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Rheumatoid Arthritis

What is Rheumatoid Arthritis?

About 300,000 Canadians are affected by rheumatoid arthritis, a condition caused by inflammation of the lining of joints. It is caused by an attack by the body's own immune system on tissue that it mistakenly recognizes as foreign. This may be caused by an inherited factor, as rheumatoid arthritis tends to run in families and affects about twice as many women as men. Rheumatoid arthritis usually becomes evident between the ages of 25 and 50, although it can develop at any age.

What are the Symptoms of Rheumatoid Arthritis?

Rheumatoid arthritis is a disease that tends to get worse with time because the attack on the tissues continues and causes damage to cartilage, bone, tendons and ligaments. Rheumatoid arthritis symptoms include the following:

Pain, swelling, tenderness, heat, or redness in joints, often in the hands and feet (inflammation and pain may start with a sudden severe attack - with flu-like symptoms - or may develop gradually over time)
Swelling that occurs on both sides of the body at the same time (i.e. both hands or both feet are affected)
Pain that occurs in three or more joints at the same time
Stiffness that is worse in the morning, usually lasting 30 minutes or longer
Pain that occurs in a joint throughout the night
Feeling low in energy and tiring very easily
Fever and weight loss

The symptoms of rheumatoid arthritis vary between people. Some people experience inflammation and pain continuously while others have periods of active disease and remission.

Coping with Rheumatoid Arthritis

In order to cope with the symptoms of arthritis you need to pace yourself and perform daily activities in a manner that will cause the least aggravation to your symptoms. For example:

You should learn to lift properly, carrying a heavy load close to your body - be aware of the stress being put on your joints when lifting
Don't do all your heavy jobs at once - slow down by performing an easier task or take a rest between jobs
Use aids that will help you to perform daily tasks more easily (for example, you should use a cart to carry your groceries, and have a grab bar in the shower to help you get in and out more easily; canes and reaching aids can also help to prevent undue stress on your joints)

The Benefits of Exercise

Physical therapists can show you exercises that will help to lessen your symptoms of rheumatoid arthritis and keep the muscles around the affected joint(s) strong and flexible. Exercise also helps to maintain a healthy weight, which reduces the stress on joints. There are three main types of exercise:

Range of motion exercises are used to reduce stiffness and to help keep joints moving.
Strengthening exercises help to prevent deterioration of muscles.
Endurance exercises such as walking, swimming and cycling improve energy levels, strengthen the heart and help with weight control.

Heat (e.g. hot shower) can help to relax aching muscles.

Cold (e.g. ice pack on a swollen joint) can help to reduce the pain and swelling in a joint. Both of these strategies can help to reduce pain associated with rheumatoid arthritis.

Medication

In the past, anti-inflammatory medications were always the first medications used for treatment of rheumatoid arthritis. Although these medications do help with symptoms of the condition, they do not address the ongoing progression of the disease. Today, medications known as 'disease modifying anti-rheumatic drugs' or DMARDs are used shortly after a diagnosis of rheumatoid arthritis is made in order to slow progression of the disease.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs) reduce pain and swelling. Care must be taken when taking NSAIDs on an ongoing basis because they increase risk for stomach ulcers and stomach bleeds. Newer NSAIDs (e.g. celecoxib) have been designed to have a less damaging effect on the stomach. These medications are preferable for people who are at high risk of stomach problems (e.g. people taking steroids, people with a history of ulcers, senior citizens). Alternatively, traditional steroids such as naproxen, ASA, ibuprofen, ketoprofen or diclofenac may be taken with an agent that protects the stomach.

DMARDs slow down the immune system attack, which leads to damage of joints, bone, cartilage and ligaments. Methotrexate is usually the first DMARD started as it has been found to be very effective, safe and relatively inexpensive. Additional DMARDs include hydroxychloroquine, azathioprine, gold salts, sulfasalazine and leflunomide.

Corticosteroids are sometimes used to reduce pain and swelling. Their side effects (e.g. thinning of bones) usually limit their use to short periods of time when inflammation is at its worst. The most common oral corticosteroid is prednisone. Injectable corticosteroids are sometimes injected directly into joints to reduce swelling.

Biologics are newly developed injectable medications that have been found effective in slowing down disease progression. They work very quickly to relieve symptoms but are usually saved for people who need them most because of expense. Examples of biologics include etanercept, infliximab and anakinra.

Getting Help with Rheumatoid Arthritis

Although there are more than 100 forms of arthritis, rheumatoid arthritis is the most painful and debilitating of them all.

Get medical help early - It is important to identify the signs and symptoms of rheumatoid arthritis as early as possible so that treatment aimed at slowing the progression of the disease can be started. If you have swelling in multiple joints on both sides of your body, talk with your doctor.

Diagnosing Rheumatoid Arthritis

Doctors use a combination of physical examination and blood tests to diagnose rheumatoid arthritis:

Erythrocyte sedimentation rate (ESR) is a blood test used to identify an inflammatory process occurring in the body. People with rheumatoid arthritis tend to have a high ESR while those with osteoarthritis do not.

Rheumatoid factor (RF) is an antibody that is present in four out of five people that have rheumatoid arthritis.

X-rays are used by doctors to identify joints that have been affected by rheumatoid arthritis, and to differentiate them from joint damage caused by osteoarthritis (which does not involve inflammation).