Rheumatoid arthritis (RA) is a chronic disease characterized by inflammation of the synovium, or lining, of the joints. RA results in chronic pain, loss of joint function, and disability as a result of long-term joint damage. RA affects 2.1 million Americans, affecting women 2 or 3 times more than men. Onset usually occurs between 30 and 50 years of age. People with the genetic marker HLA-DR4 have an increased risk of developing RA.

RA progresses in 3 stages. The first stage is swelling of the synovial lining which causes pain, warmth, stiffness, redness, and swelling around the joint. The second stage involves the rapid division of cells causing the synovium to thicken. In the third stage, enzymes are released that digest cartilage and bone causing joint deformity, pain and loss of movement. RA is a chronic disease with frequent remissions and flare-ups. RA is a systemic disease, which means that organ systems can be affected. Early diagnosis and treatment is important to maintain a normal lifestyle. Early, aggressive treatment can limit joint damage prolonging normal joint function and reducing pain. There is no cure for RA. Treatment involves medications, exercise, joint protection techniques, and disease self-management techniques.

The cause of RA is not known; as a matter of fact, researchers disagree if RA is a disease or a complex of several different diseases with common symptoms. RA is categorized as an auto-immune disease. Autoimmunity indicates that the white blood cells that normally protect the body from bacteria and viruses attack the body's own cells damaging them, which results in the symptoms of the disease.

Diagnosis of RA involves a medical history, physical exam, laboratory tests, and imaging studies. Questions asked during a medical history may include: Do you have pain in multiple joints? Do you have stiffness in the morning? Do you have periods of weakness and fatigue? Physical examination will look for symptoms such as joint swelling, tenderness, loss of motion, and deformity. Lab tests may include complete blood cell count, erythrocyte sedimentation rate, c-reactive protein, rheumatoid factor, and anti-nuclear antibodies. Imaging studies may include x-rays, MRI, joint ultrasound, and bone densitometry.

Treatment must be tailored for the individual based on the severity of the arthritis, other medical conditions, and individual lifestyle. The health care team for treatment of RA may include a rheumatologist, physical therapist, occupational therapist, psychiatrist, and a social worker. Medications used include non-steroidal anti-inflammatory drugs, pain relievers, prednisone, disease-modifying antirheumatic drugs, and biologic response modifiers.

Reference: http://www.arthritis.org/conditions/DiseaseCenter/RA/ra_overview.asp.

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