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Description: Rheumatoid Arthritis Definition Rheumatoid arthritis (RA) is an autoimmune disease that causes pain, swelling, stiffness, and loss of function in the joints. RA usually affects the same joint on both sides of the body. It occurs most frequently in the:

Elbows Fingers Hips Jaw Knees Shoulders Toes Wrists Causes Rheumatoid arthritis is likely to be caused... More

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Rheumatoid Arthritis Definition Rheumatoid arthritis (RA) is an autoimmune disease that causes pain, swelling, stiffness, and loss of function in the joints. RA usually affects the same joint on both sides of the body. It occurs most frequently in the:

Elbows Fingers Hips Jaw Knees Shoulders Toes Wrists Causes Rheumatoid arthritis is likely to be caused by a combination of genetic and environmental factors that trigger an abnormal immune response. Possible causes include:

Defects in the immune system, which cause on-going inflammation Environmental factors - Certain infectious agents, such as some viruses or bacteria, may increase susceptibility to RA. Genetic factors - Certain genes that play a role in the immune system are associated with the development of RA. Other factors - Some evidence suggests that hormonal factors may promote the development of RA in combination with genetic factors and environmental exposure. Risk Factors A risk factor is something that increases your chance of getting a disease or condition.

Ethnic background: Pima Indians Family members with rheumatoid arthritis Heavy or long-term smoking Sex: Female Symptoms When RA first begins, symptoms may include:

Joint deformity Joint pain and stiffness that is: Lasts for at least half an hour Most prominent in the morning Symmetrical Loss of appetite Mild fever, tiredness Red, warm or swollen joints Small lumps or nodules under the skin As RA progresses, it may cause complications with the:

Blood Eyes Heart Kidneys Liver Lungs Nervous system Skin Diagnosis There is no single test for RA. The doctor will ask about your symptoms and medical history. Physical exam will include an examination of your joints, skin, reflexes, and muscle strength.

Tests may include:

C-reactive protein (CRP) - an indicator of active inflammation in the blood Erythrocyte sedimentation rate (ESR) of the blood Rheumatoid factor (RF) level in the blood White blood cell count X-rays of affected joints (especially dual energy x-ray absorptiometry) Treatment There is no treatment to cure RA. The goals of treatment are to:

Improve functional ability Reduce inflammation Relieve pain Slow down joint damage Treatments include:

Medications Medications include:

Anti-inflammatory medications: Acetaminophen (Tylenol) Cox-2 inhibitors - celecoxib (Celebrex) and rofecoxib (Vioxx) Non-buffered aspirin Nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and naproxen (Advil, Aleve) Steroid drugs (prednisone) ***Please Note: On September 30, 2004, Merck & Co., Inc. announced a voluntary withdrawal of Vioxx(R) (rofecoxib) from the U.S. and worldwide market due to safety concerns. A recent study showed a small but significant increased risk of cardiovascular events (such as heart attack) in patients taking the prescription medication. Vioxx(R) is a so-called 'selective' non-steroidal anti-inflammatory drug (NSAID) specially designed to lower the risk of stomach irritation. It is commonly used in the treatment of acute and chronic pain associated with arthritis, menstruation and other conditions. Since Merck's withdrawal of Vioxx(R), evidence has come to light regarding similar dangers posed by the other popular selective NSAID, Celebrex(R) (cefecoxib), which is produced by Pfizer. Most physicians now question the wisdom of prescribing any medications from the COX-2 class.

Biologic response modifiers - drugs that interfere with the autoimmune response associated with RA. Etanercept (Enbrel) Infliximab (Remicade) Disease-modifying antirheumatic drugs (DMARDS) - to slow the course of the disease: Gold (Ridaura). Gold can also be given as an injection. Hydroxychloroquine (Plaquenil) Leflunomide (Arava), cyclosporine (Neoral) Methotrexate (Rheumatrex) Penicillamine (Cuprimine) Sulfasalazine (Azulfidine) Immunosuppressive drugs (only used when other drugs are ineffective): Azathioprine (Imuran) Chlorambucil (Leukeran) Cyclophosphamide (Cytoxan) Steroids When less potent pain relievers are ineffective, corticosteroid injections to the inflamed joint may be given. Because cortisone injections can be harmful to the tissue and bones, they are reserved for patients with more pronounced symptoms.

Rest and Exercise Rest helps reduce active joint inflammation and pain, and fight fatigue. Exercise is important for maintaining muscle strength and flexibility, as well as preserving joint mobility.

Joint Care Splints applied to painful joints may help reduce pain and swelling. Devices that assist in activities of daily living can also reduce stress on joints, such as:

Long-handled shoehorns Specially designed kitchen tools Zipper extenders Stress Reduction Stress reduction can ease the difficulties of living with a chronic, painful disease. Exercise programs, support groups, and open communication with health care providers can all help to reduce stress.

Surgery Joint replacement and tendon reconstruction can help alleviate severe joint damage.

Lifestyle Measures The following measures may relieve stiffness and weakness and reduce inflammation:

Aerobic exercise (walking, swimming, dancing) Attempt mild strength training Avoid heavy impact exercise Control weight Maintain a balance between rest and exercise Physical therapy Stop smoking Prevention There are no guidelines for preventing rheumatoid arthritis.

Last reviewed: July 2004 by Jeff Andrews, MD.

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