Rheumatoid Arthritis Progression

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Rheumatoid arthritis is a debilitating autoimmune disease, causing chronic inflammation in approximately 1% of the United States population, the majority of which are women. It is a mysterious disease, with no known cause and variable progression patterns.

The Basics

Like almost all autoimmune diseases, the underlying cause of rheumatoid arthritis (why it develops) remains to be understood. Several factors have been associated with its occurrence, including hormones (as it is 3 times more likely to occur in women), heredity, age (most often between the ages of 30 and 60), and smoking habits. Those who develop rheumatoid arthritis suffer from chronically inflamed (red, swollen, warm, painful) joints. This inflammation is the result of cells from the immune system attacking the synovial membranes surrounding joints. Proteins released by these cells eventually cause the synovial membrane to thicken, resulting in severely decreased mobility of the joint. Inflammatory-mediating cells can also through the use of enzymes digest bone, tendon, and ligament tissues, leading to disfiguration and loss of joint function.

Early Symptoms

Rheumatoid arthritis usually starts in smaller joints, such as those of the hands and feet. Joint inflammation is often symmetric, meaning either both of your hands or both of your feet will develop this inflammation. Joints will often be most painful in the morning due to lack of movement. Patients can feel fatigued (an over-active immune system takes a lot out of a person), muscle pain, decreased appetite, anemia, or depression.

Flare-Ups

Rheumatoid arthritis symptoms can easily come and go, seemingly for no reason. When inflammation is apparent, the disease is considered active. As inflammation subsides, the disease becomes inactive, or has gone into remission. Remissions can occur spontaneously (often without treatment) and last anywhere from several days to several months. During flare-ups of the disease, joints will become noticeable red, puffy, and painful as the result of increased immune activity.

Later Symptoms

While the joints are usually first to be affected, rheumatoid arthritis is a systemic autoimmune disease, meaning its effects can spread to other parts of the body. Glands in the eyes and mouth can become inflamed, limiting their activity, resulting in dry eyes and mouth. The tissue surrounding the heart, know as the pericardium, can also become inflamed, causing chest pain which often increases upon lying down. Over time, the destruction caused by inflammation will cause disfiguration of the joint and eventual loss of function. While pain can be moderately managed with the use of pain relievers, return of joint mobility and function often require complete joint replacement surgery.

Diagnosis & Treatment

While the prognosis for rheumatoid arthritis can be discouraging, early diagnosis and treatment of the disease can greatly slow its progression in most cases. Diagnosis can be tricky, and requires persistent testing an evaluation of joint function. Often, doctors will consider the combination of a patient's medical history, blood tests, and imaging results to determine the presence of rheumatoid arthritis. Because the cause of the disease is unknown, treatment centers on relieving symptoms and slowing damage of joints. Anti-inflammatory medications such as aspirin and ibuprofen are used in early cases of the disease. Often, immune suppression is required to effectively limit inflammation. Analgesics such as aspirin or morphine can be used to decrease the pain associate with swollen joints. Rheumatoid arthritis progression is nearly impossible to predict and frightening all the same. Early diagnosis of the disease and aggressive treatment, fortunately, are the best methods to prevent its progression and limit its destruction.

Sources: http://www.arthritis.org/disease-center.php?disease_id=31&df=treatments

http://www.medicinenet.com/rheumatoid_arthritis/page4.htm#5howisrat

http://www.emedicinehealth.com/rheumatoid_arthritis/page3_em.htm#Rheumatoid%20Arthritis%20Symptoms