RA

RA can strike any Age, Sex or RaceRheumatoid Arthritis: Traditionally considered a Chronic Inflammatory Autoimmune Disorder. About 1 percent of the U.S. population suffers from RA. Typically, it strikes between the ages of 30 and 60, but it can occur at any age. Women are affected more often than men. The course and the severity of the illness can vary considerably. It may develop and progress slowly or rapidly. The course of your condition may change over time, and you may experience relapses and remissions throughout your life. But despite the potential complications, most people are able to live productive lives. Rheumatoid arthritis (RA) occurs when your body's immune system is over active it attacks and destroys the healthy tissues that make up your joints. The joints become swollen, stiff, and painful. In later stages, the joints can become deformed. Other areas of your body can also be affected, including your lungs, heart, blood vessels, and eyes. Autoimmune diseases are a major threat to the health of all Americans. At least ten millions Americans suffer from the more than eighty illnesses caused by autoimmunity. They are a special threat to women; about 75% of the patients are women. Complete Blood Count: There are three types of cells in your blood: red blood cells, which carry oxygen to tissues; white blood cells, which help fight infections; and platelets, which help the blood clot. Each may be tested to check for abnormalities that might exist or to monitor side effects of drugs and check progress. People with rheumatoid arthritis often have a low red blood count, signally anemia, a common problem for people with RA. Anemia can contribute to feelings of fatigue. People with more aggressive disease tend to have more severe anemia. White blood cells may be high, signaling that infection is present in your body. A low white blood cell count could suggest Felty’s syndrome, a complication of RA, or may be caused by some medications. Your platelet count is elevated when you have inflammation present in the body. The cause of RA is still unknown to this day, but has long been suspected to be infectious. Genes may play some as yet unknown role. It also is possible that a change in the body, such as an infection or hormonal shift, can trigger its development. Researchers focus on finding the cause of rheumatoid arthritis. There is some growing belief that RA isn’t one disease, but it may be several different diseases that share commonalities. Researchers continue to search for a cure and develop better treatment options for rheumatoid arthritis. The first known traces of arthritis date back as far as 4500 BC. It was noted in skeletal remains of Indians found in Tennessee. A text dated 123 AD first describes symptoms very similar to rheumatoid arthritis. In 1859 the disease got its current name. Many people believe that rheumatoid arthritis exists only in places with cool damp climates such as Britain. This is not true. It exists all over the world, although the more severe cases are found more often in Northern Europe. The whole body hurts, in some the face is flushed; pain is most severe around the joints, so that the slightest movement of the foot, hand, or finger causes a cry of pain. At night the pain becomes more serious and the patient cannot sleep. Feeling tired and run-down with swollen lymph glands, a low fever, little or no appetite, and weight loss. Appearance of small bumps under the skin near the affected joints. It has several special features that make it different from other kinds of arthritis. For example, RA generally occurs in a symmetrical pattern which means that if one knee or hand is involved, the other one is also.The disease often affects the wrist joints and the finger joints closest to the hand but can also affect other parts of the body besides the joints. It can be accompanied by fatigue, occasional fever, and a general sense of not feeling well. The symptoms of rheumatoid arthritis may resemble other medical conditions or problems, including acute Rheumatic Fever, Lyme Disease, Psoriatic Arthritis, Gout, Osteoarthritis, Gonococcal arthritis, and Ankylosing Spondylitis. Always consult your physician for a diagnosis. How is rheumatoid arthritis diagnosed? Diagnosis of rheumatoid arthritis may be difficult in the early stages, because symptoms may be very subtle and go undetected on x-rays or blood tests. In addition to a complete medical history and physical examination, diagnostic procedures for rheumatoid arthritis may include the following: * x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. * joint aspiration - involves a removal of fluid from the swollen bursa to exclude infection or gout as possible causes. * biopsy (of nodules tissue) - a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope; to determine if cancer or other abnormal cells are present. * blood tests (to detect certain antibodies, called