Rheumatoid Arthritis

Rheumatoid arthritis is an inflammatory form of arthritis that causes joint pain and damage. Rheumatoid arthritis attacks the lining of your joints (synovium) causing swelling that can result in aching and throbbing and eventually deformity. Sometimes rheumatoid arthritis symptoms make even the simplest activities — such as opening a jar or taking a walk — difficult to manage. Rheumatoid arthritis is two to three times more common in women than in men and generally occurs between the ages of 40 and 60. But rheumatoid arthritis can also affect young children and older adults. There's no cure for rheumatoid arthritis. With proper treatment, a strategy for joint protection and changes in lifestyle, you can live a long, productive life with rheumatoid arthritis.

Signs and symptoms of rheumatoid arthritis may include:
         Joint pain Joint swelling Joints that are tender to the touch Red and puffy hands Firm bumps of tissue under the skin on your arms (rheumatoid nodules) Fatigue Morning stiffness that lasts at least 30 minutes Fever Weight loss

Signs and symptoms appear in smaller joints first Rheumatoid arthritis usually causes problems in several joints at the same time. Early rheumatoid arthritis tends to affect your smaller joints first — the joints in your wrists, hands, ankles and feet. As the disease progresses, your shoulders, elbows, knees, hips, jaw and neck can also become involved. Signs and symptoms of a rheumatoid arthritis flare Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased 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.

your lifestyle choices. The blood cells appear to play a role in causing the synovium to become inflamed. Gradually. . It's likely that rheumatoid arthritis occurs as a result of a complex combination of factors. the joint loses its shape and alignment. and things in your environment. such as bacteria and viruses — move from your bloodstream into the membranes that surround your joints (synovium). cause the synovium to thicken. The proteins can also damage the cartilage. bone. tendons and ligaments near your joint. such as viruses. including your genes. Doctors don't know what causes this process that leads to rheumatoid arthritis. it may be destroyed.Causes Rheumatoid arthritis occurs when white blood cells — whose usual job is to attack unwanted invaders. such as smoking. Eventually. over months or years. The inflammation causes the release of proteins that.

Instead. Rheumatoid arthritis occurs most commonly between the ages of 40 and 60. Family history. it's believed that you can inherit a predisposition to rheumatoid arthritis. and other autoimmune rheumatic diseases. which indicates the presence of an inflammatory process in the body. Quitting can reduce your risk. it can also occur in older adults and in children (juvenile rheumatoid arthritis).Risk factors Factors that may increase your risk of rheumatoid arthritis include:     Sex. Rheumatoid factor and anti-CCP antibodies can be present in people who have chronic infections. and drowsiness. In early rheumatoid arthritis. constipation. The fluid can be tested to help rule out other diseases and conditions. Smoking. Tests and diagnosis Diagnosing rheumatoid arthritis usually begins with a physical exam. such as active tuberculosis. Smoking cigarettes increases your risk of rheumatoid arthritis. While commonly found in the blood of people with rheumatoid arthritis. However. contact your doctor if you experience side effects from your rheumatoid arthritis medications. your doctor may recommend:  Blood tests. When to seek medical advice Make an appointment with your doctor if you have persistent discomfort and swelling in multiple joints on both sides of your body. rheumatoid factor and anti-CCP antibodies aren't present in all cases. or sed rate). . Other common blood tests look for antibodies called rheumatoid factor and anti-cyclic citrullinated peptide (antiCCP) antibodies in the blood. Age. you may have an increased risk of the disease. changes in bowel habits. Your doctor may draw fluid from your joint using a needle. such as lupus and Sjogren's syndrome. In addition. If you've already been diagnosed with rheumatoid arthritis. If a member of your family has rheumatoid arthritis. People with rheumatoid arthritis tend to have an elevated erythrocyte sedimentation rate (ESR. Doctors don't believe you can directly inherit rheumatoid arthritis. Your doctor will ask you about your signs and symptoms and examine your affected joints. Women are more likely to develop rheumatoid arthritis than men are. the presence of rheumatoid factor and anti-CCP antibodies in the blood may be associated with an increased risk of joint damage. abdominal discomfort. Side effects may include nausea.  Joint fluid analysis. black or tarry stools.

