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Term / Rheumatoid Arthritis

Rheumatoid arthritis, or RA is an autoimmune disease that is estimated to affect about 1% of the world’s population, women three times more often than men. Onset is most frequent between the ages of 40 and 50, but people of any age may be affected. It can be a painful and disabling condition that may lead to substantial loss of mobility and function. Without proper treatment, permanent joint damage may occur. Fatigue, low grade fever, malaise, morning stiffness, loss of appetite and loss of weight are common in people with active RA.

Autoimmune disease results when the body mistakenly attacks and damages it’s own healthy tissue and organs. In RA, the synovial membrane that lines joints and tendons is attacked, leading to inflammation that damages both. Joints on both sides of the body are affected equally. Hands, feet and cervical spine are most commonly affected, but larger joints like the shoulder and knee can also be involved. Joints become swollen, tender and warm, and stiffness limits their movement. Increased stiffness early in the morning is often a prominent feature of the disease and typically lasts for more than an hour. Gentle movement may relieve symptoms in early stages of the disease and helps distinguish rheumatoid arthritis from osteoarthritis, or “wear-and-tear” arthritis. As RA progresses, inflammation leads to tendon “tethering” and destruction of the joint surface, both of which impair range of movement and lead to deformity.

While RA primarily affects joints, problems involving other organs are often present. Extra-articular (“outside the joints”) problems are experienced by about 15–25% of individuals with RA. It can be difficult to determine whether these problems are caused by the rheumatoid process itself or are side effects of the medications commonly used to treat it:

  • Blood
    Anemia is by far the most common symptom experienced by patients with RA.
  • Skin
    The rheumatoid “nodule” is the most characteristic symptom of RA affecting the skin. The typical rheumatoid nodule is usually found over bony prominences or other areas that sustain repeated mechanical stress.
  • Lungs
    Fibrosis (stiffening) of the lungs is a recognized response to rheumatoid disease. It is also a rare but well recognized consequence of medications like methotrexate and leflunomide. Another complication of RA is Rheumatoid Lung Disease, which affects about 25% of all people diagnosed with RA.
  • Kidneys
    The deposit of abnormal proteins that damage the kidney (renal amyloidosis) is a potential side effect of RA. Treatment with Penicillamine and gold salts are also recognized causes of kidney damage.
  • Heart and Blood Vessels
    People with RA are more prone to atherosclerosis (clogged arteries) and at greater risk for heart attack and stroke. Many people with RA do not experience the same chest pain that others feel when they have angina or a heart attack. To reduce cardiovascular risk, exercise and medications to reduce other risk factors blood pressure and high cholesterol are critical.
  • Eye
    The eye is directly affected in agressive RA. Dryness of eyes and mouth caused by inflammation, when severe, can cause dryness of the cornea and lead to loss of vision.
  • Liver
    Although the liver may become enlarged due to an increase in the number of inflammatory cells, liver involvement in RA is essentially asymptomatic.
  • Neurological
    Peripheral neuropathy (numbness and tingling of hands and feet) may be experienced by some people with RA. Carpal tunnel syndrome, caused when swelling around the wrist compresses the major nerve serving the hand, is more common. Erosion of bones and ligaments in the cervical spine can cause vertebrae to slip over one another and compress the spinal cord. The initial symptom may be clumsiness, but without care may progress to paralysis.
  • Osteoporosis
    Osteoporosis is probably the result of a combination of factors including immobility and inflammation. Steroid therapy to treat RA may also contribute to osteoporosis.
  • Lymphoma
    The incidence of lymphoma is increased in RA, although it is still uncommon.

RA usually requires lifelong treatment that includes medication, physical therapy, exercise and in some cases, surgery. Early, aggressive treatment for RA can delay joint destruction.

Nearly 4% of the world’s population is affected by one of more than 80 different autoimmune diseases, the most common of which include type 1 diabetes, multiple sclerosis, rheumatoid arthritis, lupus, Crohn’s disease, psoriasis and scleroderma. Autoimmune diseases represent the third most common cause of chronic illness in the United States. Although many autoimmune diseases are rare, the National Institutes for Health (NIH) estimates that they collectively affect between 5% and 8% percent of the U.S. population. For unknown reasons, the prevalence of autoimmune diseases is increasing.

Because these diseases strike women three times more often than men, the Office of Research on Women’s Health at the NIH has named autoimmunity a major women’s health issue. It is estimated by the American Autoimmune Related Diseases Association (AARDA) that as many as 50 million Americans are living with an autoimmune disease – at a cost of $86 billion a year. According to the U.S. Department of Health & Human Services (HHS), these diseases represent the fourth largest cause of disability among women in the U.S. and are the eighth leading cause of death for women between the ages of 15 and 64.

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