|Rheumatoid arthritis is a chronic inflammatory disease that causes the immune system to attack the joints. In some respects, this reaction is similar to an allergy, in which the body often reacts with a runny nose and itchy eyes. In rheumatoid arthritis, the autoimmune response can lead to permanent, painful changes in the joints.
The joints are the intersections of two bones. The ends of the bones are covered with cartilage (a smooth, durable substance) that allows bones to glide over each other with minimal friction. Cartilage also acts as a cushioning device to absorb forces. A structure called the joint capsule surrounds, stabilizes, and protects the joint. Within the capsule is a synovial membrane that contains synovial fluid (viscous substance similar to oil) that transports nutrients to the cartilage and keeps its surface well lubricated so the joints can work smoothly.
In rheumatoid arthritis, an autoimmune defect causes healthy cells to be attacked, releasing enzymes that attack surrounding tissues. One of these structures is the synovium in the joint. It becomes inflamed and causes swelling and pain.
Signs and Symptoms
Rheumatoid arthritis affects women three times more often than men. Typically, it affects the small joints first, including the joints of the hands and feet. More than one joint usually is affected, and symptoms often appear bilaterally. Symptoms are usually worse in the morning or after rest.
Subcutaneous rheumatoid nodules appear in about one-quarter of cases. Nodules are firm, pea-sized masses made up of inflammatory by-products and scar tissue. They are not painful and can occur anywhere in the body, most commonly in the elbow, the back of the forearms, the ankles, or the back of the skull.
Rheumatoid arthritis is a systemic disease. In addition to joint pain and stiffness, symptoms include muscle aches, anemia (low red blood cell count), and fever. These are very general symptoms, but if they occur repeatedly, they should not be overlooked.
X-rays cannot confirm the presence of rheumatoid arthritis, but they are used to rule out other diseases. X-rays also establish a baseline for comparison as the disease progresses.
The latex test is used to diagnose rheumatoid arthritis. This test detects an antibody in the blood called the rheumatoid factor. Rheumatoid factor is present in the blood when the body reacts to inflammation in the synovial membranes. It is not always present at the beginning of the disease, but as the condition progresses, most patients with rheumatoid arthritis test positive for it. The rheumatoid factor is not exclusively a product of rheumatoid arthritis. It is an antibody produced in response to inflammation and other diseases that cause inflammation can also result in an elevated rheumatoid factor. These situations are rare, however, and the latex test can confirm a preliminary diagnosis of rheumatoid arthritis.
After the diagnosis is made, the physician determines if active inflammation is occurring in the body. This is done by a sedimentation rate test . In this test, blood is drawn and allowed to settle over a period of time. A high, or increasing sedimentation rate in the blood indicates active inflammation. A follow-up test determines if the inflammation is increasing or decreasing and the results determine if treatment is needed.
Treatment for rheumatoid arthritis requires teamwork by the patient, the podiatrist, the general physician, and, most importantly, a rheumatologist . The medications and treatments for rheumatoid arthritis are constantly changing and a rheumatologist can provide the latest treatment options.
Initial treatment usually includes nonsteroidal antiinflammatory drugs, such Advil and Aleve, to reduce inflammation and pain. A drug called methotrexate can delay the progression of the disease.
Stretching exercises and corticosteroid injections also can reduce pain. Steroidal injections lose their effectiveness after three injections, however, after which their usage can become detrimental.