 X-rays. In addition. Motrin. These medications can have potentially serious side effects such as increased susceptibility to infection. These drugs are typically used in the early stages of rheumatoid arthritis in an effort to slow the disease and save the joints and other tissues from permanent damage. and liver and kidney damage. with the goal of gradually tapering off the medication. Newer treatments may stop joint damage or prevent it so you can continue the activities you enjoy. You may find at first that tasks take more energy to accomplish. stomach bleeding. In the short term. Common DMARDs include hydroxychloroquine (Plaquenil). others) and naproxen sodium (Aleve). Early and aggressive rheumatoid arthritis treatments may slow joint damage and help reduce the risk of disability. though surgery may be necessary in cases of severe joint damage. gastric ulcers. they may become less effective and cause serious side effects. minocycline (Dynacin. which is out of control in rheumatoid arthritis. cataracts. Immunosuppressants. Treatments and drugs There is no cure for rheumatoid arthritis. TNF-alpha inhibitors. such as prednisone and methylprednisolone (Medrol). they may be combined with other medications that give you more immediate relief from signs and symptoms. Disease-modifying antirheumatic drugs (DMARDs). and slow joint damage. thinning of bones. TNF inhibitors target or block this cytokine and can help     . Steroids. or cell protein. These medications act to tame your immune system. weight gain. Sandimmune) and cyclophosphamide (Cytoxan). Doctors often prescribe a corticosteroid to relieve acute symptoms. azathioprine (Imuran). For that reason. Over-the-counter NSAIDs include ibuprofen (Advil. Doctors prescribe DMARDs to limit the amount of joint damage that occurs in rheumatoid arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Damage to your joints may make it difficult or impossible to go about your daily activities. Side effects may include easy bruising. some of these drugs attack and eliminate cells that are associated with the disease. reduce inflammation and pain. TNF-alpha is a cytokine. With time you may find you are no longer able to do them at all. the gold compound auranofin (Ridaura). Treatment typically involves medications. Side effects may include ringing in your ears. NSAIDs have risks of side effects that increase when used at high dosages for long-term treatment. a round face and diabetes. Medications Rheumatoid arthritis medications can relieve pain and slow or halt the progression of joint damage. sulfasalazine (Azulfidine). Some of the commonly used immunosuppressants include leflunomide (Arava). Medications used to treat rheumatoid arthritis include:  NSAIDs. You may need to take DMARDs for weeks or months before you notice any benefit. Minocin) and methotrexate (Rheumatrex). Treatment for rheumatoid arthritis aims to reduce inflammation in your joints in order to relieve pain and prevent or slow joint damage. such as NSAIDs or corticosteroids. Your doctor may recommend X-rays to help track the progression of rheumatoid arthritis in your joint over time. Consuming alcohol or taking corticosteroids while using NSAIDs also increases your risk of gastrointestinal bleeding. Corticosteroid medications. that acts as an inflammatory agent in rheumatoid arthritis. heart problems. cyclosporine (Neoral. corticosteroids can make you feel dramatically better. Stronger versions of these NSAIDs and others are available by prescription. Complications Rheumatoid arthritis causes joint damage that can be both debilitating and disfiguring. But when used for many months or years.

