Rheumatoid arthritis, a chronic, autoimmune disease, is the most crippling form of arthritis and affects approximately 2.1 million Americans. This chronic disease is characterized by painful and stiff joints on both sides of the body that may become enlarged and deformed. Rheumatoid arthritis affects more women than men (75 percent of persons with rheumatoid arthritis are women). Onset of the disease is usually middle-age, but it does occur in individuals as early as age 20. Patients with rheumatoid arthritis may also have osteoporosis, a progressive deterioration of bone density.

Juvenile rheumatoid arthritis (JRA) is a form of arthritis in children ages 15 or younger that causes inflammation and stiffness of joints for more than six weeks. Unlike adult rheumatoid arthritis, which is chronic and lasts a lifetime, children often outgrow juvenile rheumatoid arthritis. However, the disease can affect bone development in the growing child.

What causes rheumatoid arthritis?

The exact cause of rheumatoid arthritis is not known. Rheumatoid arthritis is an autoimmune disorder, which means the body's immune system attacks its own healthy cells and tissues. The response of the body causes inflammation in and around the joints, which then may lead to a destruction of the skeletal system. Rheumatoid arthritis also may have devastating effects on other organs, such as the heart and lungs. Researchers believe certain factors, including heredity, may contribute to the onset of the disease.

What are the symptoms of rheumatoid arthritis?

The joints most commonly affected by rheumatoid arthritis are in the hands, wrists, feet, ankles, knees, shoulders, and elbows. The disease typically causes inflammation symmetrically in the body, meaning the same joints are affected on both sides of the body. Symptoms of rheumatoid arthritis may begin suddenly or gradually. The following are the most common symptoms of rheumatoid arthritis. However each individual may experience symptoms differently. Symptoms may include:

• inflamed, painful joints
• stiff joints
• enlarged and/or deformed joints (such as fingers bent toward the little finger and/or swollen wrists)
• frozen joints (joints that freeze in one position)
• cysts behind the knees that may rupture, causing lower leg swelling and pain
• hard nodules (bumps) under the skin near affected joints
• low-grade fever
• inflamed blood vessels (vasculitis) may occur occasionally, leading to nerve damage and leg sores
• inflamed membranes around the lungs (pleurisy), the sac around the heart (pericarditis), or inflammation and scarring of the lungs themselves, that may lead to chest pain, difficulty breathing, and abnormal heart function
• swollen lymph nodes
• Sjögren's syndrome (dry eyes and mouth)
• eye inflammation

If a person has four or more of the following symptoms, he/she may be diagnosed with rheumatoid arthritis:

• morning stiffness that lasts longer than one hour for at least six weeks
• three or more joints that are inflamed for at least six weeks
• presence of arthritis in the hand, wrist, or finger joints for at least six weeks
• blood tests that reveal rheumatoid factor
• x-rays that show characteristic changes in the joints

The symptoms of rheumatoid arthritis may resemble other medical conditions or problems, including acute rheumatic fever, Lyme disease, psoriatic arthritis, gout, osteoarthritis, gonococcal arthritis, and ankylosing spondylitis. Always consult your physician for a diagnosis.

How is rheumatoid arthritis diagnosed?

Diagnosis of rheumatoid arthritis may be difficult in the early stages, because symptoms may be very subtle and go undetected on x-rays or blood tests. In addition to a complete medical history and physical examination, diagnostic procedures for rheumatoid arthritis may include the following:

• x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• joint aspiration - involves a removal of fluid from the swollen bursa to exclude infection or gout as possible causes.
• biopsy (of nodules tissue) - a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope; to determine if cancer or other abnormal cells are present.
• blood tests (to detect certain antibodies, called rheumatoid factor, and other indicators for rheumatoid arthritis)

Treatment for rheumatoid arthritis:

Specific treatment for rheumatoid arthritis will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, and therapies
• expectation for the course of the condition
• your opinion or preference

The earlier a diagnosis is made and treatment is started, the more joint damage and impairment can be prevented. Treatment can range from simple therapies, such as diet and rest, to more aggressive therapies, including medications. Treatment may include:

• resting affected joints regularly
• nonsteroidal anti-inflammatory medications, such as ibuprofen
• disease-modifying medication, such as slow-acting medications (to slow bone deformation)
• corticosteroids (to reduce inflammation)
• immunosuppressive medications, such as methotrexate (to suppress inflammation)
• exercise (to keep the joints as flexible as possible)
• physical therapy (to keep the joints from "freezing" and becoming immobile)
• heat or cold application to the joints
• surgery (to repair, replace, or fuse together an affected joint)
• special devices (to provide support for the affected joint)