rheumatoid factor, and other indicators for rheumatoid arthritis) When my Grandmother was diagnosed with Rheumatoid arthritis a few decades ago, the milder cases were simply put on aspirin, over 20 a day! If they didn't die of a bleeding ulcer, they were quickly disabled from the disease. The more severe cases might be put on Prednisone or gold salts but that was pretty much it. Not a lot to choose from.As much as I hate having RA, I am glad I have it in these days. Never before have we had so many treatment options. In the last two years we've been bombarded with new drugs and treatments. We have so much to choose from. Most of us will live full productive lives, unlike those a generation ago. Early detection and treatment are important in slowing down the disease and preserving joints. *Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen *Disease-modifying antirheumatoid drugs (DMARDs) such as gold salts, antimalarials, methotrexate, Sulfazine, cyclophosphamide and others *Corticosteroids (steroids) such as Prednisone : Side effects of prednisone and other corticosteroids range from mild annoyances to serious, irreversible damage, and they occur more frequently with higher doses and more prolonged treatment. Side effects include retention of sodium (salt) and fluid, weight gain, high blood pressure, loss of potassium, headache and muscle weakness. Prednisone also causes puffiness of the face (moon face), growth of facial hair, thinning and easy bruising of the skin, impaired wound healing, glaucoma, cataracts, ulcers in the stomach and duodenum, worsening of diabetes, irregular menses, rounding of the upper back ("buffalo hump"), obesity, retardation of growth in children, convulsions, and psychiatric disturbances. The psychiatric disturbances include depression, euphoria, insomnia, mood swings, personality changes, and even psychotic behavior. *Combination drug therapy uses two or more DMARDs together, this is cheaper than injections. *Injections-Biological agents include: *Tumor necrosis factor (TNFa) blockers - etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira) Combination therapy uses two or more DMARDs together. Corticosteroids may also be injected, either directly into a troublesome joint or into a muscle for a systemic effect. Joint injections should be limited to about four per year to prevent damage to the joint. *Folic acid, also called folate or vitamin B9, is critical to many body processes, including the health of your nervous system, blood, and cells. It protects against heart disease, birth defects, osteoporosis, and certain cancers. Folic acid protects the body against, and helps treat, many disorders. Folic acid is also beneficial in the following ways: prevents anemia, which can decrease the function and number of red blood cells, helps treat headaches, may relieve symptoms of rheumatoid arthritis. *Analgesics These drugs are painkillers. They are not sufficient by themselves as a treatment for rheumatoid arthritis, but they are useful to 'top up' the pain-relieving effects of other, more specific, drugs. Paracetamol is most often used. It may be given by itself, or alongside codeine tablets, or as combination tablets in which it is combined with codeine or other drugs. For example, co-codamol is a tablet which contains paracetamol and codeine. Some stronger painkillers such as tramadol are now available. The most common side-effect of analgesics is constipation, which can occasionally be severe. *Osteoporosis Drugs: Certain drugs have the ability in increase bone mass and are used in the treatment of osteoporosis. *Anti-Depressants such as Lexapro, Effexor *Sleep-Aids such as Trazodone: A good nights sleep can make all the difference in how you feel. Physical therapy has one simple goal: keeping you moving. It will stimulate muscles, bones, and joints through exercise or other methods. The result is more strength, tone, and overall fitness.Physical therapists help you with joint function, muscle strength, and fitness level. They understand the mechanics of bones, joints, and muscles working together, the problems that can occur, and what to do about them.Working with a physical therapist is a good idea at any stage or severity of rheumatoid arthritis.Early in the course of rheumatoid arthritis, your physical therapist can assess and document where you are in terms of function, strength, and fitness. Your exercise plan will be designed to maximize your chances of avoiding joint problems as the disease progresses. In moderate or advanced rheumatoid arthritis, a physical therapist can help you keep or increase the strength and flexibility you have.Together, you and your physical therapist will create a road map of improvement for each muscle/joint group, and for your overall fitness. This will become part of the treatment plan for your rheumatoid arthritis. There are a number of strategies your physical therapist