Speaking of Health – Rheumatoid Arthritis

By Gilda Morales, ANP, DC

Last week, we covered osteoarthritis, or OA, and today’s topic will cover rheumatoid arthritis, or RA.  Whereas OA is a degenerative, or “wear and tear” disease, RA is an autoimmune disease characterized by inflammation, which affects multiple joints.  It is a destructive, deforming disease, which ultimately results in a decrease in function and independence.

OA affects only joints while RA affects the musculoskeletal system, skin, circulatory system, the immune system, renal, cardiovascular, neurologic and pulmonary systems, affecting women over men, two to one.  Most patients that are affected are between the ages of 30 to 50.

There are several risk factors that are associated with RA including having a close relative that has it, and smoking.  Ironically, pregnancy and breastfeeding for 24 months lowers a person’s risk of developing the disease and there is a also a 50% genetic component associated with RA.

Symptoms to watch for include fatigue, a general malaise, weight loss and low-grade fevers.  Joints may become swollen and tender, and there is early morning stiffness, which lasts at least 60 minutes, leading to difficulty in performing normal activities of daily living.   Later on, there may be cardiac, pulmonary and eye symptoms, which appear gradually.  Usually, the joints of the thumb, wrist and the second through 5th finger, shoulders, elbows, hips, knees and ankles, are usually affected with painful range of motion.  Later in the disease, there is joint deformity with eventual fusion of the joints.

Diagnosis of the disease is made through lab tests, especially testing for the RA factor, which is positive in 80% of patients who develop the disease.  Plain film x-rays can demonstrate the destruction of the joints and erosion of the joint capsules.

Treatment usually consists of medications such as methotrexate and NSAIDs like Ibuprofen or Naproxen, anti-malaria medications such as hydroxychloroquine. However, if the disease does not respond, then the next line of medications will more likely include autoimmune agents and steroids, with surgery to repair fused, painful joints being the last resort.