When the immune system goes awry and attacks the joints, rheumatoid arthritis (RA) is the result. A chronic, debilitating condition that has no cure, RA is two to three times more common in women than men, according to the Mayo Clinic.
About 1.3 million Americans suffer from RA, which can cause significant pain and joint deformity as it wears away joint linings, according to the Arthritis Foundation. It usually affects joints on both sides of the body equally and starts in the small joints of the wrists, hands, ankles and feet.
Scientists are unsure what causes RA, though some known risk factors include gender, age and genetics.
RA symptoms can be very vague at the onset, resembling those of many other illnesses. They also vary from patient to patient and may come and go. According to the Mayo Clinic, symptoms include:
- Joint pain
- Swollen joints
- Swollen glands
- Fatigue or weakness
- Red, puffy hands
- Morning stiffness
- Loss of appetite or weight loss
- Firm bumps under the skin on the arms
Diagnosis & Tests
No single test confirms RA, so doctors usually rely on a variety of tests to make a diagnosis. These tests measure the amount of inflammation present in the body or study joint structure.
According to the Arthritis Foundation, tests include:
- Erythrocyte Sedimentation Rate (known as ESR or sed rate): This blood test measures how fast red blood cells fall to the bottom of a test tube. The quicker this happens, the more inflammation is present.
- C-Reactive Protein (CRP): This protein is measured through a blood test and is higher when inflammation is present. Sometimes ESR will detect inflammation when CRP does not, and vice versa.
- Rheumatoid Factor (RF): About 70 to 80 percent of those whose blood contains RF also have rheumatoid arthritis.
- X-Rays: Sometimes this imaging test will show the loss of bone density surrounding joints or swollen, soft tissue. They also serve as a valuable baseline to compare to future X-rays.
- Magnetic Resonance Imaging (MRI): This scan can detect early inflammation not visible by X-ray.
Medications & Treatments
Because RA has no cure, treatments are usually lifelong and focus on relieving symptoms as well as preventing and slowing joint damage.
Many over-the-counter and prescription drugs are available to treat RA, though some have potentially serious side effects which must be carefully monitored. Usually they are taken in combination. According to the Mayo Clinic, medications include:
- NSAIDs: Non-steroidal anti-inflammatory drugs such as ibuprofen (commonly known as Advil or Motrin) and naproxen sodium (Aleve) reduce pain and inflammation. Prescription strength NSAIDs are also available.
- Steroids: Prescription corticosteroids such as prednisone and methylprednisolone (Medrol) help control inflammation and slow joint damage by inhibiting the immune system.
- DMARDs: Disease-modifying anti-rheumatic drugs can save joints and tissues from permanent damage. They include methotrexate (Rheumatrex, Trexall), leflunomide (Arava), hydroxychloroquine (Plaquenil) and others.
- Immunosuppressants: Taming the immune system, they include azathioprine (Imuran, Azasan), cyclosporine (Neoral, Sandimmmune, Gengraf) and cyclophosphamide (Cytoxan).
- Biologics: These drugs inhibit inflammation-producing proteins called cytokines. They include etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira).
Another major RA treatment is surgery, which is an option when drugs cannot prevent or slow joint damage. According to the National Institutes of Health (NIH), procedures include total joint replacement therapy, which substitutes man-made joints for damaged ones; tendon repair; synovectomy, which removes the joint lining; and joint fusion, which can stabilize joints or relieve pain.