can use to reach your treatment goals.Exercise. This is the cornerstone of any physical therapy plan. Together with you and your doctor, your physical therapist will design an exercise plan that is targeted to your ability and fitness level. A good plan will include stretching/flexibility exercises; strength exercises, and conditioning (or aerobic) exercise. Heat/Ice. Treating inflamed or painful joints with heat or ice packs helps some people feel better. Massage. In some patients with chronic pain, therapeutic massage reduces symptoms. Motivation and encouragement. While "low-tech," it's hard to overestimate the value of having someone in your corner cheering you on-and pushing you to do better. Severely affected joints may require joint replacement surgery. Side Affects From The Medications: Sun Sensitivity Can Be Side Effect of Some Medications. Potassium levels in the blood can be abnormally high or low due to medications. Blood testing is done once a month. Hair loss is an unwanted side effect of some arthritis medications. If you do not have insurance your medications can cost $300 or more a month! These are Health Sustaining Medications. If you are uninsured and unemployed check with your local welfare office for: General Assistance Medicaid benefits this covers all medical cost. The goal of therapy is to decrease inflammation, preserve joint function and prolonging mobility. Treatment is long term! Strategies for coping People with RA may find it difficult to cope. Because the disease may be unpredictable, is often characterized by chronic pain, and can affect so many joints, emotional stress and depression may occur. While depression or other emotional problems do not cause rheumatoid arthritis, they can make it more difficult for a person to successfully cope with the disease. It's important for people with RA and their families to learn all they can about the disease and to talk about it with each other, with their physicians, and with other health professionals involved in their care. Counseling from mental health professionals on how to develop coping skills and social support mechanisms may be of help. Many people are helped by arthritis support groups. In some people with RA, special medications may be needed to relieve depression. The knowledge that you are not alone and that others understand something about the challenges you are coping with can be your best emotional support. Above all, it's important not to give up in the fight against this disease. Making new friends and maintaining existing relationships grows increasingly harder as we grow older. Work and family discourage us from forming new friendships and going out socially. Add arthritis to the mix and you have a whole new hurdle to leap. Pain and fatigue can make it hard to keep social engagements. Physical challenges and deformities can make you self-conscious or shy around other people. You know it can be frustrating to try to explain your disease to potential new friends – not to mention potential dating opportunities. How do you explain that arthritis doesn’t only affect older people or that you can’t drink alcohol because of medication? Despite the challenges, you shouldn’t let arthritis keep you from enjoying an active social life. Forming meaningful relationships is an important part of managing your disease. Friends can help you combat depression, distract you from pain and support you when you are having a flare. Research also shows that a strong support system can actually improve your physical health. Arthritis can affect sexuality in a number of ways, from fatigue to side effects of medicines to loss of desire. It’s up to you and your partner to make sure arthritis doesn’t take control of this important part of your lives. Your doctor is your best source of information on arthritis and sexuality. Your physician can provide information on enhancing your sex life safely despite arthritis pain. Sex can cause the body to release hormones called endorphins, which are the body’s own natural painkillers. Endorphins could help reduce or at least distract you from your arthritis pain. And a full sex life can help you feel less like a victim of arthritis, and more in control of your disease. Pregnacy And RA Effect of RA on pregnancy: Most women with RA have an uneventful course with no significant complications. Effect of RA on fetal outcome: RA does not appear to adversely affect the fetal outcome. Effect of RA on fertility: Patients with RA do not appear to have decreased fertility. Symptoms suggestive of RA disease activity Constitutional symptoms may be present. In most patients, morning stiffness and fatigue are diminished during pregnancy. Regarding joint pain or stiffness, approximately 75% of patients notice improvement in their joint symptoms. Most of the patients who have a favorable response notice the decrease in pain as early as the first trimester and