RHEUMATOID arthritis is a chronic joint disease that damages the joints of the body. It is also a systemic disease that potentially affects internal organs of the body and leads to disability. The joint damage is caused by inflammation of the joint lining tissue. Inflammation is normally a response by the body's immune system to "assaults" such as infections, wounds, and foreign objects. In RHEUMATOID arthritis, the inflammation is misdirected to attack the joints. RHEUMATOID arthritis is often referred to as RA".
The inflammation in the joints causes pain, stiffness, swelling, and loss of function. The inflammation often affects other organs and systems of the body,including the lungs, heart, and kidneys. If the inflammation is not slowed or stopped, it can permanently damage the affected joints and other tissues.
Rheumatoid arthritis should not be confused with other forms of arthritis, such as osteoarthritis or arthritis associated with infections. RHEUMATOID arthritis is an autoimmune disease. This means that the body's immune system mistakenly attacks the tissues it is supposed to protect.
The immune system produces specialized cells and chemicals, which are released into the bloodstream and begin to attack body tissues. This abnormal immune response causes inflammation and thickening of the membrane (synovium) that lines the joint. Inflammation of the synovium is called synovitis and is the hallmark of an inflammatory arthritis such as RHEUMATOID arthritis. As the synovitis expands inside and outside of the joint, it can damage the bone and cartilage of the joint and the surrounding tissues, such as ligaments, tendons,nerves, and blood vessels.RHEUMATOID arthritis most often affects the smaller joints, such as those of the hands and/or feet, wrists, elbows, knees, and/or ankles, but any joint can be affected. The symptoms often lead to significant discomfort and disability.
Many people with RHEUMATOID arthritis have difficulty carrying out normal activities of daily living, such as standing, walking, dressing, washing, using the toilet, preparing food, and carrying out household chores.
The symptoms of RHEUMATOID arthritis interfere with work for many people. As many as half of those with RHEUMATOID arthritis are no longer able to work10-20 years after their condition is diagnosed.
On average, life expectancy is somewhat shorter for people with RHEUMATOID arthritis than for the general population. This does not mean that every one with RHEUMATOID arthritis has a shortened life span. RHEUMATOID arthritis it self is not a fatal disease. However, it can be associated with many complications and treatment-related side effects that can contribute to premature death.
Although RHEUMATOID arthritis most often affects the joints, it is a disease of the entire body. It can affect many organs and body systems besides the joints.Therefore, RHEUMATOID arthritis is referred to as a systemic disease.
MUSCULO SKELETAL STRUCTURES:
Damage to muscles surrounding joints may cause atrophy (shrinking) that results in weakening. This is most common in the hands. Atrophy also may result from not using a muscle, usually because of pain or swelling. Damage to bones and tendons can cause deformities, especially of the hands and feet. Osteoporosis and carpal tunnel syndrome are other common complications of RHEUMATOID arthritis.
Many people with RHEUMATOID arthritis develop small nodules on or near the joint that are visible under the skin. These RHEUMATOID nodules are most notice-able under the skin on the bony areas that stick out when a joint is flexed. Dark purplish areas on the skin (purpura) are caused by bleeding in to the skin from blood vessels damaged by RHEUMATOID arthritis. Purpura is particularly common in those patients who have taken cortisone medication. This damage to the blood vessels is called vasculitis, and these vasculitic lesions also may cause skin ulcers.
A collection of fluid around the heart (pericardial effusion) from inflammation is not uncommon in RHEUMATOID arthritis. This usually causes only mild symptoms, if any, but it can be very severe. RHEUMATOID arthritis-relate to inflammation can affect the heart muscle, the heart valves, or the blood vessels of the heart (coronary arteries). Heart attacks are more frequent in patients with RHEUMATOID arthritis than those without it.
RHEUMATOID arthritis' effects on the lungs may take several forms. Fluid may collect around one or both lungs and is referred to as a pleural effusion. Inflammation of the lining tissues of the lungs is known as pleuritis. Less frequently, lung-tissues may become stiff or scarred, referred to as pulmonary fibrosis. Any of these effects can have a negative effect on breathing. Lung infections become more common.
The digestive tract is usually not affected directly by RHEUMATOID arthritis.Dry mouth, related to Sjögren's syndrome, is the most common symptom of gastrointestinal involvement. Digestive complications are much more likely to be caused by medications used to treat the condition, such as gastritis(stomach inflammation) or stomach ulcer caused by NSAID therapy. Any part of the digestive tract may become inflamed if the patient develops vasculitis, but this is uncommon. If the liver is involved, it may become enlarged and cause discomfort in the abdomen.
