An inflammatory, autoimmune type of arthritis

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Rheumatoid arthritis is a chronic, inflammatory type of arthritis. The disease is also classified as an autoimmune disease because certain immune cells malfunction and attack a person's own body.
About 1.3 million Americans have been diagnosed with rheumatoid arthritis, making the disease the most common type of inflammatory arthritis. Approximately 75 percent of rheumatoid arthritis patients are women.
Rheumatoid arthritis typically begins in middle age, but children and young adults can also develop the disease. People of all races and ethnic backgrounds can develop rheumatoid arthritis.

The exact cause of rheumatoid arthritis is still unknown, but researchers are gaining a better understanding of how the immune system and genetic factors affect the inflammatory processes that cause rheumatoid arthritis to develop.

As researchers continue to work on the cause and cure for rheumatoid arthritis, it's important for you, the patient, to recognize the signs and symptoms of rheumatoid arthritis so you can:
consult a rheumatologist
get an accurate diagnosis
develop an early treatment plan
Causes of rheumatoid arthritis:
Researchers have worked for years to find the cause of the abnormal autoimmune
response associated with rheumatoid arthritis.
There is no single cause which has been found. Common theories point to a genetic predisposition and a triggering event.
Rheumatoid arthritis symptoms
Rheumatoid arthritis usually develops gradually, but some patients experience sudden onset of symptoms: one day they
are perfectly healthy and the next they are dealing with rheumatoid arthritis.
Symptoms commonly associated with rheumatoid arthritis include:
Joint pain, joint swelling, joint stiffness, and warmth around the affected joint

Morning stiffness that lasts one or more hours

Symmetrical pattern of affected joints, meaning the same joint on both sides of the body is affected (e.g., both knees)

Small joints of the hands and feet are characteristically involved, although any joint can be affected
Rheumatoid nodules (firm lumps under the skin), found on elbows and hands of about one-fifth of rheumatoid arthritis patients
Fatigue and noticeable loss of energy

Low grLow-grades and sometimes flu-like symptoms

Loss of appetite, weight loss, anemia associated with chronic diseases, depression

Dry eyes and dry mouth associated with a secondary condition Sjogren's syndrome

Joint deformity and instability from damage to cartilage, tendons, ligaments, and bone

Limited range of motion in affected joints
Flares and remission of disease activity is characteristic of rheumatoid arthritis

Rheumatoid arthritis may have systemic effects (i.e., affect the organs of the body)
No two rheumatoid arthritis cases are exactly the same. There is so much variety among the symptoms that some researchers suspect rheumatoid arthritis is not one disease but rather several diseases with commonalities.
Tips:
Don't ignore pain that persists.
Don't assume you simply injured yourself.
Consult a rheumatologist (a medical doctor who specializes in diagnosing and treating rheumatoid arthritis patients as well as those with other rheumatic diseases).
When you consult your rheumatologist, always discuss symptoms that have improved or worsened, as well as any new symptoms.
Morning stiffness lasting more than an hour, involvement of the small bones of the hands and feet, extreme fatigue, rheumatoid nodules, and symmetrical joint involvement (e.g., both knees not one knee) are all characteristics of rheumatoid arthritis.
Prognosis follow rheumatoid arthritis diagnosis
Most newly-diagnosed rheumatoid arthritis patients have questions about how severe the disease will become and what they can expect for the future. They are anxious to know the prognosis associated with rheumatoid arthritis and what factors affect the prognosis. Patients ask:
Will I face a mild or aggressive disease course?
Will pain become unbearable?
Is disability inevitable?
Will I be able to work and take care of my family?
Determining the prognosis
Initially, the prognosis for rheumatoid arthritis is based on how advanced the disease was when the patient was first diagnosed. Another factor considered is the age of the patient when first diagnosed or at disease-onset (when the disease began). Lastly, but probably most important is how active the disease is currently. Is rheumatoid arthritis in a flare, a remission, or is it managed well with treatment?
About 10 to 20% of rheumatoid arthritis patients have sudden onset of the disease, followed by many years with no symptoms. This is considered a prolonged remission.
Some rheumatoid arthritis patients have symptoms that come and go. Periods when there are few or no symptoms, which occur between flares, can last for
months. This is referred to as intermittent symptoms of rheumatoid arthritis.
The majority of rheumatoid arthritis patients have the chronic, progressive type of rheumatoid arthritis that requires long-term medical management.
Factors that influence the prognosis
Patients with the following factors are more likely to have a progressive and destructive form of rheumatoid arthritis and a severe disease course:

Flares that are intense and last a long time
Diagnosed very young and have had active disease for years
Markers for inflammation are elevated on laboratory tests (elevated CRP and ESR)