have persistent relief throughout their pregnancy. In some patients, this improvement occurs later, during the second or third trimester. Some patients achieve remission (16%). Patients experience a decrease in the number of joints involved and the severity of pain. Symptoms due to pregnancy Nausea, vomiting, and morning sickness can occur during the first trimester. These symptoms may prevent absorption of medications. One concern is that many of the medications used to treat rheumatoid arthritis are not recommended for routine use during pregnancy. The risks and benefits of each medication should be discussed with your rheumatologist and OB/Gyn care providers. The labor and delivery process should proceed normally. Be sure to remind your care provider and nurses of any joint limitations you have. Comfortable positions and those that prevent potential trauma or joint inflammation should be used. Pregnant women who do not have rheumatoid arthritis may develop the disease within a year of giving birth. According to the study, the cytokines associated with your immune system, IL-12 and TNF, drop sharply during the late stages of pregnancy, and bounce back sharply after birth. This roller coaster ride appears to result in a rebound effect that could intensify disorders like rheumatoid arthritis. Stress hormones plummet after a woman gives birth setting the stage for immune-system disorders like rheumatoid arthritis, It is during the postpartum period that rheumatoid arthritis flares. Contact your rheumatologist if this occurs. Your medications may need to be changed. Breastfeeding for at least two years decreased the risk of rheumatoid arthritis by 50 percent. Any woman who has rheumatoid arthritis in her family should consider this as an extra reason to breastfeed her baby. It seems extraordinary to us that breastfeeding is a mutually healthy experience, benefiting the health of both the baby and mom. Hormone levels also change around the time of menopause. Nutrition Eat a variety of foods Balance the food you eat with physical activity, maintain or improve your weight Choose a diet with plenty of grain products and vegetables, and fruits Choose a diet low in fat, saturated fat and cholesterol Choose a diet moderate in sugars If you drink alcoholic beverages, do so in moderation Foods that contain a significant amount of folic acid include liver, lentils, rice germ, brewer's yeast, soy flour, black-eyed peas, navy beans, kidney beans, peanuts, spinach, turnip greens, lima beans, whole wheat, and asparagus. A number of studies have shown that diets enriched in marine fish oils have a modest beneficial calming effect on neutrophil activity. Leibniz Institute for Natural Products Research and Infection Biology, have identified compounds in mushrooms which they say are capable of treating rheumatoid and gouty arthritis. Avoid foods from the nightshade family and all milk products. The nightshade plant family consists of white potatoes, tomatoes, eggplant, tobacco, and all peppers except black pepper. Also cut back on oil-containing products such as salad dressings, fried foods, and margarine's. These foods contain high levels of omega-6 fatty acids, which have been proven to cause inflammation in those with rheumatoid arthritis. People with RA need to pay particular attention to brushing their teeth and overall dental hygiene. Patients with more advanced periodontal disease are at higher risk of having rheumatoid arthritis and vice versa. A recent study published in the June issue of the Journal of Periodontology, uncovered yet another potential side effect of RA. Researchers discovered that patients with RA have a higher incidence of periodontal disease. RA patients are nearly eight times more likely to have periodontal disease.Both rheumatoid arthritis (RA) and periodontal disease (PD) are inflammatory diseases that lead to bone destruction. There is evidence both diseases have some genetic factors in common.Some people with rheumatoid arthritis also have Sjögren's syndrome, a disorder of the salivary and tear glands that causes dryness of the mouth and eyes. This may make it difficult for you to chew your food and can cause heavy plaque deposits on your teeth, increasing the risk of tooth decay and gum disease. You also may have problems wearing dentures because of the dryness.Some of the medications used to treat rheumatoid arthritis can cause mouth irritation and inflammation. Also, many medications taken for rheumatoid arthritis can cause dry mouth, so good oral hygiene is important. Your dentist can talk to you about agents to help reduce the dryness and may prescribe a topical fluoride treatment to reduce the risk of decay.If your temporomandibular (jaw) joint is involved in your arthritis, it may be difficult for you to undergo very long dental procedures. You can have a few short appointments instead of one long one, or if the appointment is for