Rheumatoid Arthritis (RA; Arthritis, Rheumatoid)

Joint pain and stiffness that is: SymmetricalMost prominent in the morningLasts for at least half an hourRed, warm, or swollen jointsJoint deformityMild fever, tirednessLoss of appetiteSmall lumps or nodules under the skin As RA progresses, it may cause complications with the: HeartLungsEyesSkinLiverKidneysBloodNervous systemBlood vesselsIt is also associated with the development of early cardiovascular disease and death. DiagnosisThere is no single test for RA. The doctor will ask about your symptoms and medical history. The doctor will also exam of your joints, skin, reflexes, and muscle strength. Tests may include: Rheumatoid factor (RF) level in the bloodErythrocyte sedimentation rate (ESR) of the bloodto measure inflammation in the bodyC-reactive protein (CRP)an indicator of active inflammation in the bloodWhite blood cell countX-rays of affected joints (especially dual energy x-ray absorptiometry) Treatment There is no cure for RA. The goals of treatment are to: Relieve painReduce inflammationSlow down joint damageImprove functional abilityTreatments include: Medications Disease-modifying anti-rheumatic drugs (DMARDS)to slow the course of the disease These medications are used early in the course of the disease to prevent long-term damage: Methotrexate (Rheumatrex)Hydroxychloroquine (Plaquenil)Sulfasalazine (Azulfidine)Leflunomide (Arava)Cyclosporine (Neoral)Penicillamine (Cuprimine)Gold (Ridaura)Gold can also be given as an injection.Minocycline (Minocin) Immunosuppressive drugs (only used when other DMARDS are ineffective): Azathioprine (Imuran)Cyclophosphamide (Cytoxan)rarely usedChlorambucil (Leukeran)rarely used Biologic response modifiersdrugs that interfere with the autoimmune response associated with RA:Etanercept (Enbrel)Infliximab (Remicade)Adalimumab (Humira)Abatacept (Orencia)Rituximab (Rituxan) Adjunctive medications include: Acetaminophen (Tylenol)Nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen and naproxen ***Please Note: On September 30, 2004, Merck & Co., Inc. announced a voluntary withdrawal of Vioxx (rofecoxib) from the US and worldwide market due to safety concerns. A study showed a small but significant increased risk of cardiovascular events (such as heart attack) in patients taking the prescription medication. Vioxx is a so-called "selective" nonsteroidal 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, evidence has come to light regarding similar dangers posed by the other popular selective NSAID, Celebrex (celecoxib), which is produced by Pfizer. Most physicians now question the wisdom of prescribing any medications from the COX-2 class, particularly in patients with known cardiovascular disease.

SteroidsLow-dose corticosteroids (prednisone 10 mg or the equivalent) are often used first. They may then be tapered off when other drugs begin working. Long-term steroid use should be avoided. Corticosteroid injections to inflamed joints may also be used. Rest and ExerciseRest reduces active joint inflammation and pain, and fights fatigue. Exercise is important for maintaining muscle strength and flexibility. It also preserves joint mobility. Joint Care Splints applied to painful joints may reduce pain and swelling. Devices that help with daily living activities can also reduce stress on joints. Devices include: Zipper extendersLong-handled shoehornsSpecially designed kitchen tools Stress ReductionStress reduction can ease the difficulties of living with a chronic, painful disease. Exercise programs, support groups, and open communication with healthcare providers can all reduce stress. SurgeryJoint replacement and tendon reconstruction help relieve severe joint damage. Lifestyle Measures The following measures may relieve stiffness and weakness and reduce inflammation: Maintain a balance between rest and exercise.Attempt mild strength training.Participate in aerobic exercise (eg, walking, swimming, dancing).Avoid heavy impact exercise.Stop smoking.Control weight.Participate in a physical therapy program. PreventionThere are no guidelines for preventing RA.

RESOURCES: American College of Rheumatologyhttp://www.rheumatology.org/ The Arthritis Foundationhttp://www.arthritis.org/ CANADIAN RESOURCES: Canadian Orthopaedic Associationhttp://www.coa-aco.org/ Canadian Rheumatology Associationhttp://www.rheum.ca/ References: Rheumatoid arthritis. National Institute of Arthritis and Musculoskeletal and Skin Disorders website. Available at: http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp. Published January 1998. Updated May 2004. Accessed June 18, 2008. Tanaka E, et al. Impact of shoulder, elbow, and knee joint involvement on assessment of rheumatoid arthritis using the American College of Rheumatology Core Data Set. Arthritis Rheum. 2005;53:864-871. Verstappen SM, et al. Overview of work disability in rheumatoid arthritis patients as observed in cross-sectional and longitudinal surveys. Arthritis Rheum. 2004;51:488-497. Last reviewed February 2008 by Jill Landis, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.