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    Frequently Asked Questions About Rheumatoid Arthritis (RA)

    • What is rheumatoid arthritis (RA) and how is it different from "old age" arthritis?
    • Answer:

      Affecting more than two million people, rheumatoid arthritis is an autoimmune disease that causes the body to turn on itself, attacking tissue that normally helps protect and preserve joint function. It most commonly begins in the 30s and 40s and the number of women affected out number men by three to one.

      During an RA "attack" -- known as a flare -- the immune system sends out a barrage of white blood cells to the affected joint, which in turn causes inflammation in the area. It is this inflammation that is responsible for the symptoms of RA including joint swelling and pain.

      Doctors now believe that within the first year, the inflammation caused by RA can cause serious damage to cartilage (the protective tissue that is a key component of joints), thus making a strong case for early diagnosis and aggressive treatment.

      In some instances, RA can progress to produce symptoms all over the body. Eventually it can weaken the bones and muscles surrounding the affected joints, and it can also damage the eyes, the salivary glands, and the heart and lungs.

      With treatment, however, many complications of RA can be avoided.

      Osteoarthritis (OA), also known as "old age arthritis" or "wear and tear arthritis" is a natural degeneration of the cartilage between joints that occurs with aging. The degeneration can be worsened by overuse or injury, but its impact is limited to the affected joints.

    • What are the specific symptoms of rheumatoid arthritis?
    • Answer:

      The most obvious symptoms of RA are pain, redness, and swelling around specific joints, in a pattern that affects both sides of the body simultaneously. The most common joints to be affected are:

      • Wrists
      • Fingers (knuckles and middle joints)
      • Neck and shoulders
      • Elbows
      • Hips
      • Knees, ankles, feet

      Other common symptoms can include:

      What is not typically a symptom of RA:

      • Lower back pain
      • Joint pain and swelling on the knuckles closest to your fingernails
      • Stiffness that goes away in 30 minutes or less

    • Do symptoms occur suddenly, or gradually over time? And does rheumatoid arthritis get progressively worse?
    • Answer:

      In some instances RA symptoms, particularly pain, swelling, and stiffness, develop rapidly, sometimes in a matter of weeks. In most instances, the onset is gradual, with only a few symptoms appearing at first, making it easy to confuse RA with other types of arthritis or other conditions causing joint pain.

      The full complement of RA symptoms can take months or even years to develop, making it sometimes easy to elude the diagnosis for some time.

      For many people, RA ebbs and flows -- causing "flares" or " attacks" followed by periods of fewer symptoms and only rarely going into remission. More commonly flares continue to occur over a period of years.

      Without treatment, the condition usually does worsen, leading to joint deformity and damage. Sometimes, other organs can be involved. This can cause inflammation of the lining of the heart (pericarditis) and lungs (pleuritis). Inflammation of the tear and salivary glands can also occur, causing a problem known as Sjogren's syndrome. Inflammation of the eye can occur (uveitis and scleritis) as well.

      People with RA are also at increased risk for inflammation of the blood vessels that cause heart disease and may have an increased risk of heart attack and stroke.

    • What are the tests used to diagnose rheumatoid arthritis?
    • Answer:

      Frequently, the diagnosis of RA is aided by tests that rule out other diseases. That said, the most reliable and commonly used test to help diagnose RA is a blood test that looks for specific antibodies known as "rheumatoid factor" and more recently the anti-CCP antibody. Most doctors also perform other less specific blood tests designed to measure inflammation including, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Since anemia can result from RA, a red blood cell count is also important. X-rays can sometimes be helpful in diagnosing joint changes, but usually not within the first three to six months.

      Important to note: Not all people who have RA test positive for rheumatoid factor, particularly early in the disease. Moreover, some people who do test positive never go on to develop RA.

    • My mother has rheumatoid arthritis. Am I at greater risk? Are my children at greater risk?
    • Answer:

      The latest research shows that there is a genetic component to RA, so yes, both you and your children would have a greater-than-average risk.

      The conclusion of most researchers is that while genes play a role, in order for RA to occur the genetic predisposition must be "triggered" by at least one other factor. And it’s important to understand that while your risk is higher than average, the actual risk of you or your kids developing RA is still quite low.

      While no one knows precisely what factors are involved, some research suggests smoking may be one trigger. Another could be exposure to a virus or bacterial infection, though what particular germs are involved is less clear. There is, however, some evidence to show that bacteria involved in gum disease may trigger RA in those with a genetic susceptibility.

      Other theories suggest a link to reproductive hormones, particularly since women are more likely to develop RA then men. Other evidence that supports a hormonal role is the fact that RA usually significantly improves during pregnancy but returns afterward. There’s also evidence that oral contraceptives, which consist of hormones, decrease the risk of RA.

    • What medicines are available to treat rheumatoid arthritis?
    • Answer:

      The goal of all RA treatment is to relieve pain and reduce inflammation, slow down or stop joint damage, improve the sense of well-being, and improve joint function. Fortunately, over the past several years there has been increasing evidence that early, aggressive treatment, often with multiple drugs, can accomplish all of this.

      Currently, the most common medications used to treat RA include:

    • Can joint surgery help rheumatoid arthritis?
    • Answer:

      Several types of surgery are sometimes used to treat RA patients with severe joint damage. The most common include joint replacement and tendon reconstruction. Risks and benefits of surgery are highly individual, and experts say the decision must be made on a case-by-case basis, often determined by the patient's overall health and the specific condition of the affected joint.

    • Does diet affect the symptoms of rheumatoid arthritis?
    • Answer:

      To date, no scientific study has proven that changing your diet will either worsen or relieve RA symptoms. That said, many individuals anecdotally report that certain foods do have an exacerbating effect on symptoms, while others seem to provide relief. The latest research also shows that omega-3 fatty acids (found in cold water fish, flax seeds, walnuts, and other foods) may reduce some of the inflammation caused by RA. Moreover, there is some evidence that a diet high in saturated fats or vegetable oils may increase the inflammatory response, thereby contributing to joint and tissue inflammation.

    • Do joint supplements like glucosamine and chondroitin or other herbal treatments help rheumatoid arthritis?
    • Answer:

      The supplements glucosamine and chondroitin have been shown to have some mild impact on restoring the health of cartilage damaged by osteoarthritis (also known as degenerative arthritis). Because they do not affect inflammation, they are thought not to be helpful to people with rheumatoid arthritis.

      There is some evidence that ginger, evening primrose oil, and green tea may have some anti-inflammatory properties that could be beneficial to patients with RA. However, there is no consistent evidence to show that any herbs or supplements provide significant improvement for RA.

      Other natural therapies recommended for symptom relief include massage therapy, acupuncture, and acupressure.

    • Should I be exercising if I have rheumatoid arthritis or just taking it easy most of the time?
    • Answer:

      Although doctors once believed that resting the joints and avoiding exercise was the best prescription for RA, today this is no longer true. Research has shown that moderate physical activity on a regular basis can help keep joints flexible longer, as well as increase muscle strength and improve overall heart and lung health.

      At the same time, when a joint is inflamed -- warm, painful, and swollen -- rest will help reduce the inflammation. However, you should talk to your doctor about which range of motion exercises should still be performed during this time to help preserve joint mobility. Once your "flare" recedes, you should gradually resume a full exercise program, as prescribed by your doctor.

    WebMD Medical Reference

    Reviewed by David Zelman, MD on October 18, 2014

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