Rheumatoid Arthritis (RA)
Rheumatoid Arthritis is a systemic connective tissue
autoimmune disease that attacks the joints as well
as other tissues and organs. It's a chronic inflammatory
disease that is progressive and destroys the articular
cartilage of the joints causing pain and reduces the
range of motion of the joint. In human language, that
means that the soft tissue that lines the joints swell
and become stiff, and may be tender and warm. Eventually
the joint may erode causing loss of function and eventual
deformity.
RA can also cause inflammation in the lungs, heart,
eyes, skin, bowels and other tissues of the body which
makes it a systemic condition. Not all RA sufferers
will experience the systemic symptoms, some patients
may only have joint involvement while others may develop
systemic conditions over time caused by the RA.
Typically, RA presents with pain and swelling in
the joints (most commonly in the hands, wrist, knees
or feet) but other symptoms may present before joint
involvement. Other symptoms may include nodules or
lumps under the skin, usually over a bone like the
elbow or fingers, etc. Skin problems may also manifest
such as Telangiectasia (small spider-vein like spots
that typically appear across the face, trunk and arms),
skin thinning and skin atrophy. Lung involvement might
include fibrosis and other organs can also become
symptomatic before there is joint involvement. Other
symptoms may include fatigue, general ill feeling,
morning stiffness and loss of appetite.
RA is a progressive disease and early diagnosis aggressive
treatment is the best option for any patient. RA is
an individual disease, for some RA may progress slowly
while others may have a more rapid progression of
the disease. Some of the long-term affects of the
disease if untreated may include deformation of the
fingers, spine, loss of cartilage of the joints, heart
& lung problems and other complications.
There is no cure for RA but there are symptom management
treatments as well as immune-suppressant therapies
to help manage the disease. Lifestyle changes can
also greatly impact the quality of life for RA patients.
Symptoms:
Blotchy, bluish rash that looks like lace that does
not go away
Fatigue
General feeling of not feeling well or discomfort
without a reason (malaise)
General joint pain and stiffness
Gritty feeling in eyes
Impaired range of motion in joints
Joint pain with swelling and redness
Loss of muscle mass
Low grade fever
Morning stiffness
Nodules under the skin
Pain when moving eyes
Shortness of breath
Swollen lymph nodes
Tendinitis in legs
Thinning of skin
Warping or deformity of fingers
Unintentional Weight loss
Diagnosis:
Diagnosis of RA is typically made through physical
examinations, imaging such as X-ray, MRI or CT Scans
of joints and/or organs. If inflammation is present
at the time of your doctor visit, a sample of the
fluid may be drawn. Blood tests will also be used
to confirm diagnosis and may include:
Positive Anti-Nuclear Antibody
Elevated Erythrocyte Sedimentation Rate
Positive Anti-Cyclic Citrullinated Peptide
Elevated Rheumatoid Factor Quantity
Positive Rheumatoid Factor
Positive HLA-DR4
Elevated C-Reactive Protein
Positive Anti-Citrullinated Protein Antibodies
Low Total Serum Iron
From Wikipedia,
quoted from the American College of Rheumatology:
In 2010 the 2010 ACR / EULAR Rheumatoid Arthritis
Classification Criteria were introduced.[15] These
new classification criteria overruled the "old"
ACR criteria of 1987 and are adapted for early RA
diagnosis. The "new" classification criteria,
jointly published by the American College of Rheumatology
(ACR) and the European League Against Rheumatism (EULAR)
establish a point value between 0 and 10. Every patient
with a point total of 6 or higher is unequivocally
classified as an RA patient, provided he has synovitis
in at least one joint and given that there is no other
diagnosis better explaining the synovitis. Four areas
are covered in the diagnosis:
• joint involvement – depending on the
type and number of joints: up to 5 points
• serological parameters – including the
rheumatoid factors as well as ACPA – "ACPA"
stands for "anti-citrullinated protein antibody":
up to 3 points depending on titre level
• acute phase reactants: 1 point for elevated
erythrocyte sedimentation rate, ESR, or elevated CRP
value (c-reactive protein)
• duration of arthritis: 1 point for symptoms
lasting six weeks or longer
The new criteria accommodate to the growing understanding
of rheumatoid arthritis and the improvements in diagnosing
RA and disease treatment. In the "new" criteria
serology and autoimmune diagnostics carries major
weight, as ACPA detection is appropriate to diagnose
the disease in an early state, before joints destructions
occur. Destruction of the joints viewed in radiological
images was a significant point of the ACR criteria
from 1987.[16] This criterion no longer is regarded
to be relevant, as this is just the type of damage
that treatment is meant to avoid.
The criteria are not intended for the diagnosis for
routine clinical care; they were primarily intended
to categorize research (classification criteria).
In clinical practice, the following criteria apply:[citation
needed]
• two or more swollen joints
• morning stiffness lasting more than one hour
for at least six weeks
• the detection of rheumatoid factors or autoantibodies
against ACPA such as autoantibodies to mutated citrullinated
vimentin can confirm the suspicion of rheumatoid arthritis.
A negative autoantibody result does not exclude a
diagnosis of RA.
Treatment:
There is no cure for RA so treatment usually consists
of a combination of symptom management and Disease-Modifying-Anti-Rheumatic
Drugs (DMards) to slow the progression of the disease.
If DMards can't be used, Biologics such as TnFA Blockers
and other biologics may be used to reduce the Rheumatoid
factor and modify the immune system to slow the progression.
Non-Steroidal Anti-Inflammatories may be used to
reduce inflammation and pain and therapies such as
occupational and/or physical therapy might be used
to maintain joint mobility and strength.
Prognosis:
RA can range from mild to severe depending on whether
or not the disease has become systemic. In mild cases,
with treatment and therapy, most patients may only
have short-term symptoms with long-term remissions.
In moderate to severe cases, the disease is progressive
and can be limiting to daily activities, cause deformity
of the joints and become a disabling disease.
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