The kidneys are not usually affected directly by RHEUMATOID arthritis. Kidney problems in RHEUMATOID arthritis are much more likely to be caused by medications used to treat the condition. Nevertheless, severe, long-standing disease can uncommonly lead to a form of protein deposition and damage to the kidney, referred to as amyloidosis.
Inflammation of the blood vessels can cause problems in any organ but is most common in the skin, where it appears as purple patches (purpura) or skin ulcers.
Anemia or "low blood" is a common complication of RHEUMATOID arthritis. Anemia means that you have an abnormally low number of red blood-cells and that these cells are low in hemoglobin, the substance that carries oxygen through the body. (Anemia has many different causes and is by no means unique to RHEUMATOID arthritis.) A low white blood cell count (leukopenia) can occur from Felty's syndrome, a complication of RHEUMATOID arthritis that is also characterized by enlargement of the spleen.
The deformity and damage to joints in RHEUMATOID arthritis often lead to-entrapment of nerves. Carpal tunnel syndrome is one example of this. Entrapment can damage nerves and may lead to serious consequences.
The eyes commonly become dry and/or inflamed in RHEUMATOID arthritis. This is are sult of inflammation of the tear glands and is called Sjögren's syndrome. These verity of this condition depends on which parts of the eye are affected.There are many other eye complications of RHEUMATOID arthritis, including inflammation of the whites of the eyes (scleritis), that often require the at tention of an ophthalmologist.
Like many autoimmune diseases, RHEUMATOID arthritis typically waxes and wanes.Most people with RHEUMATOID arthritis experience periods when their symptoms worsen (known as flares or active disease) separated by periods in which the symptoms improve. With successful treatment, symptoms may even go away completely (remission, or inactive disease).
About 1.3 million people in the United States are believed to have RHEUMATOID arthritis.
About 75% of these are women. Women are two to three times more likely to develop RHEUMATOID arthritis than men. RHEUMATOID arthritis affects all ages,races, and social and ethnic groups. It is most likely to strike people 35-50 years of age, but it can occur in children, teenagers, and elderly people. (A similar disease affecting young people is known as juvenile RHEUMATOID arthritis.)
Worldwide, about 1% of people are believed to have RHEUMATOID arthritis, but the rate varies among different groups of people. For example, RHEUMATOID arthritis affects about 5%-6% of some Native-American groups, while the rate is very low in some Caribbean peoples of African descent. The rate is about 2%-3%in people who have a close relative with RHEUMATOID arthritis, such as a parent, brother or sister, or child.
RHEUMATOID ARTHRITIS SIGNS AND SYMPTOMS:
Although RHEUMATOID arthritis can have many different symptoms, joints are always affected. RHEUMATOID arthritis almost always affects the joints of the hands (such as the knuckle joints), wrists, elbows, knees, ankles, and/or feet. The larger joints, such as the shoulders, hips, and jaw may be affected. The vertebrae of the neck are some times involved in people who have had the disease for many years. Usually at least two or three different joints are involved on both sides of the body,often in a symmetrical (mirror image) pattern.
THE USUAL JOINT SYMPTOMS INCLUDE THE FOLLOWING:
STIFFNESS: The joint does not move as well as it once did. Its range of motion(the extent to which the appendage of the joint, such as the arm, leg, or finger, can move in different directions) may be reduced. Typically, stiffness is most noticeable in the morning and improves later in the day.
INFLAMMATION: Redness, tenderness, and warmth are the hallmarks of inflammation.
SWELLING: The area around the affected joint is swollen and puffy.
NODULES: These are hard bumps that appear on or near the joint. They often are found near the elbows. They are most noticeable on the part of the joint that juts out when the joint is flexed.
PAIN: Pain in RHEUMATOID arthritis has several sources. Pain can come from inflammation or swelling of the joint and surrounding tissues or from working the joint too hard. The intensity of the pain varies among individuals.
These symptoms may keep you from being able to carry out your normal activities.
Malaise (a"blah" feeling)
Loss of appetite
Myalgias (muscle aches)
Weakness or loss of energy
The symptoms usually come on very gradually, although in some people they come on very suddenly. Sometimes, the general symptoms come before the joint symptoms, and you may think you have the flu or a similar illness.
The following conditions suggest that RHEUMATOID arthritis is quiet, referred to as "in remission":
Morning stiffness lasting less than 15 minutes
No joint pain
No joint tenderness or pain with motion
No soft-tissue swelling
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