Rheumatoid arthritis (patient information)

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What is rheumatoid arthritis?

How do I know if I have rheumatoid arthritis and what are the symptoms of rheumatoid arthritis?

Affected joints of rheumatoid arthritis include the fingers, wrists, elbows, shoulders, hips, knees, ankles, toes, jaw, and neck. Signs and symptoms come and go, depending on the degree of tissue inflammation. When the disease is active, the following symptoms appear.

Morning stiffness in the joints
Joint pain
Joint swelling
Rheumatoid nodules: Firm bumps of tissue under the skin on the arms.
Fatigue and weakness
Low fever
Weight loss
When heart is affected, patient may show signs of chest pain, shortness of breath or edema of lower limbs.

Who is at risk for rheumatoid arthritis?

As a autoimmune disease, the cause of rheumatoid arthritis is not clear.

How to know you have rheumatoid arthritis?

Blood tests: These tests can assist in making a diagnosis of rheumatic arthritis.

Rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) and antinuclear antibody (ANA): These antibodies can be found in most of patients with rheumatoid arthritis.
Sedimentation rate (ESR): This test can measure how much inflammation is in the body. Patients with rheumatoid arthritis may show an increased ESR.
Complete blood count

Synovial fluid examination: When a patient demonstrate the signs of acute inflammatory arthritis, it is necessary to aspirate synovial fluid of the involved joint to rule out an infectious arthritis. During the procedure, the doctor may use a needle to draw fluid from your affected joint. Based on the discovery of urate crystals in the synovial fluid or soft tissues, the doctors can confirm the diagnosis.
Joint x-ray: This image can help track the progression of rheumatoid arthritis in the joints over time.
Magnetic resonance imaging (MRI): An MRI uses magnetic fields but it is a different type of image than what is produced by computed tomography (CT) and produces detailed images of the joint.

When to seek urgent medical care?

Call your doctor if you have symptoms of rheumatoid arthritis.

Treatment options

There is no cure for rheumatoid arthritis. Treatment opinion includes medication, physical therapy and surgery. The opinion depends on the diesease condition. Occupational and physical therapy can teach you how to protect your joints. If your joints are severely damaged by rheumatoid arthritis, surgery may be necessary.

Medications: The goal of medications can reduce inflammation to relieve pain and prevent or slow joint damage.

Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs may be used to control inflammation and pain in patients with rheumatoid arthritis. Usual drugs include ibuprofen, naproxen and indomethacin. Usual side effects are [][pain]], bleeding and ulcers in upper gastrointestinal tract.
Corticosteroids: Corticosteroids are generally prescribed for patients who cannot take NSAIDs. These drugs can be used by oral or by injection into the joint to control inflammation and pain. Side effects of corticosteroids may include a decreased ability against infection, worse healing in the wound and osteoporosis.
Disease-modifying antirheumatic drugs (DMARDs): These drugs can slow the progression of rheumatoid arthritis and prevent the joints and other tissues from permanent damage. Usual medications of DMARDs include methotrexate, leflunomide, hydroxychloroquine, sulfasalazine and minocycline. Side effects include liver damage, bone marrow suppression and severe pulmonary infections.
Immunosuppressants: Because rheumatoid arthritis is a autoimmunedisease, immunosuppressants can be use to control your immune system. Common medications include azathioprine, cyclosporine and cyclophosphamide. Side effects may include a decreased ability against infection.
TNF-alpha inhibitors: TNF-alpha inhibitors, such as etanercept, infliximab and adalimumab, can also help relieve symptoms of rheumatoid arthritis. Side effects include injection site irritation, congestive heart failure, lymphoma and increased risk of infection.

Physical therapy: The aim of physical therapy is to take stress off your painful joints. The therapist can treat you by hands or by assistive devices.
Surgery: If medications fail to prevent or slow joint damage, surgery may be recommended to repair damaged joints and restore your ability to use the joints. Surgeries on rheumatoid arthritis include: