preceding obvious joint involvement: fatigue and weakness;
low-grade fever; general feeling of poor health; loss of appetite
and weight loss.
swollen, painful joints that may be warm to the touch. With long-term
arthritis, joints may become bent and gnarled.
(often the second manifestation), especially after
awakening in the morning.
painless skin lumps, known as rheumatoid nodules, on the elbows,
knees, or toes.
pain and breathing difficulty.
mouth and dry, painful eyes.
When To Call Your Doctor
an appointment with a doctor if painful joints interfere with
What Is It?
Rheumatoid arthritis is a common, persistent systemic
disorder that can cause inflammation of joints throughout the
body. Joints contain a number of structures that allow for ease
of movement. The ends of the bones in a joint are protected from
rubbing together by an elastic cushioning material, known as
cartilage. The entire joint is surrounded by a capsule known
as the synovial sac. A thin layer of tissue (synovial membrane)
lines the sac and secretes synovial fluid, which provides lubrication
to ease movement.
In the early stage of rheumatoid arthritis, the
synovial membrane becomes inflamed and thickened, causing pain
and limiting joint movement. As the disease progresses, the cartilage
and the ends of the bones erode. The result is severe joint damage
and deformity. Joint pain is often preceded by general, nonspecific
symptoms, such as fever, fatigue, and loss of appetite. It may
also be prefaced by stiffness in the joints, particularly in
The hallmark of the disorder is involvement of
the small joints of the hands and wrists with painful, warm,
swollen, tender, and reddish joints. The process can also involve
the elbows, shoulders, knees, hips, ankles, feet, and neck. Symptoms
tend to occur symmetrically; that is, joints on both sides of
the body are usually affected at the same time. In some cases
other organ systems of the bodyincluding the eyes, heart,
and lungmay become inflamed too. Symptoms occur in lengthy
episodes that may be separated by remission periods of reduced
or total absence of pain and stiffness. Between 50 and 75 percent
of patients experience a remission within one to two years after
the first episode.
Current research suggests that rheumatoid arthritis
is an autoimmune disorder caused by an attack of the immune system
on some of the body's own cells. The disease usually develops
between the ages of 20 and 50, and its prevalence increases with
age. Women are affected approximately three times more frequently
than men. Treatment is aimed at relieving pain and inflammation,
preventing joint deformity, and preserving function.
What Causes It?
The cause of
rheumatoid arthritis is unknown.
play a role.
suggest that a virus may be associated with the development of
rheumatoid arthritis may be triggered by emotional stress or
other concurrent illness.
There is no
known way to prevent rheumatoid arthritis.
and physical examination. There is no specific diagnostic test
for rheumatoid arthritis; long-term observation of joint changes
may be necessary for definitive diagnosis.
for autoimmune rheumatoid factors; anemia may be found in almost
half of patients. The white blood cell count is usually normal,
but may be high (in active inflammation) or low (in the variant
called Felty's syndrome).
X-rays of the
analysis. Under local anesthetic, synovial fluid is drawn from
the affected joint.
How To Treat It
To reduce fever
and treat pain, your doctor may prescribe large doses of aspirin,
or one of the many other nonsteroidal anti-inflammatory drugs
(NSAIDs), such as ibuprofen, naproxen, nabumetone, salsalate,
or COX-2 inhibitors.
trend is to move patients more rapidly to other, more potent
antirheumatic drugs if initial anti-inflammatories fail to control
symptoms. Because of potential side effects, patients receiving
such therapy must be closely monitored.
a drug used to treat malaria, may also be prescribed to relieve
symptoms of rheumatoid arthritis. The drug's effects may not
be felt for three to six months.
containing gold salts may be taken orally or injected to reduce
inflammation and pain.
an antimetabolite drug, may be prescribed to subdue the immune
system. If symptoms persist, immunosuppressants such as azathioprine
or cyclophosphamide may be tried.
a penicillin derivative, may be prescribed to relieve symptoms
if other drugs are ineffective (though its use is limited by
a large number of side effects).
appears to work by suppressing the immune response that is active
in rheumatoid arthritis, and also as an anti-inflammatory agent.
is an antibiotic that acts more as an anti-inflammatory; it has
modest benefit in some patients with early disease.
such as prednisone, offer quick relief from symptoms of rheumatoid
arthritis. Because prednisone has serious side effects when used
for extended periods, it is often reserved for severe flare-ups
of the disease or when other treatments are ineffective. Injection
of corticosteroids into an affected joint may also be helpful.
are developing drugs that target the mechanisms in the disease
process and have the potential to prevent joint damage. Recent
drug treatment advances include: Leflunomide, an immunomodulator
that has antiproliferative activity as well as an anti-inflammatory
effect, and etanercept and infliximab, which inhibit the action
of tumor necrosis factor (TNF), a naturally occurring substance
that is overproduced in people with rheumatoid arthritis. Another
advance is anakinra, which inhibits the activity of a protein
called interleukin-1 that invades the joints of people with RA.
In addition, innovative strategies such as combination therapy
are being applied with encouraging results.
Hot or cold
compresses may provide pain relief.
of rest. People with rheumatoid arthritis often need over 10
hours of sleep a night, or eight hours a night and a two-hour
nap during the day, and may need more during severe episodes.
Creams or lotions
containing capsaicin may be applied to relieve minor joint pain.
Those containing camphor, menthol, or turpentine oil may mask
pain and provide some relief from minor symptoms.
popular belief, there is no evidence that bee venom relieves
or cures rheumatoid arthritis.
be prescribed to relieve pain by immobilizing the joints during
may prescribe an exercise program or may advise you to see a
physical therapist. While exercise that is too vigorous may worsen
symptoms, some regular activity is necessary to maintain full
range of motion of the joints and to prevent muscle deterioration
(atrophy). Such programs outline gentle exercises that can be
done to increase the range of motion of the joints.
are easier to perform in a pool or hot tub, because water helps
support the body; these techniques should be discussed with your
doctor or physical therapist.
remove the diseased synovial membrane from affected joints (synovectomy)
may be performed in advanced cases.
remove the damaged joint and replace it with a mechanical joint
(arthroplasty, or total joint replacement) may be performed in
advanced cases. Almost 90 percent of the 150,000 joint replacements
each year are of the hip or knee, but the shoulders, elbows,
and joints in the hands and feet may be replaced as well. Discussion
of the types of activities the patient would like to continue
after joint replacement aids the surgeon in selecting the appropriate
type of prosthesis and implantation technique, while making the
patient more aware of the risks and limitations of surgery.
Hopkins Symptoms and Remedies, the complete home medical
reference. You can order
this book now on our secure server.