التهاب المفاصل الرثياني Rheumatoid Arthritis

Dr.Ahmad

What is Rheumatoid Arthritis?

Rheumatoid arthritis is a disease characterized by pain and swelling (inflammation) in and

around joints, stiffness in the joints and muscles which is more apparent in the morning and

fatigue. Joint swelling is common and the small joints of the hands and feet are those most

usually affected, but it can occur in any of the joints. Rheumatoid arthritis may start gradually or

with a sudden severe attack. The disease is chronic. However, periods of complete freedom from

symptoms may occur. Rheumatoid arthritis not only damages joints but can also affect the

muscles, lungs, skin, blood vessels, nerves and eyes. Rheumatoid arthritis is a systemic disease,

meaning it affects the whole body and can result in symptoms like fever, fatigue and weight loss.

The patient may feel unwell, depressed and easily tired.

Who Gets Rheumatoid Arthritis?

Anyone, at any age, can get rheumatoid arthritis. Most commonly it appears between the ages of

25 and 50. Women are affected about 3 times as frequently as men. Rheumatoid arthritis can

occur in children.

What Causes Rheumatoid Arthritis?

The precise cause of rheumatoid arthritis is not yet known. We know that the inflammation in

rheumatoid arthritis appears to be due to a disorder in the body's immune defense system. This

leads to an immune reaction to the body's own cells. The continuous inflammation in the joints

accounts for the damage of joints. Some researchers suspect that a virus may trigger the

inflammatory process in rheumatoid arthritis although the nature of the virus is unknown. Also, it

may be that the disease occurs only in people with a genetic or inherited tendency toward the

disease. According to scientific evidence now available, rheumatoid arthritis is NOT CAUSED

by:

• cold, dampness or changes in weather

• lack or excesses of vitamins or any other dietary elements such as fats, sugars, acids or

metals

• faulty absorption or elimination of substances from the bowel

• infection in the internal organs of the body

What are the effects of inflammation in rheumatoid arthritis?

Early in the disease, most people complain of fatigue, stiffness and aching in the joints. Muscle

stiffness commonly occurs in the morning. Usually some of the joints gradually become warm,

painful and swollen. Swelling of the joint is partly due to increased fluid in the joint cavity and

partly due to thickening of the lining of the joint capsule. The joints most affected are those in

the hands and feet. Often the same joints on both sides of the body become affected. That is, the

problems occur in both hands, both feet, both elbows and so forth

If the pain is very severe, the muscles surrounding the affected joints contract and stiffen up.

This is called muscle spasm. People with rheumatoid arthritis may lose their appetite and their

weight. General tiredness and fatigue are related to the amount of inflammation present.

Sometimes, depression sets in and excessive worry about having arthritis impedes improvement.

Other possible body changes include anaemia (low red blood cell counts), lumps or nodules

under the skin, inflammation of the eyes and pleurisy (pain in the chest on deep breathing).

Diagnosis

The diagnosis of rheumatoid arthritis may require several visits to the doctor over a period of

time. You will be asked questions about your symptoms. The doctor will perform a physical

examination, looking at and inspecting each joint for signs of inflammation or other problems.

The diagnosis will be based on the overall pattern of the symptoms, physical examination, blood

tests and x-rays.

The doctor may drain fluid from your joints and examine it to make sure the arthritis is not due

to an infection or some other cause. The fluid is removed by putting a needle into the joint.

Rarely, your doctor may remove small bits of inflamed joint tissue or nodules for examination

with a microscope. This procedure is called a biopsy.

Is There Any Effective Treatment for Rheumatoid Arthritis?

YES. Treatment involves a combination of medication, rest, exercise and methods of protecting

the joints.

Medication

This consists of anti-inflammatory drugs which reduce the swelling, pain and stiffness which

result from the inflammatory response. They are called non-steroidal anti-inflammatory drugs

(NSAIDs) and include aspirin, ibuprofen diclofenac and piroxicam. A patient's response to a

particular drug and the degree of disease activity dictate the potency of the drugs prescribed.

Some patients require drugs called "disease-modifying" agents such as sulphasalazine or

methotrexate. Newer drugs such as Enbrel, Humira and Remicade are also available. These

drugs can have side effects so treatment should be closely supervised by your rheumatologist.

The main aim of treatment is the control of the inflammatory process early so as to lessen the

disability that can result from long-term effects of joint destruction.

Corticosteroids are drugs related to the natural hormone cortisone. They have side effects but are

usually used in low doses for rheumatoid arthritis. If used in doses of 5 -10 mg daily the side

effects are less. The decision to start or stop corticosteroids must be made by your physician.

Exercise

Once inflammation is satisfactorily controlled, appropriate and regular exercises is essential to

strengthen muscles weakened by disease. Rheumatoid arthritis often makes joints stiff and

restricts their motion if they aren't used regularly. Exercises are designed to meet the needs of

each patient and should be monitored by professionals specializing in physical medicine.

Heat and Cold Treatment

Heat and cold treatment are effective means of relaxing muscles and relieving pain in arthritic

joints. A hot bath, hot pads, paraffin wax and cold compresses are some methods frequently

used.

Adequate Rest

Rest decreases the swelling and pain around inflamed joints and reduces fatigue. The number of

hours that a patient should rest every day and the way they should rest should be reviewed with

your doctor. In some cases, splints may be prescribed to rest joints, hold them in correct

positions and prevent muscles around joints from becoming too tight.

No special diet causes or cures rheumatoid arthritis. Nevertheless, a well-balanced and nutritious

diet is beneficial. If you are overweight, a diet to reduce weight will reduce stress on affected

joints.

Is There a Cure for Rheumatoid Arthritis?

NO. But with appropriate treatment the disease can be kept under control. There is still no drug

or remedy which will wipe out the disease in all cases.

What is the Outlook for Patients?

Rheumatoid arthritis can be mild, moderate or severe. For most people who begin to follow a

proper treatment program early in their illness, the amount of permanent joint damage is small.

In fact, most of the disabilities due to rheumatoid arthritis are preventable. A small minority of

patients develop severely deformed joints. This is because of unusually severe disease or neglect.

In the early stages of the disease with appropriate treatment, the majority of patients improve.

Most patients with rheumatoid arthritis can look to the future with confidence.

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