Rheumatoid arthritis

In rheumatoid arthritis, the affected joints become stiff and swollen as a result of inflammation of the synovial membrance, which encloses each joint. If the inflammation persists, it may damage both the ends of the bones and the cartilage that cover them. Tendons and ligaments, which support the joints, may also become worn and slack, and deformity of the joints occurs.


In most cases, rheumatoid arthritis affects several joints. The disorder usually appears first in the small joints of the hands and feet but may develop in any joints. Rheumatoid arthritis usually tends to appear in similar areas on both sides of the body. Tissues in other parts of the body, such as the eyes, the lungs, the membranous sac around the heart, and blood vessels, may also be affected.

Rheumatoid arthritis is a long-term disease and usually recurs in episodes lasting for several weeks or months. Some people remain free of symptoms between episodes. The disorder affects about 1 in 100 people and is three times more common in women than in men. A similar but distinct arthritis disorder can develop in children.

Rheumatoid arthritis is an autoimmune disorder in which the body produces antibodies that attack the synovial membrane and, in some cases, other body tissues.

What are the symptoms?

Rheumatoid arthritis usually develops slowly, although sometimes the onset of the inflammation can be abrupt. General symptoms associated with the condition may include tiredness, poor appetite, and lost of weight. Specific symptoms may include:


- Painfull, swollen joints that are stiff on waking in the morning.
- Painless, small bumps (nodules) on areas of pressure, such as the elbows. Since the condition can be both painful and debilitating, depression is common in people with rheumatoid arthritis. In women, the symptoms of rheumatoid arthritis may be improve during pregnancy but may then flare up again after the baby is born.

Are there complications?

Over time, thinning of the bones and greater susceptibility to fractures may develop in people with rheumatoid arthritis. This results partly from the disease itself and partly from reduced mobility.

The general symptoms of rheumatoid arthritis are partly due to anaemia, cause by a failure of the bone marrow to manufacture enough new red blood cells.

Bursitis may develop, in which one or more of the fluid-filled sacs around a joint become inflamed. Swelling that compresses the median nerve in the wrist may lead to a tingling feeling and pain in the fingers. Spasm or narrowing of the walls of the arteries that supply the fingers and toes results in Raynaud’s phenomenon, in which the digits become pale and painful on exposure to cold.

A less common complication is when the spleen and the lymph nodes enlarge. Inflammation may affect the membranous sac that surrounds the heart and also the lungs. In some cases, there may be inflammation of the white of the eye, or the eyes may become very dry.

How is it diagnosed?

The diagnosis is usually based on your medical history and a physical examination. Your doctor may arrange for blood tests to check for the presence of an antibody known as rheumatoid factor, which is usually associated with rheumatoid arthritis. You may also have blood tests to measure the severity of the inflammation. X-rays of the affected joints may be taken to assess the degree of damage.

What is the treatment?

There is no cure for rheumatoid arthritis. The aim of treatment is to control symptoms and reduce further joint, damage by slowing the progression of the disease. Various types of drug are available, and your doctor’s recommendation will depend on the severity and progression of the disease, your age, and your general health.

If your symptoms are usually mild, your doctor may simply prescribe a nonsteroidal anti-inflammatiory drug. However, if your symptoms are severe, he or she may prescribe drugs that slow the progression of the disease, which should limit permanent joint damage. These drugs may have to be taken for several months before the full benefits are felt. An antirheumatic such as sulfasalazine or hydroxychloroquine may be given first. If your symptoms persist, the doctor may prescribe a drug such as gold, penicillamine, methotrexate, or ciclosporin. Since these drugs can sometimes cause serious side effects, which include kidney damage and blood disorders, the doctor will closely monitor your condition.

Your doctor may recommend that you use a splint or brace co support a particularly painful joint and to slow down the development of deformities. Taking gentle, regular exercise may help to keep your joints flexible and prevent supporting muscles from weakening. Physiotherapy may be given to improve your joint mobility and help to increase muscle strength. Hydro-therapy and heat or ice treatments may provide pain relief.

An intensely painful joint may be eased if your doctor injects it with a corticosteroid drug. If a joint is severely damaged, your doctor may suggest that you have surgery to replace the damaged joint with an artificial one.

What is the prognosis?

Many people with rheumaitoid arthritis are able to lead a normal life, but lifelong drug treatment may be needed to control the symptoms. About 1 in 10 people becomes severely disabled as repeated attacks destroy the joints. To monitor progression of the disease and your response to treatment, regular blood tests will be needed. Sometimes, the attacks gradually cease, and the disease is said to have burned itself out, but some permanent disability may remain.

JOINT REPLACEMENT

Joints that have been severely damaged by a disorder such as arthritis or by an injury may be surgically replaced with artifical joints made of metal, ceramic, or plastic. The joints in the body that are most commonly replaced are the hips, knees, and shoulders. During the operation, the ends of damaged bones are removed and the artificial components are fixed in place. The operation usually relieves pain and increases the range of movement in the affected joint.

Hip replacement

The most commonly replaced joint in the body is the hip. During the operation, both the pelvic socket and the head of the femur (thighbone), which fits into the socket, are replaced. The operation is carried out under general anaesthesia and involves a short stay in hospital.

Other joints

Many different types of joint in the body can be replaced, from tiny finger joints to large joints such as the knees.