Rheumatoid Arthritis

Rheumatoid arthritis, or RA, is a form of inflammatory arthritis and an autoimmune disease. For reasons no one fully understands, in rheumatoid arthritis, the immune system – which is designed to protect our health by attacking foreign cells such as viruses and bacteria – instead attacks the body’s own tissues, specifically the synovium, a thin membrane that lines the joints. As a result of the attack, fluid builds up in the joints, causing pain in the joints and inflammation that’s systemic – meaning it can occur throughout the body.

Rheumatoid arthritis is a chronic disease, meaning it can’t be cured. Most people with RA experience intermittent bouts of intense disease activity, called flares. In some people the disease is continuously active and gets worse over time. Others enjoy long periods of remission – no disease activity or symptoms at all. Evidence shows that early diagnosis and aggressive treatment to put the disease into remission is the best means of avoiding joint destruction, organ damage and disability.

Signs and Symptoms

The symptoms and course of rheumatoid arthritis vary from person to person and can change on a daily basis. Your joints may feel warm to the touch and you might notice a decreased range of motion, as well as inflammation, swelling and pain in the areas around the affected joints. Rheumatoid arthritis is symmetrical, meaning if a joint on one side of the body is affected, the corresponding joint on the other side of the body is also involved. Because the inflammation is systemic, you’re likely to feel fatigued and you may become anemic, lose your appetite and run a low-grade fever.

Long-Term Effects

Rheumatoid arthritis may affect many different joints and cause damage to cartilage, tendons and ligaments – it can even wear away the ends of your bones. One common outcome is joint deformity and disability. Some people with RA develop rheumatoid nodules; lumps of tissue that form under the skin, often over bony areas exposed to pressure. These occur most often around the elbows but can be found elsewhere on the body, such as on the fingers, over the spine or on the heels. Over time, the inflammation that characterizes RA can also affect numerous organs and internal systems.

Treatment Options

We offer many treatment options including disease-modifying antiheumatic drugs (DMARDs).

Disease-modifying medications
Drugs that both relieve symptoms and have the potential to modify the disease process of RA are called disease-modifying antiheumatic drugs (DMARDs). As the foundation of all successful approaches to managing RA, DMARDs are an essential part of the treatment plan for almost everyone with RA. Starting treatment early is the key to long-term success.

Corticosteroids
Corticosteroids, such as cortisone and prednisone, can help relieve RA symptoms. These medications are related to cortisol, a hormone that occurs naturally in the body.

Low doses of corticosteroids taken in pill form may be used along with or in place of aspirin, NSAIDs, disease-modifying antiheumatic drugs (DMARDs) or biologic agents to help control joint inflammation. Much of the benefit and many of the side effects of corticosteroids are directly related to the dose and how long it's taken. The goal is to find the lowest effective dose and to use corticosteroids for the shortest period possible.

When prescribed, corticosteroids in pill form are typically given in combination with DMARDs or biologic agents and should not be relied upon as the only form of drug treatment for RA. If you take high doses of corticosteroids for a few months, you may experience side effects such as easy bruising, osteoporosis, cataracts, glaucoma, delayed healing, weight gain, a round face, susceptibility to infections, diabetes, high blood pressure, and emotional or psychiatric problems. If you take corticosteroids on a regular basis, talk to your doctor about calcium and vitamin D intake, as well as prescription medications that may prevent osteoporosis. Very high doses of corticosteroids may require regular doses of antibiotics to prevent infections.

Some corticosteroids are injected directly into joints affected by RA. Such treatments can reduce inflammation in joints that are swollen or painful or that frequently flare. Direct injection of corticosteroids into a joint rapidly controls inflammation and avoids most of the undesirable side effects seen with daily corticosteroid pills. The injections may product a temporary effect on your whole body. However, they may have harmful side effects if given more than a few times a year and should not be used in infected joints.


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