than X-ray, but aren’t always needed to make an RA diagnosis. Computerized technology (CT scans) are rarely used to detect RA because, although they show bone damage, they lack the sensitivity to reveal soft-tissue changes.

Biopsy of rheumatoid nodules: Rheumatoid nodules are rubbery lumps under the skin that often form near the joints in people who have RA. Occasionally, a biopsy will be done to rule out other conditions, like infections or gout. However, this is not a very common procedure.Unless the rheumatoid nodules cause pain or impair your range of motion, they usually don’t need to be treated. But since other bumps and lumps can look and feel like RA nodules, your doctor may want to take a piece of tissue from one of them and examine it under a microscope to confirm the diagnosis. After carefully cleansing the skin and injecting a local anesthetic, the doctor makes a tiny cut near the nodule and, if possible, shaves off a piece of tissue. Or they may push a thin, hollow needle into the nodule and, using suction, pull out a tissue sample.

Although RA is often a chronic disease, most people respond well to treatment and lead active, productive lives. A few years back, a victim of RA could look forward to a dreary life spent bedridden or in a wheelchair. But today, they have a better prognosis: Only about one in ten patients progresses to the point of disability, and in a full 70 percent of the cases, symptoms are relieved or controlled for long periods of time.