Significant joint damage already evident on x-rays when diagnosed
Presence of rheumatoid nodules
Test positive for rheumatoid factor or anti-CCP
Treatment of rheumatoid arthritis:
Arthritis medications are the primary course of traditional treatment for rheumatoid arthritis. Each individual patient is evaluated by their rheumatologist and a treatment plan is recommended. Along with medication, some forms of complementary treatment or local injections may help relieve pain.
Medications used for rheumatoid arthritis may include:
Biologics, such as Enbrel (etanercept), Remicade (infliximab), Humira (adalimumab), (Simponi (golimumab), Cimzia (certolizumab pegol), Rituxan (rituximab), Orencia (abatacept)
DMARDs (disease modifying anti-rheumatic drugs), such as methotrexate,Plaquenil
(hydroxychloroquine), Azulfidine (sulfasalazine)
Corticosteroids (such as
prednisone)
NSAIDs (nonsteroidal anti-inflammatory drugs such as Celebrex (celecoxib) andNaproxen (Naprosyn)
Analgesics (painkillers)
Prevalence of rheumatoid
arthritis:
Approximately 1.5 million people in the United States have rheumatoid arthritis and about 1-2 percent of the world population are affected by rheumatoid
arthritis.
Women are more affected than men. About 75 percent of rheumatoid arthritis patients are women. Men, women and even children can develop rheumatoid arthritis. Typically, disease onset for rheumatoid arthritis occurs between 30 and 60 years old.
Points of interest about rheumatoid arthritis:
About 20 percent of people who have rheumatoid arthritis test negative for the rheumatoid factor. Those patients are classified as "seronegative rheumatoid arthritis". It is generally thought the seronegative patients have a less severe case of rheumatoid arthritis and less disability, but that is not always the case.
Rheumatoid arthritis has been associated with a higher risk of mortality, higher risk of heart disease, and also a higher risk of lymphoma than the general population.
Another point of interest is that smoking has been identified as a risk factor for developing rheumatoid arthritis.

Severe rheumatoid arthritis - what you need to know
When assessing the severity of rheumatoid arthritis, doctors consider your symptoms, joint damage, and physical function. Symptoms of severe rheumatoid arthritis include a high level of joint pain, stiffness, or swelling of the affected joints. You may have trouble performing your usual daily activities.
Joint deformities, especially hand deformity, are common with severe rheumatoid arthritis. The condition can also affect other organs in your body, leading to systemic symptoms, such as persistent fatigue.
While physical examinations, laboratory tests (including CRP and erythrocyte sedimentation rate), and imaging studies can help your doctor determine the severity of your condition, your own self-assessment is important, too. For example, how long does morning stiffness last? Have symptoms, including your pain and fatigue levels, worsened? How is rheumatoid arthritis affecting your daily activities, family life, leisure time, and work?
The goal of treating rheumatoid arthritis is to manage symptoms, minimize damage, and prevent disability. Early diagnosis and treatment is essential. But even with an aggressive treatment plan, there is no arthritis cure, and there is no guarantee that the disease will not progress from mild to severe.
What can you do to stave off severe rheumatoid arthritis? Start by learning all you can about the disease. When symptoms first occur, consult a doctor or rheumatologist.
Decide on a treatment plan with your doctor. Be compliant with the treatment plan. Be open and honest with your doctor about changes in your condition or any concerns that develop.

Rheumatoid Arthritis Hand Deformity - Inevitable or Preventable?

Hand deformities, joint problems, and joint damage caused by rheumatoid arthritis can include:
rheumatoid nodules
joint swelling
joint stiffness
ulnar drift / ulnar deviation
contractures
wrist subluxation
other hand, finger, thumb, and wrist problems
Are the aforementioned hand problems and deformities inevitable with rheumatoid arthritis?
Hand deformity is a common but significant complication of rheumatoid arthritis. For example, one of the more recognizable rheumatoid arthritis hand deformities occurs when the hand deviates to the ulnar (pinkie side).
Also, a finger can lose function due to rupture of tendons. Once these deformities occur, they are not reversible medically and may require surgery.
Surgery
Some of the indications for hand surgery include pain, limited function, cosmetic, as well as a way to prevent further injury to other joints.
Early treatment
Early treatment of rheumatoid arthritis is the best way to control the disease and prevent deformity, as well as disability which often occurs when joints get damaged.
Even at later stages of the disease, there is evidence that treating patients with active disease may help. In early or mild rheumatoid arthritis, DMARDs (disease-modifying anti-rheumatic drugs), such as Plaquenil (hydroxychloroquine) and Azulfidine (sulfasalazine) may be effective.
Moderate to severe rheumatoid arthritis
Moderate to severe rheumatoid arthritis typically requires treatment with potentially more effective DMARDs including methotrexate (Rheumatrex, Trexall) and Arava (leflunomide), or one of the TNF blockers.
Drug combinations
In many cases, two or even three DMARDs may be combined to help patients.
Some common examples include:

Methotrexate and one of the TNF blockers
Methotrexate, Plaquenil, and Azulfidine
Combination Treatment for Rheumatoid Arthritis
Create an action plan with your doctor
If you and your doctor have assessed the factors that influence your prognosis, the next thing to do is periodically reassess those factors. At certain intervals, you should have x-rays, laboratory tests, and an examination to see if your physical results have changed.
If you find that your disease is very active, you are in a flare that seems unstoppable, lab results are worse, or x-ray evidence of joint damage is more pronounced, your treatment options should be reconsidered.
You and your doctor may need a new plan of attack to slow or halt disease progression.
Many of the new biologic treatments, often in combination with a traditional DMARD, have been successful for disease management.
To assess the effect of rheumatoid arthritis on how well you perform usual daily activities, you can take the Health Assessment Questionnaire (HAQ).
By taking the HAQ periodically, you can determine if function is worsening. Again, you and your doctor may need to review your treatment options.
(Photo Credit: Getty Images)
Source: Primer on the Rheumatic Diseases. Arthritis Foundation. Thirteenth Edition.
Courtesy: verywell