elective dental care, you can wait until you feel better. Colgate PreviDent 5000 Plus is a prescription-strength toothpaste that can deliver 5000 ppm fluoride. It combines the cleaning power of a toothpaste with maximum-strength fluoride for dental caries protection. RA usually affects the cervical spine. The cervical spine is involved in up to 25% of patients with rheumatoid arthritis RA destroys synovial joints. As the joints are destroyed, the connection between each vertebra becomes unstable. The damage allows the upper vertebra to slide forward on top of the lower vertebra in the joint. This slippage is called spondylolisthesis (spon-dil-low-liss-the-sis). Spondolisthesis can cause pain due to pressure applied by the slipped vertebra on the nerve roots and the spinal cord. The problem of joint instability is very serious when it occurs between the C1 and C2 vertebrae in the cervical spine. The upper cervical spine can be damaged by the inflammation that is caused by rheumatoid arthritis. This disease is three times more common in women than in men and usually occurs between the ages of 20 and 50. Just like the gradual destruction of other joints in the body, several joints between the base of the skull and uppermost vertebral bodies in the cervical spine are very susceptible to damage from rheumatoid arthritis. The chances of having abnormal changes in the cervical spine as a result of rheumatoid arthritis increase over time. Patients may not notice that their rheumatoid arthritis is affecting their spinal cord because this disease also causes arthritis in the fingers, hands, and hips at the same time. Arthritis in these joints can sometimes mask the symptoms of spinal cord compression from rheumatoid arthritis. If you have rheumatoid arthritis and you now have difficulty with the use of your hands or you are feeling unsteady on your feet, this is a definite sign that you should talk to your doctor about how your spine may be affected by this disease. RA in the spine causes a wide range of symptoms. Pain is the earliest symptom and may be part of the overall joint inflammation that occurs with the arthritis. As the disease progresses, the symptoms that are most worrisome are those that suggest your spinal cord is being affected. Pain at the base of the skull is common when the cervical spine is affected by RA, and can indicate that the nerves that exit the skull and the upper spine are being irritated or compressed. Pressure on the vertebral arteries can lead to blackout spells when the blood flow through these arteries is reduced when you move your head and neck a certain way. A change in the ability to walk can signal increasing pressure on your spinal cord. Your gait (the way you walk) may become irregular, and may be accompanied by weakness and problems keeping your balance. This is an indication that your spinal cord is being compressed. Any change in the ability to walk should be brought to the attention of your doctor. Feelings of tingling, weakness, or a loss of coordination can affect the arms or legs. Changes in bowel or bladder control such as incontinence or inability to urinate can also occur. For people with RA, the effects of the arthritis on the spine can vary from minimal symptoms to life-threatening pressure on the spinal cord that requires complicated surgery to stabilize the spine and reduce the pressure on the spinal cord. Any patient with rheumatoid arthritis should have neck x-rays taken. These patients can develop instability in the upper cervical spine that can endanger the spinal cord. This is easily recognized on plain x-rays. Episcleritis Episcleritis is an inflammatory condition of the connective tissue between the conjunctiva and sclera known as the episclera. The eye's red appearance makes it look similar to conjunctivitis, or pink eye. Signs and Symptoms: Generalized or local redness, Mild soreness or discomfort. It usually has no apparent cause; however, it is sometimes associated with systemic inflammatory conditions such as rheumatoid arthritis. Women are typically affected by episcleritis more frequently than men. It characteristically occurs in people who are in their 30's and 40's and is often a recurrent problem. Treatment for episcleritis is usually not needed. Chilled artificial tears can be used to soothe the eye and reduce mild inflammation. In more severe cases of episcleritis, mild steroids and anti-inflammatory medications are prescribed to reduce inflammation. Optometrist Recommend Corneal and conjunctival drying is found in 25% of patients with rheumatoid arthritis, more commonly in the severe forms. Lymphocytic infiltration destroys the tear-forming glands. The patient experiences a foreign body sensation and blurred vision. Fluorescein dye applied to the cornea usually discloses green punctate staining of de-epithelialized areas. If the drying is severe, the cornea may become permanently scarred.