and methotrexate or leflunomide for all levels of disease severity with or without a poor prognosis. your overall physical function. the ACR recommends combinations of DMARDs or a TNFalpha inhibitor. nausea and mild infections. Serious infections. demyelinating diseases. Side effects may include headache. Potential side effects include injection site irritation (adalimumab and etanercept). Infections due to tuberculosis and certain types of invasive fungi. you and your doctor may consider surgery to repair damaged joints. don't use anakinra. Anakinra (Kineret). Surgery If medications fail to prevent or slow joint damage. and tender or swollen joints — usually within one or two weeks after treatment begins. which is usually given along with methotrexate. There is evidence that TNF inhibitors may stop progression of disease. People who haven't found relief using TNF inhibitors might consider using rituximab. including serious infection leading to death if treatment is delayed. If you have an active infection. The ACR recommends hydroxychloroquine or minocycline for people with mild rheumatoid arthritis that has been present for less than two years. Abatacept (Orencia). such as difficulty breathing and heart problems. results from blood tests and X-rays. Potential side effects include injection site reactions. such as fever. In 2008. These medications often are taken with methotrexate. don't take these medications. Some people experience extreme reactions to the infusion. its severity and your prognosis. Doctors use these factors to determine the duration of your disease. If you have an active infection. Anakinra is given as a daily self-administered injection under the skin. People who haven't been helped by TNF-alpha inhibitors might consider abatacept. Ritixumab has been linked to a fatal brain infection in one person with rheumatoid arthritis. Rituximab (Rituxan).   reduce pain. headache and an increase in upper respiratory infections. chills and nausea. worsening congestive heart failure (infliximab). There may be a slightly higher rate of respiratory infections in people who have asthma or chronic obstructive pulmonary disease. Anakinra is similar to a naturally occurring chemical in your body — interleukin-1 receptor antagonist (IL-1Ra) — that stops a certain chemical signal from causing inflammation. It can also reduce pain and correct deformities. What medications you can consider will depend on the severity of your rheumatoid arthritis. Rheumatoid arthritis surgery may involve one or more of the following procedures: . blood disorders. such as histoplasmosis. such as pneumonia. decreased white blood cell counts. which help to develop a treatment plan. B cells are involved in inflammation. For people with more severe rheumatoid arthritis. sulfasalazine for all levels of disease severity in people without a poor prognosis. the length of time that you've been experiencing signs and symptoms. morning stiffness. You might consider anakinra if you have moderate to severe rheumatoid arthritis and haven't been helped by conventional DMARD therapy. such as upper respiratory tract infections. and is sometimes combined with methotrexate. Rituximab is administered as an infusion into a vein in your arm. Abatacept reduces the inflammation and joint damage caused by rheumatoid arthritis by inactivating T cells — a type of white blood cell. lymphoma. and other medical problems you have. have been associated with the use of TNF-alpha inhibitors. can occur. Side effects include flu-like signs and symptoms. which is administered monthly through a vein in your arm (intravenously). and increased risk of infection. Surgery may help restore your ability to use your joint. TNF inhibitors approved for treatment of rheumatoid arthritis are etanercept (Enbrel). the American College of Rheumatology (ACR) updated its recommendations for selecting certain rheumatoid arthritis medications. coccidioidomycosis and blastomycosis. infliximab (Remicade) and adalimumab (Humira). Rituximab reduces the number of B cells in your body.

Protect your joints. Surgery carries a risk of bleeding. and it can help fight fatigue you might feel. Removal of the joint lining (synovectomy). stop. Try swimming or gentle water aerobics. Avoid exercising tender. injured or severely inflamed joints. If pain persists for more than a few days. Inflammation and joint damage may cause tendons around your joint to loosen or tighten. Gentle exercise can help strengthen the muscles around your joints. Check with your doctor before you start exercising. Tendon repair. However. Find different ways to approach everyday tasks in order to take stress off your painful joints. Lean into a glass door to force it open. If you're just getting started. If you feel new joint pain. During joint replacement surgery. Consider trying to:  Exercise regularly. New pain that lasts more than two hours after you exercise probably means you've overdone it. For instance. Public pools and health clubs in your area may offer classes. Your doctor or occupational therapist may have ideas about what    . Try a cane to help you get around. A healthy diet emphasizing fruit. begin by taking a walk. your surgeon may recommend removing the lining of the joint. vegetables and whole grains can help you control your weight and maintain your overall health. Use assistive devices. Eat a healthy diet. For instance.   Total joint replacement (arthroplasty). If the lining around your joint (synovium) is inflamed and causing pain. These selfcare measures. Assistive devices can make it easier to go about your day without stressing your painful joints. when used along with your rheumatoid arthritis medications. your surgeon removes the damaged parts of your joint and inserts a metal and plastic prosthesis. using specially designed gripping and grabbing tools may make it easier to work in the kitchen if you have pain in your fingers. infection and pain. pick up an object using your forearms. can help you cope with your signs and symptoms. if your fingers are sore. rather than pushing on the door with sore arms. It hasn't been proved that eating any particular food will make your joint pain or inflammation better or worse. Lifestyle and home remedies You can take steps to care for your body if you have rheumatoid arthritis. Your surgeon may be able to repair the tendons around your joint. Discuss the benefits and risks with your doctor. there's no special diet that can be used to treat rheumatoid arthritis. call your doctor.

