Rheumatoid Arthritis

Rheumatoid Arthritis or RA is a medical condition of the joints that is considered an autoimmune and inflammatory disease. This means that your own body attacks itself causing an Inflammation response. Likely part of the Immune System Response – but out of control.

RA mainly attacks the Joints such as hands, wrist, knees. But other joints can be involved as well. The lining of the joint becomes inflamed, causing pain and damage to the joint. The damage can become chronic and long-lasting. There is often a deformity of the joint that can take place over time.

If a joint like the knee or hip becomes seriously involved, the individual can be prone to falls, unsteadiness, and an overall decrease in movement and ambulation.

Potential Symptoms

–  Pain/Ache in multiple Joints
–  Stiffness of joint – often more than one
–  Swelling of joints
–  Tenderness in joints
–  Joints affected may be on both sides of the body. (Example – left hand and right knee)
–  Deformity of joints
– Skin redness around joints involved
–  Fatigue
–  Tiredness
–  Weakness
–  Fever
–  Weightloss
–  Loss of strength
–  Loss of movement

Risk Factors

1.)  Age – Onset is most likely in those sixty and above. (Can begin at any age)
2.)  Sex – RA cases are almost 3 times more likely in women than men
3.)  Genetic –  The HLA (human leukocyte antigen) gene has been studied and a link with RA has been seen. However, environmental factors along with genetic factors are likely but not well understood.
4.)  Obesity – There is an increased risk of RA with obesity
5.)  Smoking – There is an increased risk of RA in those who smoke.
6.)  Lack of live births – There is a possible increased risk of RA in those who have never given birth
7.)  Environmental Exposures at a young age – There is a possible risk of some environmental factors such as mothers who smoked or low income, etc.

Activities that Can Decrease the Risk

1.)  Breastfeeding – There are several studies that show women who have breastfed their children have a decreased risk of developing RA.

Diagnosis

1.)  Clinical Examination of Joints involved
2.)  Blood work
3.)  X-ray
4.)  Often these patients are referred to a Rheumatologist – specialist of autoimmune issues affecting joints and other areas.

Management

1.)  Become physically active

–  Increase exercise.
–  Includes: walking, biking, swimming, etc

2.)  Stop Smoking

–  Not only does smoking increase your risk, but it also makes the symptoms worse

3.)  Search for Self Management Classes

–  Learn to have confidence in treatment and management
–  Learn from others with RA and their struggles and success
–  Learn what to expect. Changes will be seen, learn to deal with them early on.

4.)  Weight

–  Avoid gaining weight
–  If possible, try to lose 5-10 lbs
–  A healthy weight will give you confidence and less pain/stress about your limitations

Treatment

Medications

1.)  NSAIDs

.       IBU
.       Naproxen
.       Meloxicam
.       Piroxicam
.       Sulindac
.       Diclofenac
–  Others

2.)  Methotrexate

–  Methotrexate is an effective option
–  It is considered a DMARDs
–  Typically one of the first drugs to be used for treatment in RA
–  Help ease symptoms of pain, inflammation, redness, swelling, and more.

3.)  DMARDs

–  DMARDs = Disease-modifying drugs
–  Act on the immune system
–  Can slow the profession of RA

.       Hydroxychloroquine (Plaquenil)
.       Sulfasalazine (Azulfidine)
–  Hydroxychloroquine and Sulfasalzine are used for mild symptoms
–  Not as powerful but also has fewer side effects

.       Leflunomide (Arava)
–   Can be more powerful
–  Limited use in Pregnancy

.       Cyclosporine (Neoral)
.       Azathioprine  (Imuran)

–  Others

Physical Therapy

Surgery

Acupuncture

Diet Changes

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