Rheumatory arthritis



by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit


This is the term some people use to describe “rheumatoid arthritis”. Rheumatoid arthritis (RA) is the most common inflammatory form of arthritis and affects roughly 1 per cent of the population (2 million Americans).

It is more common in women than men.

While it affects people of all ages it is more common in the 30- 50 year age group and also there is a secondary peak in the 60-70 age group.

RA is a disease in which the immune system begins to attack multiple organ systems, the most visible of which are the joints. Typically the lining of the joint, which is called the synovium” becomes infiltrated with inflammatory cells. These cells consist of neutrophils, macrophages, plasma cells, dendritic cells, and lymphocytes. There is a complex interaction where these cells are prompted to produce inflammatory cytokines. These cytokines perpetuate and magnify inflammatory and destructive changes.

Because it is a systemic disease, patients may have other organ systems besides the joints become involved. The eyes, lungs, and bone marrow are among the more common areas that may be affected.

Typically, a patient with RA will complain of generalized morning stiffness lasting more than an hour. They will have joint pain and swelling. On examination, mostly small joints early on and small as well as large joints later on will be swollen and tender.

Laboratory testing will show elevation of the erythrocyte sedimentation rate or C-reactive protein, blood tests that measure the amount of inflammation in the body.

The patient may also be anemic. The rheumatoid factor- another blood test- is positive in about 80% of patients. A more specific test is the anti-CCP antibody.

Magnetic resonance imaging will show evidence of inflammation of the synovium and possibly erosions.

Sometimes arthroscopy will be done (arthroscopy involves using a small telescope to look inside a joint). Arthroscopy also allows the physician to obtain biopsies.

Early and aggressive treatment is mandatory. Evidence exist showing that irreversible damage takes place in the first year of disease. Treatment of rheumatoid arthritis will consist of a combination of anti-inflammatory medicines as well as disease-modifying drugs.

Anti-inflammatory drugs can either be steroids like prednisone or non-steroidal drugs like ibuprofen, and more recently COX 2 drugs like Celebrex.

Disease modifying drugs help slow progression. Examples include methotrexate, azathioprine (Imuran), cyclosporine (Sandimmune), leflunomide (Arava), hydroxyxhloroquine (Plaquenil), and sulfasalazine (Azuulfidine).

Biologic therapies are used to effect remission. These include Enbrel, Humira, Remicade, Cimzia, Simponi, Actemra, Orencia, Rituxan, and Xeljanz.



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