Find ways to cope with pain by reducing stress in your life. Apply cold. Techniques may include using cold packs. don't use heat treatments. If your skin has poor sensation or if you have poor circulation. One of the easiest and most effective ways to apply heat is to take a hot shower or bath for 15 minutes. Techniques such as hypnosis. Heat can help ease your pain and relax tense. Apply heat. Cold also has a numbing effect and decreases muscle spasms. Catalogs and medical supply stores may also be places to look for ideas. guided imagery. painful muscles. deep breathing and muscle relaxation can all be used to control pain.   sorts of assistive devices may be helpful to you. soaking the affected joints in cold water and ice massage. Other options include using a hot pack or an electric heat pad set on its lowest setting. Relax. Cold may dull the sensation of pain. Don't use cold treatments if you have poor circulation or numbness. .

Talk to your doctor or nurse about strategies for coping. This will help you feel in charge of your disease.Coping and support The degree to which rheumatoid arthritis affects your daily activities depends in part on how well you cope with the disease. make a plan for managing your arthritis. In the meantime. Connect with others. With time you'll find what strategies work best for you. Know your limits. try to:     Keep a positive attitude. Rest when you're tired. Find a family member or friend you can talk to when you're feeling especially overwhelmed. A rest or short nap that doesn't interfere with nighttime sleep may help. With your doctor. whether it's time to write in a journal. 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. go for a . Rheumatoid arthritis can make you prone to fatigue and muscle weakness. Find time for what you like. Keep your family aware of how you're feeling. Sometimes you'll feel like your friends and family can't understand what it's like to have rheumatoid arthritis. It's easy to get busy and not take time for yourself. They may be worried about you but might not feel comfortable asking about your pain. Also connect with other people who have rheumatoid arthritis — whether through a support group in your community or online. Take time for yourself. and other people with the disease can offer unique support during these times. Contact the Arthritis Foundation for more information.

In some cases. Before taking any complementary medications or dietary supplements. so check with your doctor first. discuss these treatments with your doctor first. Some studies indicate GLA may help with rheumatoid arthritis pain and morning stiffness. Some plant oils can cause liver damage or interfere with medications. Mainstream doctors are becoming more open to discussing these options. Fish oil can interfere with medications. though more research is needed. but more study is needed. Side effects can include nausea. Some preliminary studies have found that fish oil may reduce rheumatoid arthritis pain and stiffness. Tai chi. Be careful when considering alternative therapies. Many people use tai chi to relieve stress in their lives. so check with your doctor first. such as evening primrose. But don't do any moves that cause pain. . though more study is needed. borage and black currant. Talk to your doctor if you'd like to give tai chi a try. Side effects may include nausea.walk or listen to music. EPA and DHA are omegea-3 fatty acids commonly found in fish oil. belching and a fishy taste in the mouth. But. Fish oil that contains eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA). Many are expensive and some may be harmful. talk with your doctor to learn about potential dangers. More serious side effects can include bleeding and mercury poisoning. particularly if you're taking other medications. Together you can weigh the benefits and risks and decide whether the treatments will interfere with your current rheumatoid arthritis medications. since few of these treatments have been extensively studied in clinical trials. Use this time to relieve stress and reflect on your feelings. it's difficult to assess whether these treatments are helpful for rheumatoid arthritis pain. diarrhea and gas. GLA is a type of omega-6 fatty acid that comes from plant oils. When led by a knowledgeable instructor. If you're interested in trying complementary and alternative medicine therapies for your rheumatoid arthritis pain. Some common complementary and alternative treatments that have shown promise for rheumatoid arthritis include:    Plant oils that contain gamma-linolenic acid (GLA). tai chi is safe. Small studies have found tai chi may reduce rheumatoid arthritis pain. This movement therapy involves gentle exercises and stretches combined with deep breathing. the risks of these treatments aren't known. Alternative medicine People who are frustrated by conventional rheumatoid arthritis treatments sometimes turn to complementary and alternative medicine practices for relief.

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