Rheumatoid Arthritis Disease

A. What is Rheumatoid Arthritis?



There are over 100 types of arthritis, rheumatic diseases and related conditions. The two most common types of arthritis areosteoarthritis and rheumatoid arthritis. It is a chronic disease, in which various joints in the body are inflamed, leading to swelling, pain, stiffness, and the possible loss of function. The joint inflammation begins in the synovium. Continuous inflammation of the synovium slowly destroys the cartilage, narrowing the joint space and eventually damaging bone.

B. The Diagnosis of Rheumatoid Arthritis

1. Morning stiffness, lasting for at least an hour, present daily for at least 6 weeks.
2. Arthritis of 3 or more joints, lasting for at least 6 weeks.
3. Arthritis of the hand joints, lasting for at least 6 weeks.
4. Symmetric arthritis, lasting for at least 6 weeks.
5. Rheumatoid nodules.
6. Positive rheumatoid factor (blood test).
7. Joint changes on x-ray.
   

C. The Treatment of Rheumatoid Arthritis

Treatment of rheumatoid arthritis focuses on relieving pain, reducing inflammation, slowing or stopping joint damage, and improving the person's sense of well-being and ability to function. A combination of treatments is almost always used.

1. Rest and exercise: Both rest and exercise help in important ways. People with rheumatoid arthritis need a good balance between the two, with more rest when the disease is active and more exercise when it is not. A physical therapist is useful in instructing the person with arthritis how to exercise without further damaging the joints.
   
2. Joint protection: Splints, braces and supports can protect the joints and help prevent further damage. A doctor or a physical or occupational therapist can help get a splint and ensure that it fits properly. Other ways to reduce stress on joints include self-help devices, devices to help with getting on and off chairs, toilet seats, and beds; and changes in the ways that a person carries out daily activities.
   
3. Diet: However some people are able to lessen their symptoms by a change in diet. The best diet plan for a person with RA is simply a healthy balanced diet. Eat 1 to 1.2 grams of protein per kilogram of body weight . The most commonly reported triggers of symptoms are dairy protein, corn, wheat, citrus fruits, eggs, red meat, sugar, fats, salt, caffeine, and nightshade plants like potatoes and eggplant. 200 kcal/day fasts consisting of fruit and vegetable juices showed some short-term improvement in symptoms. The vegetarian diet positively influenced measures of inflammation and disease activity.
4. Weight Control
   
5. Effects of Long Chain Fatty Acids. The types and amounts of fatty acids in the diet affect prostaglandin metabolism and a change in prostaglandin concentrations can effect the body's immune responses. A diet high in polyunsaturated fat and low in saturated fat with a daily supplement of eicosapentaenoic acid allowed for decreased morning stiffness and fewer tender joints, with symptoms returning after discontinuation of the diet. Daily supplementation with 18 g of fish oil has also led to an improvement in tender joint score and grip strength when compared to an olive oil supplement (20). As noted by Davis (21) vegetarians can improve their omega-3 intake with the use of flax seed and other plant foods.
6. Medications: NSAIDS (Nonsteroidal anti-inflammatory drugs) are commonly used to treat rheumatoid arthritis. Available over the counter or by prescription, they fight inflammation or swelling and relieve pain. NSAIDS are usually the first drug prescribed to a person newly diagnosed with rheumatoid arthritis. NSAIDS may relieve pain and swelling, but they do not slow the disease process. DMARDS (disease modifying anti-rheumatic drugs) are also known as SAARDS (slow acting anti rheumatic drugs. As their name might suggest these medications take some time to be effective, up to several months. Most of them were originally invented to treat other diseases but were noted to have a positive effect on rheumatoid arthritis. Most of them do not have any common properties other than their ability to slow down the progression of the disease. The most common DMARDS used include methotrexate, hydroxychloroquine, sulfasalazine, gold and leflunomide (Arava). Another new treatment is a device called the Prosorba column. It mechanically removes inflammatory antibodies from the blood. The blood is first removed from the body through a catheter (a process called apheresis) and then passes through a column coated with a substance called protein A, which binds to the antibodies. The blood is then returned to the patient.Oral corticodsteroid, such as prednisolone and prednisone (Deltasone, Orasone) usually work quickly to control inflammation. Corticosteroids can also be injected directly into the joint for relief of inflammation limited to one particular joint. Recent studies have shown the antibiotics in the tetracycline family to have a positive impact on the progression of rheumatoid arthritis. Topical pain-relieving creams,rubs, and sprays can be applied directly to the skin for temporary relief. There are many brands available over the counter.
7. Traditional Therapy. Traditionally, Rheumatoid Arthritis therapy has involved an approach in which doctors prescribed aspirin or similar drugs, rest, and physical therapy first, and prescribed more powerful drugs later only if the disease became much worse.
8. Surgery: Several types of surgery are available to patients with severe joint damage. These procedures can help reduce pain, improve the affected joint's function and appearance, and improve the patient's ability to perform daily activities. Surgical procedures include joint replacement, tendon reconstruction, and synovectomy.